title: Clinically meaningful performance benchmarks in MS: timed 25-foot walk and the real world.
abstract: OBJECTIVE
  Identify and validate clinically meaningful Timed 25-Foot Walk (T25FW) performance benchmarks in individuals living with multiple sclerosis (MS).
  
  
  METHODS
  Cross-sectional study of 159 MS patients first identified candidate T25FW benchmarks. To characterize the clinical meaningfulness of T25FW benchmarks, we ascertained their relationships to real-life anchors, functional independence, and physiologic measurements of gait and disease progression. Candidate T25FW benchmarks were then prospectively validated in 95 subjects using 13 measures of ambulation and cognition, patient-reported outcomes, and optical coherence tomography.
  
  
  RESULTS
  T25FW of 6 to 7.99 seconds was associated with a change in occupation due to MS, occupational disability, walking with a cane, and needing "some help" with instrumental activities of daily living; T25FW ≥8 seconds was associated with collecting Supplemental Security Income and government health care, walking with a walker, and inability to do instrumental activities of daily living. During prospective benchmark validation, we trichotomized data by T25FW benchmarks (<6 seconds, 6-7.99 seconds, and ≥8 seconds) and found group main effects on 12 of 13 objective and subjective measures (p < 0.05).
  
  
  CONCLUSIONS
  Using a cross-sectional design, we identified 2 clinically meaningful T25FW benchmarks of ≥6 seconds (6-7.99) and ≥8 seconds. Longitudinal and larger studies are needed to confirm the clinical utility and relevance of these proposed T25FW benchmarks and to parse out whether there are additional benchmarks in the lower (<6 seconds) and higher (>10 seconds) ranges of performance.
authors.affiliation: From the Department of Neurology (M.D.G.), University of Virginia, Charlottesville, VA; University of Illinois (R.W.M., J.J.S.), Urbana, IL; Raleigh Neurology Associates (J.S.), Raleigh, NC; University of Illinois College of Medicine at Peoria (J.H.P.), IL; and Biogen Idec (D.C.), Cambridge, MA.
authors.forename: Myla D
authors.initials: MD
authors.lastname: Goldman
authors.forename: Robert W
authors.initials: RW
authors.lastname: Motl
authors.forename: John
authors.initials: J
authors.lastname: Scagnelli
authors.forename: John H
authors.initials: JH
authors.lastname: Pula
authors.forename: Jacob J
authors.initials: JJ
authors.lastname: Sosnoff
authors.forename: Diego
authors.initials: D
authors.lastname: Cadavid
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D004651:Employment; D005080:Exercise Test / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016138:Walking / Q000592:standards