BACKGROUND: Evaluation of treatment effects on walking requires appropriate and responsive outcome measures. OBJECTIVES: To determine responsiveness of 5 walking measures and provide reference values for clinically meaningful improvements, according to disability level, in persons with multiple sclerosis (pwMS). METHODS: Walking tests were measured pre- and postrehabilitation in 290 pwMS from 17 European centers. Combined anchor- and distribution-based methods determined responsiveness of objective short and long walking capacity tests (Timed 25-Foot Walk [T25FW] and 2- and 6-Minute Walk Tests [2MWT and 6MWT] and of the patient-reported Multiple Sclerosis Walking Scale-12 [MSWS-12]). A global rating of change scale, from patients' and therapists' perspective, was used as external criteria to determine the area under the receiver operating characteristic curve (AUC), minimally important change (MIC), and smallest real change (SRC). Patients were stratified into disability subgroups (Expanded Disability Status Scale score ≤4 [n = 98], >4 [n = 186]). RESULTS: MSWS-12, 2MWT, and 6MWT were more responsive (AUC 0.64-0.73) than T25FW (0.50-0.63), especially in moderate to severely disabled pwMS. Clinically meaningful changes (MICs) from patient and therapist perspective were -10.4 and -11.4 for MSWS-12 (P < .01), 9.6 m and 6.8 m for 2MWT (P < .05), and 21.6 m (P < .05) and 9.1 m (P = .3) for 6MWT. In subgroups, MIC was significant from patient perspective for 2MWT (10.8 m) and from therapist perspective for MSWS-12 (-10.7) in mildly disabled pwMS. In moderate to severely disabled pwMS, MIC was significant for MSWS-12 (-14.1 and -11.9). CONCLUSIONS: Long walking tests and patient-reported MSWS-12 were more appropriate than short walking tests in detecting clinically meaningful improvement after physical rehabilitation, particularly the MSWS-12 for moderate to severely disabled pwMS.

Aarhus University Aarhus Denmark

Centre Neurologique et de Réadaptation Fonctionelle Fraiture en Condroz Belgium

Charles University Prague Czech Republic

Eugenia Epalza Rehabilitation Center Bilbao Spain

Hasselt University Diepenbeek Belgium

Haukeland University Hospital Bergen Norway

Helsinki MS Neuvola Helsinki Finland

Hospital de Dia de Barcelona CEMCat Barcelona Spain

Kongsgaarden Physiotherapy AS Nordland Hospital Trust Bodø Norway

Masku Neurological Rehabilitation Center Masku Finland

Multiple Sclerosis Center Hakadal AS Norway

Multiple Sclerosis Hospital Haslev Denmark Multiple Sclerosis Hospital Ry Denmark

National Multiple Sclerosis Center Melsbroek Belgium

Plymouth University Plymouth UK

Poole Hospital NHS Foundation Trust Dorset UK

Rehabilitation and Multiple Sclerosis Center Overpelt Belgium

Sheba Medical Center Tel Hashomer Israel

University Medical Center Ljubljana Slovenia

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Real-World Goal Setting and Use of Outcome Measures According to the International Classification of Functioning, Disability and Health: A European Survey of Physical Therapy Practice in Multiple Sclerosis