title: Loss of mobility and the patient burden of multiple sclerosis: expert opinion on relevance to daily clinical practice.
abstract: BACKGROUND
  Walking impairment is one of the most visible and important manifestations of multiple sclerosis. MS Studies have consistently found that walking impairment occurs early during MS, and recent studies suggest that the greatest impact on socioeconomic outcomes occurs during the early stages of disability. Walking impairment is often perceived by the affected individual prior to its clinical manifestation, supporting the need for patient education and walking assessments that may be self-administered. Patient perceptions should lead to pre-emptive management strategies to maintain independence and delay the need for walking assistive devices or caregiving. Patient management should also include regular quantitative and qualitative assessments of walking by physicians or other clinicians, such as nurse practitioners, physician assistants, or physical therapists.
  
  
  METHODS
  PubMed searches retrieved recent studies (November 2008 to August 2013) evaluating the contribution of walking impairment to the burden of MS.
  
  
  RESULTS
  Several objective measures of walking are available, such as measures of walking speed (Timed 25-Foot Walk Test) and distance (2- or 6-Minute Walk); however, these measures may have practical considerations such as time and space. Patient-reported measures, which should have a low administration burden, include walking-specific (Multiple Sclerosis Walking Scale) and health-related quality-of-life outcome assessments.
  
  
  CONCLUSIONS
  When used in tandem, patient-reported and objective measures can help monitor changes and facilitate patient-clinician discussions of problems, management strategies, and long-term goals related to walking impairment.
authors.affiliation: a University of Miami Multiple Sclerosis Center of Excellence , UHealth at Boca Raton , Boca Raton , FL , USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Smrtka
authors.affiliation: b Evergreen Neuroscience Institute and Medical Center , Kirkland , WA , USA.
authors.forename: Theodore
authors.initials: T
authors.lastname: Brown
authors.affiliation: c Sanford Neuroscience Clinic , Fargo , ND , USA.
authors.forename: Greg
authors.initials: G
authors.lastname: Bjorklund
mesh_terms: D017281:Cost of Illness; D051341:Dependent Ambulation; D006801:Humans; D009103:Multiple Sclerosis / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D063868:Patient Outcome Assessment; D011788:Quality of Life
keywords: Multiple sclerosis; assessment; burden; mobility; walking