Walking in MS: new outcomes

W
Wetzel et al. Six-minute walk test for persons with mild or moderate disability from multiple sclerosis: performance and explanatory factors. Physiother Can. 2011 Spring;63(2):166-80. Epub 2011 Apr 13. 

Purpose: The primary purpose of this study was to determine the extent to which health factors, functional measures, and pulmonary or lung impairment explain performance on 6-Minute Walk Test (6MWT) distance in ambulatory MS’ers. Another purpose was to determine the effect of disability and age on 6MWT performance and explanatory factors.


Methods: 64 MS’ers took part; 43 (67.2%) exhibited mild disability (EDSS <4.0) and 21 (32.8%) had moderate disability (EDSS 4.0-6.5). Different outcome measures were then assessed to document balance, mobility and lung function. 

Results: EDSS, 
activities-specific balance confidence, 
functional stair test, 
sit-to-stand test, static standing balance, 
maximal voluntary ventilation , 
maximal inspiratory pressure (breathing-in) and 
maximal expiratory pressure (breathing-out) were significantly associated with 6MWT distance after adjusting for age. 
Conclusions: 6MWT performance in MS’ers was explained by balance confidence and stair-climbing ability. Activities-specific balance confidence and 
functional stair test may be practical clinical measures for explaining walking ability and determining risk for disablement in MS’ers. 

“This study provides some additional context to walking problems in MS; in other words walking restriction is due to problems with balance and confidence. We kind of knew this but having it documented is important for us getting funding to treat people with MS on Fampridine. Our funders don’t think the 25-foot timed walk is clinically meaningful; if we can show  that Fampridine improves the 6MWT and hence helps with confidence and stair-climbing; bingo!”

“We have a list of MS’ers keen to have a trial of Fampridine; this study will help us make an argument to get the drug funded.”

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.

5 comments

  • This is what gets my goat: Harris Interactive reported that 70% of people with MS claim walking is the most challenging aspect of MS.

    No I realise Fampradine is no miracle pill but it does improve walking and balance in some cases.

    There is such a huge unmet need and everyone is dragging their feet on the subject (pun intended).

    The NHS is in a mess. It is failing Britain. We all talk about it like it's a sacred cow but the truth is that it's a poor and expensive service at best.

    I say let's give Andrew Lansley's health care plans a chance. There is no way he can make it any wrse than what it currently is.

  • Re: "How do you get onto the list of people keen to have a trial of fampridine?"

    Biogen-Idec have to do a follow-on phase 3 trial in Europe; this was a condition of their provisional license. We anticipate that this study will start later this year. Please speak to your MS team about this; they may be a trial centre. We have put our centre forward to be involved.

  • Re: "The NHS is in a mess. It is failing Britain."

    I would disagree with this to some extent. I agree that it fails individuals quite frequently because there is not much spare-capacity in the system and it rations care (waiting times and limits the access to new and expensive therapies). However, at a population level it is the most cost-effective comprehensive healthcare system in the world. We shouldn't forget that. Allowing the private sector into the NHS will push up costs; that may not be a bad thing if we want to "comsumerise" healthcare. Why not? This is a philosophical debate; is access to healthcare a basic human right or should should it be like anything else subject to the market? In other words should your access to healthcare, or superior healthcare, relate to how wealthy you are? In the USA 60% or more of personal bankruptcies are related to healthcare bills. Do we want that happening in the UK? I don't, which is why I will always sing the praises of the NHS.

  • Well said indeed. I have an appointment with my MS nurse this week..I have SPMS, still walking v short distances..seem to have been left to my own devices..what should I be asking? Have been told PCT can't afford Fampradine.
    Keep up the good work and definately keep going on social network front, I like reading yours news .

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