Balance control in multiple sclerosis: Correlations of trunk sway during stance and gait tests with disease severity

Abstract Objective The mini-BESTest is a balance measure for assessment of the underlying physiological systems for balance control in adults. Evaluations of test–retest reliability of the mini-BESTest in larger samples of people with multiple sclerosis (MS) are lacking. The purpose of this study was to investigate test–retest reliability of the mini-BESTest total and section sum scores and individual items in people with mild to moderate overall MS disability. Methods This study used a test–retest design in a movement laboratory setting. Fifty-four people with mild to moderate overall MS disability according to the Expanded Disability Status scale (EDSS) were included, with 28 in the mild subgroup (EDSS 2.0–3.5) and 26 in the moderate subgroup (EDSS 4.0–5.5). Test–retest reliability of the mini-BESTest was evaluated by repeated measurements taken 1 week apart. Reliability and measurement error were analyzed. Results Test–retest reliability for the total scores were considered good to excellent, with intraclass correlation coefficients of .88 for the whole sample, .83 for the mild MS subgroup, and .80 for the moderate MS subgroup. Measurement errors were small, with standard error of measurement and minimal detectable change of 1.3 and 3.5, respectively, in mild MS, and 1.7 and 4.7, respectively, in moderate MS. The limits of agreement were − 3.4 and 4.6. Test–retest reliability for the section scores were fair to good or excellent; weighted kappa values ranged from .62 to .83. All items but 1 showed fair to good or excellent test–retest reliability, and percentage agreement ranged from 61% to 100%. Conclusions The mini-BESTest demonstrated good to excellent test–retest reliability and small measurement errors and is recommended for use in people with mild to moderate MS. Impact Knowledge of limits of agreement and minimal detectable change contribute to interpretability of the mini-BESTest total score. The findings of this study enhance the clinical usefulness of the test for evaluation of balance control and for designing individually customized balance training with high precision and accuracy in people with MS.

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Cutting Edge: Mast Cells Regulate Disease Severity in a Relapsing–Remitting Model of Multiple Sclerosis

The Journal of Immunology ◽

10.4049/jimmunol.1003574 ◽

2011 ◽

Vol 186 (6) ◽

pp. 3294-3298 ◽

Cited By ~ 59

Author(s):

Blayne A. Sayed ◽

Margaret E. Walker ◽

Melissa A. Brown

Keyword(s):

Multiple Sclerosis ◽

Mast Cells ◽

Disease Severity ◽

Cutting Edge ◽

Relapsing Remitting

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PNL20 DISEASE SEVERITY AND HEALTH CARE COSTS OF RELAPSING-REMITTING MULTIPLE SCLEROSIS IN PORTUGAL

Value in Health ◽

10.1016/s1098-3015(10)67559-6 ◽

2005 ◽

Vol 8 (6) ◽

pp. A134

Author(s):

C Mateus ◽

J Pereira

Keyword(s):

Multiple Sclerosis ◽

Health Care ◽

Disease Severity ◽

Health Care Costs ◽

Relapsing Remitting ◽

Remitting Multiple Sclerosis ◽

Relapsing Remitting Multiple Sclerosis ◽

Care Costs

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A null mutation within the ciliary neurotrophic factor (CNTF)-gene: implications for susceptibility and disease severity in patients with multiple sclerosis

Genes and Immunity ◽

10.1038/sj.gene.6363818 ◽

2002 ◽

Vol 3 (1) ◽

pp. 53-55 ◽

Cited By ~ 15

Author(s):

V Hoffmann ◽

D Pöhlau ◽

H Przuntek ◽

J T Epplen ◽

C Hardt

Keyword(s):

Multiple Sclerosis ◽

Disease Severity ◽

Neurotrophic Factor ◽

Ciliary Neurotrophic Factor ◽

Null Mutation

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Measurements of Trunk Sway for Stance and Gait Tasks 2 Years after Vestibular Neurectomy

Audiology and Neurotology ◽

10.1159/000494965 ◽

2018 ◽

Vol 23 (5) ◽

pp. 298-308 ◽

Cited By ~ 1

Author(s):

Dominique Vibert ◽

John H.J. Allum ◽

Martin Kompis ◽

Simona Wiedmer ◽

Christof Stieger ◽

...

Keyword(s):

Balance Control ◽

Recovery Period ◽

Subjective Assessment ◽

Vestibular Neurectomy ◽

Eyes Closed ◽

Before And After ◽

Task Durations ◽

Trunk Sway ◽

Central Compensation ◽

Balance Problems

The aim of this study was to investigate changes in balance control for stance and gait tasks in patients 2 years before and after vestibular neurectomy (VN) performed to alleviate intractable Meniere’s disease. Amplitudes of trunk sway in roll and pitch directions were measured for stance and gait tasks in 19 patients using gyroscopes mounted at the lower-back. Measurements before VN and 2 years later were compared to those of healthy age-matched controls (HC). We also examined if changes in trunk sway amplitudes were correlated with patients’ subjective assessment of disability using the AAO-HNS scale. For patients with low AAO-HNS scores 0–2 (n = 14), trunk roll and pitch sway velocities, standing eyes closed on foam, increased 2 years post VN compared to HC values (p < 0.01). Trunk sway amplitudes remained at levels of HC for simple gait tasks, but task durations were longer and therefore gait slower. For complex gait tasks (stairs), balance control remained impaired at 2 years. In patients with AAO-HNS high scores level 6 (n = 5), balance control remained abnormal, compared to HC, 2 years postoperatively for all stance, several simple and all complex gait tasks. Trunk sway in the pitch and roll directions for stance tasks was correlated with clinical (AAO-HNS) scores (p ≤ 0.05). These results indicate that VN leads to chronic balance problems for stance and complex gait tasks. The problems are greater for patients with high compared to low AAO-HNS scores, thereby explaining the different symptoms reported by these patients. The lack of balance recovery in VN patients to levels of HCs after 2 years contrasts with the 3 months average recovery period for acute vestibular neuritis patients and is indicative of the effects of neurectomy on central compensation processes.

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