Spatial and temporal characteristics of gait as outcome measures in multiple sclerosis (EDSS 0 to 6.5)

Journal of NeuroEngineering and Rehabilitation, Feb 2015

Background Gait impairment represents one of the most common and disabling symptom of multiple sclerosis. Quantification of the gait is an important aspect of clinical trials. In order to identify which temporal or spatial parameters of gait could be used as outcome measures in interventional studies of patients with different levels of disability, we evaluated characteristics of these parameters in MS patients across the whole spectrum of mobility from EDSS 0 to 6.5. Methods This is a cross-sectional study of spatial and temporal parameters of gait at self selected speed and at fast speed of walking in 284 patients with multiple sclerosis (108 men, mean age 38 years ± SD 10.8 years, range 18–64) divided into seven levels of disability (EDSS 0 to 1.5, EDSS 2.0 to 2.5, EDSS 3.0 to 3.5, EDSS 4.0 to 4.5, EDSS 5.0 to 5.5, EDSS 6.0, EDSS 6.5). Results The velocity of gait decreases with increasing EDSS levels. Hovewer, the spatio-temporal parameters of gait that are involved in this process differ across the EDSS levels. The step length is decreased at higher EDSS levels up to the EDSS 6.0, but was not different between EDSS 6.0 and 6.5. The step time is significantly longer at EDSS 6.0 and 6.5, while the step length remains the same at those levels. The increase in percentage of double support time becomes statistically significant at EDSS 3.0-3.5 and continues to increase until EDSS 6.5. Variability of step time, step length or step width did not show significant difference between studied EDSS levels. Conclusions There is no single spatio-temporal parameter of gait (other than velocity of gait) that would show significant differences among all levels of EDSS. The step length reflects shortening of steps at lower EDSS levels (2.0 to 6.0), and percentage of double support time better reflects changes at higher EDSS levels 3.0 – 6.5. Gait variability is not associated with disability in MS and therefore would not be a suitable outcome measure. These observations have to be considered when designing gait experiments with temporal and spatial parameters of gait as outcomes.

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Spatial and temporal characteristics of gait as outcome measures in multiple sclerosis (EDSS 0 to 6.5)

Prague Spatial and temporal characteristics of gait as outcome measures in multiple sclerosis (EDSS 0 to 6.5) Jana Lizrova Preiningerova 0 Klara Novotna 0 Jan Rusz 0 Lucie Sucha 0 Evzen Ruzicka 0 Eva Havrdova 0 0 Department of Neurology and Centre of Clinical Neuroscience, Charles University in Prague, First School of Medicine and General University Hospital , Katerinska 32, Prague 1, 128 00 , Czech Republic Background: Gait impairment represents one of the most common and disabling symptom of multiple sclerosis. Quantification of the gait is an important aspect of clinical trials. In order to identify which temporal or spatial parameters of gait could be used as outcome measures in interventional studies of patients with different levels of disability, we evaluated characteristics of these parameters in MS patients across the whole spectrum of mobility from EDSS 0 to 6.5. Methods: This is a cross-sectional study of spatial and temporal parameters of gait at self selected speed and at fast speed of walking in 284 patients with multiple sclerosis (108 men, mean age 38 years SD 10.8 years, range 18-64) divided into seven levels of disability (EDSS 0 to 1.5, EDSS 2.0 to 2.5, EDSS 3.0 to 3.5, EDSS 4.0 to 4.5, EDSS 5.0 to 5.5, EDSS 6.0, EDSS 6.5). Results: The velocity of gait decreases with increasing EDSS levels. Hovewer, the spatio-temporal parameters of gait that are involved in this process differ across the EDSS levels. The step length is decreased at higher EDSS levels up to the EDSS 6.0, but was not different between EDSS 6.0 and 6.5. The step time is significantly longer at EDSS 6.0 and 6.5, while the step length remains the same at those levels. The increase in percentage of double support time becomes statistically significant at EDSS 3.0-3.5 and continues to increase until EDSS 6.5. Variability of step time, step length or step width did not show significant difference between studied EDSS levels. Conclusions: There is no single spatio-temporal parameter of gait (other than velocity of gait) that would show significant differences among all levels of EDSS. The step length reflects shortening of steps at lower EDSS levels (2.0 to 6.0), and percentage of double support time better reflects changes at higher EDSS levels 3.0 - 6.5. Gait variability is not associated with disability in MS and therefore would not be a suitable outcome measure. These observations have to be considered when designing gait experiments with temporal and spatial parameters of gait as outcomes. Gait; Multiple sclerosis; EDSS; Velocity; Step length; GAITRite instrument - Introduction Over 75% of multiple sclerosis (MS) patients experience difficulty in walking [1]. Gait impairment can occur in all stages of MS and represents one of the most common and disabling symptom of this disease [2,3]. Quantifying impairment of walking is important when assessing new interventions to treat MS. The expanded disability scale score (EDSS) is the most common measure of disability used in multiple sclerosis studies, and although it is driven in part by ability to walk, it is limited in its sensitivity to measure gait impairment [4,5]. Other methods that have been validated to quantify ability to walk in MS patients, such as the 25 foot walk test (25FWT), two minute walk test, or patient reported Multiple Sclerosis Walking Scale (MSWS-12), do not allow assessment of the gait cycle [6,7]. It has been established that patients with MS have significantly different parameters of gait cycle when compared with healthy controls. The most typical change in MS patients is a decrease in distance and speed of walking [8-11], but MS patients also have decreased stride length and limited range of ankle, knee and hip motion [10,11]. Prior studies investigating specifically spatial and temporal parameters of gait have reported decrease in velocity, cadence, step length, and increased step time in MS patients [2,8,12]. Martin et al. has shown also a trend towards increase in double support time in MS patients in comparison with normal controls [3]. Current studies provide an insight into gait changes in MS but do not provide enough of data to characterize gait cycle abnormalities at all levels of disability. In order to choose, which temporal or spatial parameters of gait are applicable as outcome measures at different levels of disability, we evaluated characteristics of these parameters in MS patients across the whole spectrum of mobility from EDSS 0 to 6.5. Methods Subjects The study group in this observational cross-sectional study consists of 284 patients (108 men (38%)) with multiple sclerosis (mean age 38.9 years standard deviation (SD) 10.8 years, range 1864) (Table 1). Consecutive patients whether treated or untreated were invited to participate in the study during the regular outpatient visits at the multiple sclerosis clinic affiliated with an academic institution. Patients with acute MS relapse, orthopaedic problems, or a vision problem sev (...truncated)


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Jana Lizrova Preiningerova, Klara Novotna, Jan Rusz, Lucie Sucha, Evzen Ruzicka, Eva Havrdova. Spatial and temporal characteristics of gait as outcome measures in multiple sclerosis (EDSS 0 to 6.5), Journal of NeuroEngineering and Rehabilitation, 2015, pp. 14, 12, DOI: 10.1186/s12984-015-0001-0