Walking speed is a better outcome measure than the EDSS

Epub: Bosma L, Kragt J, Polman C, Uitdehaag B.Walking speed, rather than Expanded Disability Status Scale, relates to long-term patient-reported impact in progressive MS. Mult Scler. 2012 Aug 20.

OBJECTIVE: To study the relationships between 1-2 year changes in well-known physician-rated measurements (Expanded Disability Status Scale (EDSS), Timed 25-Foot Walk (T25FW), 9-Hole Peg Test (9HPT)) and the long-term (≥ 5 years) outcome in patient-reported outcome (PRO) measures (Multiple Sclerosis Impact Scale (MSIS-29), Multiple Sclerosis Walking Scale (MSWS-12)) that reflect the patient-perceived impact of disease, in progressive MS.

METHODS: We selected all progressive patients having at least two complete visits within 1-2 years, from a larger cohort of prospectively-followed MS patients. These were invited for another visit, at least 5 years later, consisting of another series of similar examinations, plus 2 PRO scales: the MSIS-29 and MSWS-12. We explored associations between early changes in physician-rated measurements and the long-term outcome as per the PRO measures.

RESULTS: In this study,134 patients fulfilled the selection criteria. We found that early change in T25FW was the only physician-rated change that was significantly related to long-term physical impact experienced by the patient, as was assessed by MSIS-29 (Kruskal-Wallis test: χ(2)=7.8, p=0.020). Early T25FW change, and to a lesser degree early 9HPT change, were significantly related to the reported long-term walking limitations, as assessed by MSWS-12 (Kruskal-Wallis test: χ(2)=13.8 and p=0.001 for T25FW, χ(2)=6.5 and p=0.038 for 9HPT). None of the early physician-rated changes were related to the long-term psychological impact experienced by the patient.

CONCLUSION: Early changes on physician-rated scales do have long-term impact in terms of potentially predictive value of outcomes for groups of patients in progressive MS, regarding walking limitations and more global physical impact. Surprisingly, early change in T25FW, rather than early change in EDSS, was significantly associated with longer-term patient-reported disease impact. Our study data support the value of using early physician-rated examinations in clinical trials in progressive MS.

The timed walk is better than the EDSS; we have known this for sometime and see the same with our mice with progressive EAE; rotorod or physical activity is better than the mouse EDSS. 

Other posts of interest in relation to walking:

28 May 2012
Generalised fatigue has a major impact on walking ability, with moderately disabled MSers experiencing difficulty in walking extended distances. Localised motor fatigue in the ankle dorsiflexors can lead to foot drop, further 
07 Apr 2012
METHODS: 44 participants completed 4 trials of walking on a GAITRite mat (measures how you walk and detect your foot steps) and one 6-minute trial of walking on a treadmill at a constant, controlled speed of 54 meters per 
27 Mar 2012
OBJECTIVES: To determine whether there is a relationship between self-reported fatigue and the energy cost of walking (ECw), and how self-reported fatigue and ECw relate to physical functioning in patients with multiple 
23 Mar 2012
43 PwMS with minimal disability and 43 healthy controls completed four walking trials along a 26 foot long pressure sensitive pathway (GAITRite). Spatiotemporal markers of gait including variability metrics were determined.
03 Mar 2012
“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 
06 Mar 2012
Timed walking in MS. Epub ahead of print: Motl et al. Evidence for the different physiological significance of the 6- and 2-minute walk tests in multiple sclerosis. BMC Neurol. 2012 Mar 1;12(1):6. BACKGROUND: Researchers 
22 Aug 2012
OBJECTIVES: To determine whether there is a relationship between self-reported fatigue and the energy cost of walking (ECw), and how self-reported fatigue and ECw relate to physical functioning in patients with multiple .
11 Nov 2011
Walking impairment is the single biggest issue for me. I have PPMS. The first symptoms I noticed were to do with my walking and it has continued in that manner. I have seen Youtube clips on the internet where some people 
20 Jul 2011
My former neurologist was really unsympathetic when it came to talking about walking issues. He bluntly told me there was nothing he can do about it. Even my new neurologist is hopeless, making sure he never even asks 
15 Nov 2011
Methods: In 10 patients with multiple sclerosis and stroke the energy cost of walking, 3 dimentional kinematics, joint power, and joint work were measured during gait, with and without the AFO. The mechanical characteristics 
25 Jul 2011
Gait problems in MS’ers is characterised by reduced walking speed, walking endurance, step length, cadence (how smooth your gait is) and joint motion, as well as increased energy requirements of walking and increased 
03 Nov 2011
Participants conducted baseline walking tests at their preferred speed along an instrumented walkway (GAITRite) in a laboratory setting, and temporal-spatial gait parameters were extracted. Participants then wore the insoles 
20 Jul 2012
Aims: This study examined the association between rates of activity counts and energy expenditure during walking by using two models of accelerometers and generated cut-points representing moderate-to-vigorous physical 
22 Dec 2010
Walking impairment in patients with multiple sclerosis: exercise training as a treatment option; “exercise training and physical activity might hold significant potential for the management of progressive mobility disability in MS.” 
13 Nov 2011
Walking speed was measured with a 10-m test and a 4-minute figure-8 test; physiological cost index (PCI) and device usage were also measured. The subjects were tested with FES on and off (orthotic effect) before and after 
23 Jun 2012
BACKGROUND: In developing the PatientsLikeMe online platform for MSers, they required a patient-reported assessment of functional status that was easy to complete and identified disability in domains other than walking.
19 May 2011
Impact of extended-release dalfampridine on walking ability in patients with multiple sclerosis. Hayes KC. Neuropsychiatr Dis Treat. 2011;7:229-39. A good summary of Dalfampridine (formerly fampridine) use in MS.
21 Oct 2009
Panel recommends that FDA approves Fampridine for increasing walking speed in PwMS. http://www.nationalmssociety.org/news/news-detail/index.aspx?nid=2239. Concerns: Aminopyridines, a family of compounds to which 
15 May 2012
Slower walking speed for automated and clinician setups compared to the participants’ own setup may be due to the participants’ lack of familiarity with responses different to their usual setups. Automated setup using the 

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  • The dangers, though, of limiting clinical trial analysis just to walking speed and T2 lesions loads is that it might not take into consideration the real issues that destroy QOL – i.e. cognitive impairment, bowel incontinence, sleep issues, depression etc.

    Would it be useful if there was a universally acknowledged 5 point (say) analytical system that was used in all trials – creating a standard point of reference and one that included emotional, intellectual and personal (ED, bowel) issues as well as walking.

    Or is this naive?

  • Re: "Or is this naive?"

    Outcome people have been working on developing a universal outcome measure of sometime. Nothing fits the bill – yet! Let's hope something emerges.

  • My neurologist at Mt. Sinai relies on the 25 ft walking test since I have PPMS. I also have tested myself with a longer walk and find that I power down (like a drained battery) more quickly as the years pass. I know there are many studies using the 25 ft test, but it seems to miss issues affecting the duration of walking normally. (Agree with Iain that other outcomes also are missed – cognitive decline, sleep, mood.)

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