Balance and Gait Impairment in Persons with Multiple Sclerosis with the Absence of Clinical Disability

Hatice Ayan; Özge Ertekin; Turhan Kahraman; Serkan Özakbaş

doi:10.4274/tnd.2020.36036

Hatice Ayan¹, Özge Ertekin², Turhan Kahraman³, Serkan Özakbaş⁴

¹Izmir University of Economics Vocational School of Health Services, Department of Physiotherapy, Dokuz Eylul University, Institute of Health Sciences, Izmir, Turkey
²Dokuz Eylul University School of Physical Therapy and Rehabilitation, Izmir, Turkey
³Izmir Katip Celebi University Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Izmir, Turkey
⁴Dokuz Eylul University Faculty of Medicine, Department of Neurology, Izmir, Turkey

Keywords: Multiple sclerosis, balance, gait, disability

Abstract

Objective: Impaired balance is one of the most important risk factors for falls in persons with multiple sclerosis (pwMS). The aim was to evaluate balance and gait performance in pwMS with the absence of clinical disability (pwMS-AD) compared with pwMS with minimal disability (MD) and healthy controls (HC).

Materials and Methods: Nineteen pwMS-AD were assessed using the Expanded Disability Status scale (EDSS) score ≤1.5, 16 pwMS-MD (2.0≤ EDSS ≤3.0), and 39 HC were assessed using a posturography. Limits of stability (LOS), postural stability (PS) and fall risk index tests were performed. The Brief-Balance Evaluation Systems Test (Brief-BESTest), Activities-Specific Balance Confidence (ABC) scale, timed 25 foot walk test (T25FW) and 12-Item MS walking scale (MSWS-12) were used.

Results: Significant differences were observed between pwMS-AD and pwMS-MD in terms of PS (overall, anteroposterior, mediolateral), Brief-BESTest, T25FW, and MSWS-12 (p<0.05). The stability limits (overall, forward LOS score) of the pwMS-AD group decreased significantly compared with the HC (p<0.05). There was also a significant difference in mediolateral PS, fall risk, Brief-BESTest and T25FW scores (p<0.05), but no significant difference was found in the ABC scale score (p=0.543) between pwMS-AD and HC.

Conclusion: The results showed that pwMS with the absence of clinical disability had better balance and gait performance than pwMS with minimal disability, but compared with HC, pwMS-AD have impaired balance and gait performance; however, subjective confidence in balance is not significantly different. PwMSAD should be assessed regularly for the early detection of impaired balance and fall risk, even if there are no reported problems related to balance and gait.