title: Local dynamic stability as a responsive index for the evaluation of rehabilitation effect on fall risk in patients with multiple sclerosis: a longitudinal study.
abstract: BACKGROUND
  Gait and balance problems are common in patients with multiple sclerosis, leading to high risk for falls. Local Dynamic Stability (LDS), a non-linear gait stability index, has been advocated as an early indicator of risk for falls. With this longitudinal study over three weeks, we aimed to assess the responsiveness of Local Dynamic Stability to a rehabilitation program and to compare it to other measures.
  
  
  METHODS
  Eighteen patients (mean 54 years, median EDSS score: 5) participated. They were admitted to inpatient rehabilitation and received a three weeks individually tailored program. They performed a 3-minute walking test at the beginning and at the end of the stay, as well as pain, wellbeing, fatigue, and balance assessment. The Local Dynamic Stability was computed from the acceleration signals measured with a 3D-accelerometer.
  
  
  RESULTS
  At the end of the rehabilitation process, patients reported reduced pain (Effect Size: -0.7), fatigue (ES:-0.6), and increased wellbeing (ES: 1.1). A small positive effect on static balance was observed (ES: 0.3). LDS was improved (ES: 0.6), and the effect was higher than walking speed improvement (ES: 0.4).
  
  
  CONCLUSIONS
  The Local Dynamic Stability seemed responsive to assess rehabilitation effects in patients with multiple sclerosis. It could constitute a valuable gait quality index, which could evaluate potential effects of rehabilitation on fall risk.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN69803702.
authors.affiliation: Institute Health & Social Work; HES-SO Valais-Wallis, University of Applied Sciences Western Switzerland, Sion and Leukerbad, Switzerland. roger.hilfiker@hevs.ch
authors.forename: Roger
authors.initials: R
authors.lastname: Hilfiker
authors.forename: Claude
authors.initials: C
authors.lastname: Vaney
authors.forename: Brigitte
authors.initials: B
authors.lastname: Gattlen
authors.forename: André
authors.initials: A
authors.lastname: Meichtry
authors.forename: Olivier
authors.initials: O
authors.lastname: Deriaz
authors.forename: Véronique
authors.initials: V
authors.lastname: Lugon-Moulin
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Anchisi-Bellwald
authors.forename: Cécilia
authors.initials: C
authors.lastname: Palaci
authors.forename: Denise
authors.initials: D
authors.lastname: Foinant
authors.forename: Philippe
authors.initials: P
authors.lastname: Terrier
mesh_terms: D000058:Accidental Falls; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000503:physiopathology*; D014947:Wounds and Injuries / Q000209:etiology / Q000534:rehabilitation*