title: Static posturography across the EDSS scale in people with multiple sclerosis: a cross sectional study.
abstract: Posturography is considered the gold standard objective measure of standing postural control in people with multiple sclerosis (PwMS). This reliable tool provides quantitative data related to risk of falling and white and gray matter brain damage due to MS. Nevertheless, it remains unclear whether and to what extent, postural control declines throughout the disease process. We therefore examined the impact of disability on posturography measures in PwMS.
  
  
  
  In this cross-sectional study, the data pool was divided into seven levels of disability based on the Expanded Disability Status Scale (EDSS) score. The study group comprised 464 PwMS, mean disease duration was 6.2 (SD = 7.5) years and mean age 42.6 (SD = 14.1). Static postural control parameters were obtained from the Zebris FDM-T instrumented Treadmill (Medical GmbH, Germany).
  
  
  
  A significant positive correlation between the EDSS and posturography parameters was found. Scores for the ellipse area, center of pressure (CoP) path length and sway rate with eyes open were Spearman's rho =0.512, 0.527, 0.528; (P-value < 0.001), respectively. Non-significant differences were observed between the EDSS subgroups at the lower end of the spectrum (EDSS 0-2.5) in all posturography parameters. In contrast, MS patients with an EDSS score of 3.0-3.5 demonstrated a significant increase in the ellipse area with eyes open (~108 %) and closed (~169 %), CoP path length with eyes open (~83 %) and closed (~88 %) and sway rate with eyes open (~39 %) and closed (~148 %), compared with those who scored within the range of 0-2.5 in the EDSS. Non-significant differences were observed between MS patients with an EDSS score of 3.0-5.5. MS patients with an EDSS score of 6.0-6.5 were significantly poorer in 4 (out of 6) balance measures compared to other disability subgroups.
  
  
  
  Posturography CoP trajectories are appropriate outcome measures indicating disability deterioration in PwMS.
authors.affiliation: Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel. alkalron@gmail.com.
authors.forename: Alon
authors.initials: A
authors.lastname: Kalron
authors.affiliation: Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Dalia
authors.initials: D
authors.lastname: Nitzani
authors.affiliation: Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel.|Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Anat
authors.initials: A
authors.lastname: Achiron
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000503:physiopathology*; D004856:Postural Balance / Q000502:physiology*; D012720:Severity of Illness Index; D055815:Young Adult
keywords: Balance; Disability; EDSS; Multiple sclerosis; Neurological; Postural control