IRCSS Fondazione Don Carlo Gnocchi, Milan, Italy.
CRRF Mons. Luigi Novarese, Moncrivello (VC), Italy.
Eur J Neurol. 2021 Jul;28(7):2259-2268. doi: 10.1111/ene.14866. Epub 2021 May 2.
People with multiple sclerosis (PwMS) often report walking limitations even when the gold standard Expanded Disability Status Scale (EDSS) indicates normal walking endurance/autonomy. The present multicenter study on early-stage PwMS aims at analyzing which aspects are associated with patient-reported walking limitations measured with the 12-item Multiple Sclerosis Walking Scale (MSWS-12).
Eighty-two PwMS (EDSS ≤ 2.5) were assessed using the Fullerton Advanced Balance Scale-short (FAB-s), the Fatigue Severity Scale (FSS) and the 6-min Walk Test (6MWT), the latter administered also to 21 healthy subjects. Participants performed the 6MWT wearing three inertial sensors on ankles and trunk. Instrumented metrics describing gait velocity (stride length and frequency) and quality (regularity, symmetry, instability) were computed from sensor data. Fatigue (FSS), balance (FAB-s), walking endurance (6MWT) and instrumented metrics were entered in a multiple regression model with MSWS-12 as dependent variable.
Gait symmetry, gait instability, fatigue and balance were significantly associated with self-rated walking ability, whilst walking endurance and velocity were not. Fatigue, balance, gait symmetry and instability were more impaired in participants reporting mild-to-moderate (MS , 25 ≤ MSWS-12 < 75) compared to those reporting none-to-minimal (MS , 0 ≤ MSWS-12 ≤ 25) perceived walking limitations. Compared to healthy subjects, gait symmetry and stability were reduced in MS and MS , even in those participants with EDSS ≤ 1.5.
Instrumentally assessed gait quality aspects (symmetry and instability) are associated with patient-reported walking ability in early-stage PwMS and seem sensitive biomarkers to detect subtle impairments even in the earliest stages of the disease (EDSS ≤ 1.5). Future studies should assess their ability to follow walking change due to MS progression or pharmacological/rehabilitation interventions.
多发性硬化症（MS）患者即使扩展残疾状态量表（EDSS）显示正常行走耐力/自主能力，也常报告行走受限。本研究旨在分析哪些方面与使用 12 项多发性硬化症行走量表（MSWS-12）测量的患者报告的行走受限有关。
对 82 例 EDSS≤2.5 的 MS 患者进行评估，使用完整的高级平衡量表-短版（FAB-s）、疲劳严重程度量表（FSS）和 6 分钟步行试验（6MWT），其中 21 名健康受试者也进行了 6MWT。参与者在脚踝和躯干上佩戴三个惯性传感器进行 6MWT。从传感器数据中计算出描述步态速度（步长和频率）和质量（规律性、对称性、不稳定性）的仪器化指标。将疲劳（FSS）、平衡（FAB-s）、行走耐力（6MWT）和仪器化指标作为因变量，进入多元回归模型，用 MSWS-12 作为因变量。
步态对称性、步态不稳定性、疲劳和平衡与自我报告的行走能力显著相关，而行走耐力和速度则没有。与无至轻度（MS，0≤MSWS-12≤25）报告的患者相比，报告轻至中度（MS，25≤MSWS-12＜75）的患者疲劳、平衡、步态对称性和不稳定性更差。与健康受试者相比，MS 和 MS 患者的步态对称性和稳定性降低，即使在 EDSS≤1.5 的患者中也是如此。
仪器评估的步态质量方面（对称性和不稳定性）与早期 MS 患者的患者报告的行走能力相关，并且似乎是检测疾病早期（EDSS≤1.5）细微损伤的敏感生物标志物。未来的研究应评估它们在 MS 进展或药物治疗/康复干预的情况下，跟踪行走变化的能力。
