Gait disturbance is common and often begins early in multiple sclerosis (MS). We have previously identified higher-challenge balance tasks as more sensitive than gait speed tasks (Timed 25 Foot Walk [T25FW], Two-Minute-Walk-Test [2MWT]) to patient-reported gait change and fall risk in a cohort of persons with early relapsing MS (<5 years diagnosed).
To assess whether a clinically-feasible, quantifiable higher-challenge dynamic balance task is sensitive to subtle patient-reported gait changes and falls in persons with relapsing MS of varied disease duration and with normal gait speed as measured by the T25FW.
Persons with relapsing MS or clinically isolated syndrome (n=218, aged 18-65 years) with normal gait speed (T25FW <5.0s) reported gait disturbance (MS Walking Scale-12 [MSWS-12]) and recent falls/near-falls (within the past month); healthy controls (n=200) also reported recent falls/near-falls. Dynamic balance was assessed with the novel 10-Foot Tandem Walk (10FTW) task requiring patients to tandem walk on a 10-foot straight line with arms across their chest; number of quarters successfully completed across three trials was recorded (0-12). For comparison, patients also performed the 2MWT as a high-challenge gait speed task.
Nearly half of patients (48.2%) reported at least mild walking difficulty despite normal T25FW, and MS patients reported twice as many falls as controls (11.5% vs. 5.5%). Among MS patients, logistic regression revealed that worse 10FTW (p=.006), but not 2MWT (p=.121), independently predicted falls. Percent of MS patients reporting falls across 10FTW quartiles was 22.4%, 11.7%, 9.5%, 2.5%. Supplemental analyses replicated findings when considering near-falls and when controlling for mood.
Many MS patients report gait disturbance despite normal walking speed (T25FW). Dynamic balance assessed with the clinically-feasible and quantifiable 10FTW was sensitive to subtle walking difficulties and fall risk in these patients. These findings replicate our previous work identifying balance tasks as more sensitive to gait disturbance and fall risk than speeded walking tasks. The 10FTW may hold promise as an clinical trial outcome measure, especially among patients with more mild disability.