Friday, 23 November 2012

Walking variability

Epub: Socie MJ, Motl RW, Pula JH, Sandroff BM, Sosnoff JJ. Gait variability and disability in multiple sclerosis.Gait Posture. 2012 Nov 12. doi:pii: S0966-6362(12)00385-2.10.1016/j.gaitpost. 2012. 10.012.

Gait variability is clinically relevant in some populations, but there is limited documentation of gait variability in persons with multiple sclerosis (MS). This investigation examined average and variability of spatiotemporal gait parameters in persons with MS and healthy controls and subsequent associations with disability status. 88 individuals with MS (age 52.4±11.1) and 20 healthy controls (age 50.9±8.7) performed two self-paced walking trials on a 7.9-m electronic walkway to determine gait parameters. Disability was indexed by the Expanded Disability Status Scale (EDSS) and ranged between 2.5 and 6.5. Gait variability was indexed by standard deviation (SD) and coefficient of variation (CV=SD/mean) of step time, step length, and step width. Average gait parameters were significantly correlated with EDSS (ρ=0.756-0.609) and were significantly different in individuals with MS compared to controls (p≤0.002). Also, step length (p<0.001) and step time (p<0.001) variability were both significantly greater in MS compared to controls. EDSS was positively correlated with step length variability and individuals with MS who used assistive devices to walk had significantly greater step length variability than those who walked independently (p<.05). EDSS was correlated with step time and length variability even when age was taken into account. The average gait parameters were more closely related to disability status than gait variability in individuals with MS. This suggests that focusing on average gait parameters may be more important than variability in therapeutic interventions in MS.



This is further work showing who is sort of intuitive that that there is variability in walking characteristics between MSers and the more disability that is accumulated with influence these parameters. The question is whether these can be robust enough for trials such that we can move away from the insensitive EDSS. The way to find out if to have them as exploratory outcomes in trials and see how they do and maybe one day they will become primary or secondary outcomes as we need better outcomes. However they have to be shown to be relevant.

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