title: Clinical importance of steps taken per day among persons with multiple sclerosis.
abstract: BACKGROUND
  The number of steps taken per day (steps/day) provides a reliable and valid outcome of free-living walking behavior in persons with multiple sclerosis (MS).
  
  
  OBJECTIVE
  This study examined the clinical meaningfulness of steps/day using the minimal clinically important difference (MCID) value across stages representing the developing impact of MS.
  
  
  METHODS
  This study was a secondary analysis of de-identified data from 15 investigations totaling 786 persons with MS and 157 healthy controls. All participants provided demographic information and wore an accelerometer or pedometer during the waking hours of a 7-day period. Those with MS further provided real-life, health, and clinical information and completed the Multiple Sclerosis Walking Scale-12 (MSWS-12) and Patient Determined Disease Steps (PDDS) scale. MCID estimates were based on regression analyses and analysis of variance for between group differences.
  
  
  RESULTS
  The mean MCID from self-report scales that capture subtle changes in ambulation (1-point change in PDSS scores and 10-point change in MSWS-12 scores) was 779 steps/day (14% of mean score for MS sample); the mean MCID for clinical/health outcomes (MS type, duration, weight status) was 1,455 steps/day (26% of mean score for MS sample); real-life anchors (unemployment, divorce, assistive device use) resulted in a mean MCID of 2,580 steps/day (45% of mean score for MS sample); and the MCID for the cumulative impact of MS (MS vs. control) was 2,747 steps/day (48% of mean score for MS sample).
  
  
  CONCLUSIONS
  The change in motion sensor output of ~800 steps/day appears to represent a lower-bound estimate of clinically meaningful change in free-living walking behavior in interventions of MS.
authors.affiliation: Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Motl
authors.forename: Lara A
authors.initials: LA
authors.lastname: Pilutti
authors.forename: Yvonne C
authors.initials: YC
authors.lastname: Learmonth
authors.forename: Myla D
authors.initials: MD
authors.lastname: Goldman
authors.forename: Ted
authors.initials: T
authors.lastname: Brown
mesh_terms: D000704:Analysis of Variance; D016022:Case-Control Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis / Q000503:physiopathology*; D012044:Regression Analysis; D013997:Time Factors; D016138:Walking
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