Speed but Not Smoothness of Gait Reacts to Rehabilitation in Multiple Sclerosis

Abstract

Introduction. Improved gait is one of the leading therapy goals in multiple sclerosis. A plethora of clinical timed trials and state-of-the-art technology-based approaches are available to assess gait performance. Objectives. To examine what aspects of gait react to inpatient rehabilitation in MS and which parameters should be best assessed. Design. In this longitudinal study, we examined the performance of 76 patients with MS to shed further light on factors influencing gait, associations between tests, and the reaction to inpatient rehabilitation during an average time span of 16 d. Setting. Private specialist clinic for inpatient neurorehabilitation. Main Outcome Measures. Clinical walk tests (timed 25-foot walk test at normal pace, maximum pace over 10 m or 6 min) and IMU-based measures of movement smoothness. Results. All gait parameters were strongly intercorrelated (all p<0.05), and a model multiple linear regression for the 6MWT revealed short distance velocity (10 m) and movement smoothness as predictors in a strong model (R2adjusted 0.75, p<0.01). A second model with natural pace on short distance and movement smoothness was almost equally strong (R2adjusted 0.71, p<0.01). Patients improved their walking speed (p<0.01), but not smoothness (p=0.08–0.12), over the course of rehabilitation. Conclusions. Since we were not able to observe improvements in smoothness of gait, we conclude that rehabilitation programs should be adapted to the patient’s physiological capacities in order to allow for such improvements in smoothness of gait. Externally valid gait capacity (6MWT) could be predicted by a single walk for 10 s at natural pace.