Italian Validation of the 12-Item Multiple Sclerosis Walking Scale

Hindawi Publishing Corporation Multiple Sclerosis International Volume 2015, Article ID 540828, 6 pages http://dx.doi.org/10.1155/2015/540828 Research Article Italian Validation of the 12-Item Multiple Sclerosis Walking Scale C. Solaro,1 E. Trabucco,1,2 A. Signori,3 M. Cella,1 M. Messmer Uccelli,4 G. Brichetto,5 P. Cavalla,6 M. Gironi,7,8 F. Patti,9 and L. Prosperini10 1 Neurology Unit, Head and Neck Department, ASL 3 “Genovese”, 16154 Genova, Italy Department of Experimental Medicine, Section of Diagnostic Radiology, University of Genoa, 16126 Genova, Italy 3 Department of Health Sciences, Section of Biostatistics University of Genova, 16126 Genova, Italy 4 Italian Multiple Sclerosis Society, 16149 Genova, Italy 5 Scientific Research Area, Italian Multiple Sclerosis Foundation, 16149 Genova, Italy 6 Department of Neurosciences, AOU S. Giovanni Battista, University of Torino, 10124 Torino, Italy 7 INSPE, Neuroscience Division, IRCCS HSR, 20132 Milano, Italy 8 CAM, Polidiagnostic Center, 20900 Monza, Italy 9 Department DANA, “GF Ingrassia”, Neuroscience Section (Multiple Sclerosis Centre), University of Catania, 95124 Catania, Italy 10 MS Centre, Department of Neurology and Psychiatry, Sapienza University, 00185 Rome, Italy 2 Correspondence should be addressed to C. Solaro; Received 26 November 2014; Revised 5 February 2015; Accepted 21 February 2015 Academic Editor: Bianca Weinstock-Guttman Copyright © 2015 C. Solaro et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective. Gait impairment is commonly in people with multiple sclerosis (MS). The 12-item MS walking scale (MSWS-12) assesses patients’ measurement of walking quality. The aim of this study was to cross-culturally adapt and validate the MSWS-12 for the Italian population with MS. Methods. Six MS out-patient clinics across Italy enrolled subjects between June 2013 and December 2013. Construct validity of MSWS-12 was determined by examining correlations with the Italian version of the EDSS, the timed 25-foot walk (T25FW), and the Fatigue Severity Scale (FSS). Results. 321 MS subjects were enrolled. Mean age was 47.55 years and mean disease duration was 13.8 years. Mean EDSS score was 4.46. 185 subjects had a relapsing-remitting course, 92 were secondary progressive, 43 were primary progressive, and 1 had a clinically isolated syndrome. The mean total score of the MSWS-12 was 49.6 (SD: 31) with values ranging between 0 and 100. Correlations between the MSWS-12 with age, disease duration, and disease course were found but not with gender. Values of the MSWS-12/IT were significantly related to EDSS (0.71), to the T25FW (0.65), and to the FSS (0.51). Conclusion. MSWS-12/IT has been adapted and validated, it is a reliable and reproducible scale for Italian patients with MS. 1. Introduction Multiple sclerosis (MS) is a chronic, autoimmune disease associated with progressive disability. The course of MS is heterogeneous, is generally diagnosed in adults between the ages of 20–50 years, and is characterized by multiple neurologic deficits and significantly decreased quality of life [1]. Gait impairment is reported as a primary complaint by 85% of people with MS and more than one-third are not able to walk 20 years after the diagnosis [2]. Walking impairment has often been measured in clinical research and practice using the Expanded Disability Status Scale (EDSS) [3], the timed 25-foot walk (T25FW) [4, 5], the 6-minute walk (6MW) [6, 7], and quantitative analysis (gait kinematics) [5]. The 12-item multiple sclerosis walking scale (MSWS-12) provides a patient-reported outcome of the impact of MS on walking [3]. A recent study confirmed the association between MSWS-12 scores and T25FW and 6MW performance and showed the association between MSWS-12 scores and spatial and temporal parameters of gait [8]. This provided evidence for the validity of the MSWS-12 as a measure of aspects of the quality of walking in addition to walking speed and endurance [8]. 2 To our knowledge, the scale has only been translated into Portuguese for the Brazilian population [9]. The aims of the present study were to translate and adapt the MSWS-12 into Italian and to test the resulting Italian version in a group of patients followed in specialized MS outpatient clinics. 2. Methods 2.1. Subjects. The present study involved six MS outpatient clinics across Italy, between June 2013 and December 2013. Inclusion criteria were a confirmed MS diagnosis according to McDonald’s [10], age greater than 18 years, ability to walk with or without the use of adaptive devices, and an EDSS range from 0 to 7. Patients experiencing an exacerbation within 30 days prior to the assessment, with an additional neurological disease or with one or more concomitant illnesses, were excluded from the study. Ethical approval for this study was obtained from the ethical committees of each participating hospital. Signed informed consent was obtained from each patient prior to enrollment in the study according to the Declaration of Helsinki. Multiple Sclerosis International The hypothesis is that MSWS-12/IT should correlate with objective measure of disability (EDSS), disease course, and walking speed (T25FW), while fatigue and multidimensional symptoms should be only incompletely related to MSWS12/IT. The EDSS assesses neurological impairment and disability due to MS in 20 steps from 0 (normal neurological examination) to 10 (death due to MS) [3]. The T25FW is a component of the Multiple Sclerosis Functional Composite (MSFC) [14] and measures the time needed to walk 25 feet (7.62 meters) with or without an assistive device as quickly and safely as possible. The final result is the mean time (in seconds) needed to complete two consecutive attempts of the T25FW. The FSS is commonly used in MS. The subject is asked to read each statement and circle a number from 1 (strong disagreement) to 7 (strong agreement), depending on how appropriate they feel the statement applies to them over the preceding week [15]. Construct validity of MSWS-12 was determined by examining correlations with the Italian version of the EDSS, the timed 25-foot walk (T25FW), and the Fatigue Severity Scale (FSS). 2.2. Translation and Adaptation. The MSWS-12 was translated into Italian by a professional translator with knowledge of health terminology. The translation was evaluated to ensure semantic equivalence and acceptability. During an initial meeting of MS experts, a list of possible alternatives for the controversial item stems and response choices was developed. Problematic items and response choices were retranslated into Italian from the original version and a definitive version was determined by consensus. Subsequently, the Italian version was back-translated into English and compared with the original one. The transl (...truncated)