J P Stellmann1, E Vettorazzi2, J Poettgen3, C Heesen3. 1. Institute for Neuroimmunology and Clinical MS Research (inims) and Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address: j.stellmann@uke.de. 2. Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 3. Institute for Neuroimmunology and Clinical MS Research (inims) and Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Abstract
BACKGROUND: Mobility assessment in Multiple Sclerosis (MS) is crucial for trials and individual patient counseling. Up to now, standard tests as the Timed 25-Foot Walk (T25FW) are restricted by floor effects in mildly disabled patients. The 3-meter Timed Tandem Walk (TTW) as a possibly more sensitive measure has not been investigated yet. OBJECTIVE: To investigate sensitivity and specificity of the TTW and T25FW to detect mild clinical impairment in a large cohort of MS patients. METHODS: We extracted T25FW, TTW and EDSS from our UMC patient database (2009-2012). After randomization into an explorative (n = 497) and validation (n = 228) cohort, we calculated change rates and performed ROC analyses of gait tests and EDSS including Functional System Scores. RESULTS: Between disability stages of EDSS 0-2.5 and EDSS 3.0-4.0, the mean TTW difference was 4s (T25FW = 0.9s). The accuracy to separate between EDSS groups was moderate but identical for both tests (ROC-AUC T25FW = 0.79, TTW = 0.80, p = 0.4). TTW had a higher sensitivity and specificity to differentiate between asymptomatic and symptomatic patients concerning FS motor/cerebellar scores (ROC-AUC T25FW = 0.71, TTW = 0.75, p < 0.05). All hypotheses could be validated in the second cohort. CONCLUSION: A 3-m Timed Tandem Walk is a standardized test that is easy to implement to detect impairment of the motor or cerebellar system in fully ambulatory MS patients. Based on the complex-task character, TTW is a potential new outcome measure for MS mobility in mildly disabled patients and can act as easily accessible and significant additional information in patient counseling.
RCT Entities:
BACKGROUND: Mobility assessment in Multiple Sclerosis (MS) is crucial for trials and individual patient counseling. Up to now, standard tests as the Timed 25-Foot Walk (T25FW) are restricted by floor effects in mildly disabled patients. The 3-meter Timed Tandem Walk (TTW) as a possibly more sensitive measure has not been investigated yet. OBJECTIVE: To investigate sensitivity and specificity of the TTW and T25FW to detect mild clinical impairment in a large cohort of MSpatients. METHODS: We extracted T25FW, TTW and EDSS from our UMC patient database (2009-2012). After randomization into an explorative (n = 497) and validation (n = 228) cohort, we calculated change rates and performed ROC analyses of gait tests and EDSS including Functional System Scores. RESULTS: Between disability stages of EDSS 0-2.5 and EDSS 3.0-4.0, the mean TTW difference was 4s (T25FW = 0.9s). The accuracy to separate between EDSS groups was moderate but identical for both tests (ROC-AUC T25FW = 0.79, TTW = 0.80, p = 0.4). TTW had a higher sensitivity and specificity to differentiate between asymptomatic and symptomatic patients concerning FS motor/cerebellar scores (ROC-AUC T25FW = 0.71, TTW = 0.75, p < 0.05). All hypotheses could be validated in the second cohort. CONCLUSION: A 3-m Timed Tandem Walk is a standardized test that is easy to implement to detect impairment of the motor or cerebellar system in fully ambulatory MSpatients. Based on the complex-task character, TTW is a potential new outcome measure for MS mobility in mildly disabled patients and can act as easily accessible and significant additional information in patient counseling.
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Authors: Elke Warmerdam; Maike Schumacher; Thorben Beyer; Patrik Theodor Nerdal; Linda Schebesta; Klarissa H Stürner; Kirsten E Zeuner; Clint Hansen; Walter Maetzler Journal: Front Neurol Date: 2022-03-29 Impact factor: 4.003
Authors: Inga Heinrich; Friederike Rosenthal; Stefan Patra; Karl-Heinz Schulz; Götz H Welsch; Eik Vettorazzi; Sina C Rosenkranz; Jan Patrick Stellmann; Caren Ramien; Jana Pöttgen; Stefan M Gold; Christoph Heesen Journal: Front Neurol Date: 2021-07-19 Impact factor: 4.003