BACKGROUND: The 12-item Multiple Sclerosis Walking Scale (MSWS-12) is currently the most widely validated, patient-reported outcome measure assessing patients' perception of the impact of multiple sclerosis (MS) on walking ability. To date, the majority of previous studies investigating the MSWS-12 have focused on the total score despite individual items being potentially informative. Therefore, our objective was to examine the associations between the individual items of the MSWS-12 and mobility and whether these associations depend on disability level. METHODS: Participants completed the MSWS-12, Two-Minute Walk Test (2MWT), Timed 25-Foot Walk (T25FW), Timed Up and Go Test (TUG) and the Four Square Step Test (FSST). Subsequently, they were divided into two groups according to their disability level, classified as either "mildly" or "moderately-severely" disabled. The correlation between individual items of the MSWS-12 and clinical measures of mobility were separately examined by Spearman's correlation coefficients; linear regression analyses were performed for each disability group, with/without adjusting for cognition, age and gender. RESULTS: 242 people with MS (PwMS), 108 mildly and 134 moderately-severely disabled, were included. Stronger correlations between the MSWS-12 items and mobility tests were found in the mildly disabled compared to the moderately-severely disabled group. The linear regression analysis showed that in the mildly disabled, item 9 (use of support outdoors) explained 35.4%, 30.8%, and 23.7% of the variance related to the 2MWT, T25FW and TUG, respectively. As for the moderately-severely disabled, the linear regression analysis presented a model which included item 8 (use of support indoors), explaining 31.6%, 18.0%, 20.2% and 9.5% of the variance related to the 2MWT, T25FWT, TUG and FSST, respectively. CONCLUSIONS: Items 8 and 9 of the MSWS-12 focusing on the patient's use of walking support in and outdoors, provide a robust indicator of mobility capabilities for mildly and moderately-severely disabled PwMS.

Association of Multiple Sclerosis of Biscay Bilbao Spain

Clinic of Physical Medicine and Rehabilitation Clinical Center of Serbia Faculty of Medicine University of Belgrade Belgrade Serbia

Department of Neurology Clinic for Rehabilitation Münster Münster Austria; Karl Landsteiner Institut für Interdisziplinäre Forschung am Reha Zentrum Münster Münster Austria

Department of Physical Therapy School of Health Professions Sackler Faculty of Medicine and Sagol School of Neuroscience Tel Aviv University Tel Aviv Israel; Multiple Sclerosis Center Sheba Medical Center Tel Hashomer Israel

Department of Rehabilitation 3rd Faculty of Medicine Charles University Prague Czech Republic

John Paul 2 Rehabilitation Centre for People with Multiple Sclerosis Borne Sulinowo Poland

LaRiCE Lab Gait and Balance Disorders Laboratory Don Gnocchi Foundation 1 R C C S Milan Italy

Multiple Sclerosis Center Hakadal AS Norway

Neurological Rehabilitation Centre Quellenhof Sana AG Germany

Norwegian Multiple Sclerosis Competence Centre Department of Neurology and Department of Physiotherapy Haukeland University Hospital Bergen Norway

Rehabilitation and MS Centre Overpelt Belgium

REVAL Rehabilitation Research Center BIOMED Biomedical Research Institute Faculty of Medicine and Life Sciences Hasselt University Diepenbeek Belgium

REVAL Rehabilitation Research Center Faculty of Rehabilitation Sciences Hasselt University Hasselt Belgium

School of Medicine University of Colorado Anschutz Medical Campus United States

Scientific Research Area Italian Multiple Sclerosis Foundation Genoa Italy

The Research Unit in Exercise Biology Department of Public Health Aarhus University Aarhus Denmark

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