Saturday, 28 September 2013

Measuring mobility in MSers

Your legs are made for walking. Lose leg function and it correlates with the impact of MS on your life in general. #MSBlog #MSResearch

"Who thought you could relate the social and occupational impact of MS to mobility as determined by the number of steps you take in a single day? So called real-life anchors (unemployment, divorce, assistive device use) resulted in a mean minimal clinically important difference MCID of 2,580 steps/day, which was only 45% of mean score for MS group as a whole. Put in another way MSers who were unemployed, divorced or needed a assistive device took 55% fewer steps on average than the whole MS group. Are you surprised? The question that this study raises is whether or not the regulators will accept steps per day as a surrogate, or indicator, for the impact that MS has on the life of someone with the disease?"

Motl et al. Clinical Importance of Steps Taken per Day among Persons with Multiple Sclerosis. mPLoS One. 2013 Sep;8(9):e73247. 

BACKGROUND: The number of steps taken per day (steps/day) provides a reliable and valid outcome of free-living walking behavior in MSers.

OBJECTIVE: This study examined the clinical meaningfulness of steps/day using the minimal clinically important difference (MCID) value across stages representing the developing impact of MS.

METHODS: This study was a secondary analysis of de-identified data from 15 investigations totalling 786 MSers and 157 healthy controls. All participants provided demographic information and wore an accelerometer or pedometer during the waking hours of a 7-day period. Those with MS further provided real-life, health, and clinical information and completed the Multiple Sclerosis Walking Scale-12 (MSWS-12) and Patient Determined Disease Steps (PDDS) scale. MCID estimates were based on regression analyses and analysis of variance for between group differences.

RESULTS: The mean MCID from self-report scales that capture subtle changes in ambulation (1-point change in PDSS scores and 10-point change in MSWS-12 scores) was 779 steps/day (14% of mean score for MS sample); the mean MCID for clinical/health outcomes (MS type, duration, weight status) was 1,455 steps/day (26% of mean score for MS sample); real-life anchors (unemployment, divorce, assistive device use) resulted in a mean MCID of 2,580 steps/day (45% of mean score for MS sample); and the MCID for the cumulative impact of MS (MS vs. control) was 2,747 steps/day (48% of mean score for MS sample).

CONCLUSION: The change in motion sensor output of ∼800 steps/day appears to represent a lower-bound estimate of clinically meaningful change in free-living walking behavior in interventions of MS.

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