title: Responsiveness and clinically meaningful improvement, according to disability level, of five walking measures after rehabilitation in multiple sclerosis: a European multicenter study.
abstract: BACKGROUND
  Evaluation of treatment effects on walking requires appropriate and responsive outcome measures.
  
  
  OBJECTIVE
  To determine responsiveness of 5 walking measures and provide reference values for clinically meaningful improvements, according to disability level, in persons with multiple sclerosis (pwMS).
  
  
  METHODS
  Walking tests were measured pre- and postrehabilitation in 290 pwMS from 17 European centers. Combined anchor- and distribution-based methods determined responsiveness of objective short and long walking capacity tests (Timed 25-Foot Walk [T25FW] and 2- and 6-Minute Walk Tests [2MWT and 6MWT] and of the patient-reported Multiple Sclerosis Walking Scale-12 [MSWS-12]). A global rating of change scale, from patients' and therapists' perspective, was used as external criteria to determine the area under the receiver operating characteristic curve (AUC), minimally important change (MIC), and smallest real change (SRC). Patients were stratified into disability subgroups (Expanded Disability Status Scale score ≤4 [n = 98], >4 [n = 186]).
  
  
  RESULTS
  MSWS-12, 2MWT, and 6MWT were more responsive (AUC 0.64-0.73) than T25FW (0.50-0.63), especially in moderate to severely disabled pwMS. Clinically meaningful changes (MICs) from patient and therapist perspective were -10.4 and -11.4 for MSWS-12 (P < .01), 9.6 m and 6.8 m for 2MWT (P < .05), and 21.6 m (P < .05) and 9.1 m (P = .3) for 6MWT. In subgroups, MIC was significant from patient perspective for 2MWT (10.8 m) and from therapist perspective for MSWS-12 (-10.7) in mildly disabled pwMS. In moderate to severely disabled pwMS, MIC was significant for MSWS-12 (-14.1 and -11.9).
  
  
  CONCLUSIONS
  Long walking tests and patient-reported MSWS-12 were more appropriate than short walking tests in detecting clinically meaningful improvement after physical rehabilitation, particularly the MSWS-12 for moderate to severely disabled pwMS.
authors: Hasselt University, Diepenbeek, Belgium ilse.baert@uhasselt.be.
authors: Ilse
authors: I
authors: Baert
authors: Plymouth University, Plymouth, UK.
authors: Jennifer
authors: J
authors: Freeman
authors: Haukeland University Hospital, Bergen, Norway.
authors: Tori
authors: T
authors: Smedal
authors: Aarhus University, Aarhus, Denmark.
authors: Ulrik
authors: U
authors: Dalgas
authors: Masku Neurological Rehabilitation Center, Masku, Finland.
authors: Anders
authors: A
authors: Romberg
authors: Sheba Medical Center, Tel-Hashomer, Israel.
authors: Alon
authors: A
authors: Kalron
authors: Poole Hospital, NHS Foundation Trust, Dorset, UK.
authors: Helen
authors: H
authors: Conyers
authors: Eugenia Epalza Rehabilitation Center, Bilbao, Spain.
authors: Iratxe
authors: I
authors: Elorriaga
authors: National Multiple Sclerosis Center, Melsbroek, Belgium.
authors: Benoit
authors: B
authors: Gebara
authors: Helsinki MS-Neuvola, Helsinki, Finland.
authors: Johanna
authors: J
authors: Gumse
authors: Multiple Sclerosis Center, Hakadal AS, Norway.
authors: Adnan
authors: A
authors: Heric
authors: Multiple Sclerosis Hospital, Haslev, Denmark Multiple Sclerosis Hospital, Ry, Denmark.
authors: Ellen
authors: E
authors: Jensen
authors: Haukeland University Hospital, Bergen, Norway.
authors: Kari
authors: K
authors: Jones
authors: Rehabilitation and Multiple Sclerosis Center, Overpelt, Belgium.
authors: Kathy
authors: K
authors: Knuts
authors: Centre Neurologique et de Réadaptation Fonctionelle, Fraiture-en-Condroz, Belgium.
authors: Benoît
authors: B
authors: Maertens de Noordhout
authors: University Medical Center, Ljubljana, Slovenia.
authors: Andrej
authors: A
authors: Martic
authors: Kongsgaarden Physiotherapy AS/Nordland Hospital Trust, Bodø, Norway.
authors: Britt
authors: B
authors: Normann
authors: Hasselt University, Diepenbeek, Belgium.
authors: Bert O
authors: BO
authors: Eijnde
authors: Charles University, Prague, Czech Republic.
authors: Kamila
authors: K
authors: Rasova
authors: Hospital de Dia de Barcelona, CEMCat, Barcelona, Spain.
authors: Carmen
authors: C
authors: Santoyo Medina
authors: Rehabilitation and Multiple Sclerosis Center, Overpelt, Belgium.
authors: Veronik
authors: V
authors: Truyens
authors: Hasselt University, Diepenbeek, Belgium.
authors: Inez
authors: I
authors: Wens
authors: Hasselt University, Diepenbeek, Belgium.
authors: Peter
authors: P
authors: Feys
mesh_terms: D000328:Adult; D004185:Disability Evaluation; D005060:Europe; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000534:rehabilitation*; D026741:Physical Therapy Modalities / Q000592:standards; D020127:Recovery of Function; D012015:Reference Standards; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology*
keywords: clinically meaningful improvement; multiple sclerosis rehabilitation; responsiveness; walking measures