Walk test linked to quality of life in multiple sclerosis

1. The timed 25-foot walk (T25-FW) test is a means for assessing disability due to walking impairment in multiple sclerosis.

2. Decreases in T25-FW walking speed of 20-25% were associated with significant decreases in patient-reported quality of life scales.

Evidence Rating Level: 2 (Good)

Study Rundown: Multiple sclerosis (MS) is a chronic demyelinating disease which results in a variety of disability-causing symptoms, including sensory loss, spasticity, weakness, and incoordination of the limbs. Past studies demonstrated that many patients with MS report their ability or inability to walk as being the most important factor in terms of quality of life. This study sought to validate the timed 25-foot walk (T25-FW) test, a part of the more comprehensive Multiple Sclerosis Functional Composite (MSFC), relative to patient-reported quality of life scales. The authors emphasized a need to correlate physician-generated outcome measures with patient-generated outcome measures.

This study found that decreases in T25-FW walking speed of 20-25% were associated with significant declines (greater than 5 point decrease) in the SF-36. A strength of this study is that patients were included from various treatment centers. Those with relapsing-remitting and secondary-progressive MS were both included, as were patients on placebo therapy or active therapy with natalizumab and other agents. In this diverse population, walking speed was found to be a clinically meaningful data point for quantifying the progression of MS. This study is limited by the post hoc analysis design, which inherently is at risk to commit a type 1 error. Moreover, the study examines clinical trials, which have specific exclusion criteria, so the results may not be generalizable to all patients.

Click to read the study, published today in JAMA Neurology

Relevant Reading: The impact of slower walking speed on activities of daily living in patients with multiple sclerosis

In-Depth [post hoc analysis]: This study retrospectively analyzed data from three clinical trials, including a total of 2549 patients (AFFIRM, IMPACT, and SENTINEL). The T25-FW test consisted of a having a patient walk (with an aid if necessary) as fast as they could over a 25 foot long course. After two trials, the average time was used to calculate the speed (25 feet/time in seconds to complete course). Patients also completed the SF-36, a 36 item questionnaire that can be scored from 0-100, with higher scores indicating better health-related quality of life.

For all 3 trials, baseline walking speed was positively associated with baseline SF-36 scores (r=0.48, P<0.001). In the subscale analysis, the strongest association was found between the SF-36 subscore for physical functioning and T25-FW scores. Data from the placebo groups of the AFFIRM and IMPACT trials were used for an analysis of mean change from baseline in both T25-FW and SF-36 scores after 2 years. For these patients, the percentage change in walking speed at 2 years was significantly correlated with changes in quality of life on the SF-36 (r=0.35; p<0.001).

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