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Neurology. 2018 Nov 13;91(20):e1880-e1892. doi: 10.1212/WNL.0000000000006532. Epub 2018 Oct 17.

Responsiveness and meaningful improvement of mobility measures following MS rehabilitation.

Author information

1
From the REVAL Rehabilitation Research Center (I.B., P.F.), BIOMED Biomedical Research Institute, Faculty of Medicine & Life Sciences, Hasselt University, Belgium; Haukeland University Hospital (Norwegian MS Competence Centre and Department of Physiotherapy) (T.S.), Bergen, Norway; Department of Physical Therapy (A.K.), Sackler Faculty of Medicine, Tel-Aviv University; Multiple Sclerosis Center (A.K.), Sheba Medical Center, Tel-Hashomer, Israel; Department of Rehabilitation, Third Faculty of Medicine (K.R.), Charles University and Faculty Hospital Royal Vineyards, Prague, Czech Republic; Multiple Sclerosis Center (A.H.-M.), Hakadal AS, Norway; Department of Neurology (R.E.), Clinic for Rehabilitation Münster, Austria; Eugenia Epalza Rehabilitation Center (I.E.M.), Bilbao, Spain; Clinical Center in Belgrado (U.N.), Serbia; Italian Multiple Sclerosis Foundation (FISM) (A.T.), Scientific Research Area, Genoa, Italy; National MS Center (P.H.), Melsbroek; AZ Klina (G.A.), Campus De Mick, Rehabilitation, Brasschaat, Belgium; John Paul II Rehabilitation Centre for People with Multiple Sclerosis (G.S.), Borne Sulinowo, Poland; Neurological Rehabilitation Centre Quellenhof (K.G.), Sana AG, Germany; IRCSS Fondazione Don Carlo Gnocchi (D.C.), Milan, Italy; Rehabilitation and MS Center Overpelt (S.B.), Belgium; University of Colorado-Anschutz Medical Campus (J.H.); and Section of Sport Science (U.D.), Department Public Health, Aarhus University, Denmark. ilse.baert@uhasselt.be.
2
From the REVAL Rehabilitation Research Center (I.B., P.F.), BIOMED Biomedical Research Institute, Faculty of Medicine & Life Sciences, Hasselt University, Belgium; Haukeland University Hospital (Norwegian MS Competence Centre and Department of Physiotherapy) (T.S.), Bergen, Norway; Department of Physical Therapy (A.K.), Sackler Faculty of Medicine, Tel-Aviv University; Multiple Sclerosis Center (A.K.), Sheba Medical Center, Tel-Hashomer, Israel; Department of Rehabilitation, Third Faculty of Medicine (K.R.), Charles University and Faculty Hospital Royal Vineyards, Prague, Czech Republic; Multiple Sclerosis Center (A.H.-M.), Hakadal AS, Norway; Department of Neurology (R.E.), Clinic for Rehabilitation Münster, Austria; Eugenia Epalza Rehabilitation Center (I.E.M.), Bilbao, Spain; Clinical Center in Belgrado (U.N.), Serbia; Italian Multiple Sclerosis Foundation (FISM) (A.T.), Scientific Research Area, Genoa, Italy; National MS Center (P.H.), Melsbroek; AZ Klina (G.A.), Campus De Mick, Rehabilitation, Brasschaat, Belgium; John Paul II Rehabilitation Centre for People with Multiple Sclerosis (G.S.), Borne Sulinowo, Poland; Neurological Rehabilitation Centre Quellenhof (K.G.), Sana AG, Germany; IRCSS Fondazione Don Carlo Gnocchi (D.C.), Milan, Italy; Rehabilitation and MS Center Overpelt (S.B.), Belgium; University of Colorado-Anschutz Medical Campus (J.H.); and Section of Sport Science (U.D.), Department Public Health, Aarhus University, Denmark.

Abstract

OBJECTIVE:

To determine responsiveness of functional mobility measures, and provide reference values for clinically meaningful improvements, according to disability level, in persons with multiple sclerosis (pwMS) in response to physical rehabilitation.

METHODS:

Thirteen mobility measures (clinician- and patient-reported) were assessed before and after rehabilitation in 191 pwMS from 17 international centers (European and United States). Combined anchor- and distribution-based methods were used. A global rating of change scale, from patients' and therapists' perspective, served as external criteria when determining the area under the receiver operating characteristic curve (AUC), the minimally important change (MIC), and the smallest real change (SRC). Patients were stratified into 2 subgroups based on disability level (Expanded Disability Status Scale score ≤4 [n = 72], >4 [n = 119]).

RESULTS:

The Multiple Sclerosis Walking Scale-12, physical subscale of the Multiple Sclerosis Impact Scale-29 (especially for the mildly disabled pwMS), Rivermead Mobility Index, and 5-repetition sit-to-stand test (especially for the moderately to severely disabled pwMS) were the most sensitive measures in detecting improvements in mobility. Findings were determined once the AUC (95% confidence interval) was above 0.5, MIC was greater than SRC, and results were comparable from the patient and therapist perspective.

CONCLUSIONS:

Responsiveness, clinically meaningful improvement, and real changes of frequently used mobility measures were calculated, showing great heterogeneity, and were dependent on disability level in pwMS.

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