Disease Progression in Multiple Sclerosis II. Methods for the Determination of Walking Impairment and Its Impact on Activities and Social Participation

Walking ability is a vital component of validated test procedures to assess mobility impairment in multiple sclerosis (MS). The methods used to assess walking ability vary widely between treatment centres, and the accuracy of the methods used and numbers of parameters determined to analyse specific aspects of walking and gait are often limited. The questionnaireand task-based methods used to assess walking in MS can be divided into different categories. First, there are the general-purpose tests such as the Expanded Disability Status Scale (EDSS), the Multiple Sclerosis Functional Composite (MSFC), the Family Assessment of Multiple Sclerosis Trial Outcome Index (FAMS-TOI) and the Short Form-36 (SF-36). These, particularly EDSS, are widely used in MS to assess limitations of all activities and social participation, of which walking is only a part. Others, such as SF-36, assess health-related quality of life (HRQoL). Second, there are methods designed to specifically assess walking or gait, including the timed 25-foot walk (T25FW), the Dynamic Gait Index (DGI), the 12-Item MS Walking Scale (MSWS-12) and the Timed Up and Go Test (TUGT). These test methods require minimal equipment to perform such as a stopwatch, a hallway or a chair, and can be completed at a medical centre in a few minutes. Most of these tests provide reliable and valid data but some lack accurate assessment of gait and some require clinician training. Third, there are tests that specifically measure balance, such as the Berg Balance Test, in which the patient completes a series of balance exercises while being observed. A recent development is the use of accelerometers to monitor MS patients over extended periods; these can provide more accurate data than patient self-report tools. In future, it is likely that more specific tests of walking ability will be more widely used as an important part of MS diagnosis and to more precisely monitor disease progression and assess patient needs.