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12-Item Multiple Sclerosis Walking Scale

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Purpose

The 12-item Multiple Sclerosis Walking Scale (MSWS-12) is a self-report measure of the impact of MS on the individual’s walking ability.

Link to Instrument

Instrument Details

Acronym MSWS-12

Area of Assessment

Gait

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Multiple Sclerosis

Key Descriptions

  • The original scoring provides options 1-5 for each item, with 1 meaning no limitation and 5 meaning extreme limitation on the gait-related item. In a version 2, three items are scored 1-3, and nine items are scored 1-5. All references below refer to version 1. In version 1, all items are scored 1 -5.
  • This instrument has been included in the gait outcome measures recommended by the consensus conference of the Consortium of Multiple Sclerosis Centers, November 2007.
  • In version 2, 3 items are scored 1 – 3, and the other 9 items are scored 1 – 5. Scores on the 12 items are summed. To transform to a 0 – 100 scale (Nilsagard et al., 2007), the minimum score of 12 is subtracted from the sum; the result is divided by 48 (for version 1) or 42 (for version 2) and then multiplied by 100.

Number of Items

12

Equipment Required

  • 12-Item Multiple Sclerosis Walking Scale
  • Pen/Pencil

Time to Administer

Less than or equal to 10 minutes

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by Diane D. Allen, PT, PhD and the MS EDGE taskforce of the Neurology Section of the APTA in July 2011.

ICF Domain

Activity

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit: http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

Abbreviations:

 

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended


Recommendations based on EDSS Classification:

  EDSS 0.0 – 3.5 EDSS 4.0 – 5.5 EDSS 6.0 – 7.5 EDSS 8.0 – 9.5
MS EDGE HR HR HR NR

Recommendations for entry-level physical therapy education and use in research:

Students should learn to administer this tool? (Y/N) Students should be exposed to tool? (Y/N) Appropriate for use in intervention research studies? (Y/N) Is additional research warranted for this tool (Y/N)  
MS EDGE Yes Yes Yes No

Considerations

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Multiple Sclerosis

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Normative Data

Healthy Adults:

(Goldman, MD et al, 2008; n = 20 healthy controls; average MSWS-12 score = 2.2 (5.6))

 

Multiple Sclerosis:

(Goldman, MD et al, 2008; n = 40 MS patients; average MSWS-12 = 28.2 (25); EDSS = 0 – 6.5)

Test/Retest Reliability

Multiple Sclerosis:

(Hobart JC et al, 2003; n = 400 people with MS in community)

  • Excellent when test was taken twice with an interval of 10 days (ICC = .94)

(Motl RW et al, 2011; n = 260 people with MS)

  • Excellent after a period of 6 months (ICC = 0.86)
  • Excellent after a periods of 12 months (ICC = 0.87)

Internal Consistency

Multiple Sclerosis:

(Hobart JC et al, 2003; n = 54 to n = 602 for MS patients)

  • Excellent in three samples of patients with MS (Cronbach’s alpha = 0.94 to 0.97)

(McGuigan C et al, 2004; n = 149 in community population; n = 53 in outpatient population with MS)

  • Excellent in community and outpatient population with MS (Cronbach’s alpha = 0.97)

Criterion Validity (Predictive/Concurrent)

Multiple Sclerosis:

Concurrent validity:

(Cavanaugh JT et al, 2011; n = 21 people with MS; EDSS = 3.5 – 7.5; MSWS-12 scores correlated with Daily Step Count, T25FW, six-minute walk test, BBS and ABC; Spearman’s rho correlation used)

  • Excellent for Daily Step Count (rho = -0.83)

  • Excellent for T25FW (rho = 0.78)

  • Excellent for six-minute walk test (rho = -0.80)

  • Excellent for BBS (rho = -0.78)

  • Excellent for ABC (rho = -0.72)

(Goldman, MD et al, 2008; n = 40 people with MS; EDSS = 0 – 6.5; Spearmans’ rho used for correlation)

  • Excellent for EDSS (rho = 0.69)
  • Excellent for MSFC (rho = 0.67)
  • Excellent for 6 – minute walk (rho = 0.81)

(Hobart JC et al, 2003; = 54 for EDSS; n = 78 patients for physical functioning scale of the SF-36; = 602 community people for the physical portion of the MSIS-29; = 54 patients with the T25FW; Pearson’s r for correlation used)

  • Excellent for EDSS (= 0.65)
  • Excellent for SF-36 (= -0.79)
  • Excellent for MSIS-29 (= 0.79)
  • Adequate for T25FW (r = 0.46)

(McGuigan C et al, 2004; = 54 for EDSS; n = 78 patients for physical functioning scale of the SF-36; = 602 community people for the physical portion of the MSIS-29; n = 54 patients with the T25FW; Spearman’s rho for correlation used)

  • Excellent for EDSS (rho = 0.73 to 0.84
  • Excellent for MSIS-29 (rho = 0.80 to 0.87)
  • Excellent for T25FW in community and outpatient MS groups (rho = 0.65)

(Motl RW et al, 2008; n = 133 people with MS; Spearman’s rho for correlation of the MSWS-12 with accelerometer counts over a 7-day period was 0.68)

  • Excellent for MSIS-29 physical (rho = 0.78)
  • Adequate for MSIS-29 psychological (rho = 0.36)

(Motl RW et al, 2010; n = 24 people with MS; Pearson’s r showed a correlation of the MSWS-12 with oxygen cost (ml/kg/meter) but not for oxygen consumption (ml/kg/minute) for the six-minute walk test)

  • Excellent for comfortable walking speed (= 0.64)
  • Excellent for fast walking speed (= 0.62)

(Nilsagard Y et al, 2007; n = 81 people with MS; EDSS 3.5 – 6.0; Kendall tau coefficient used for correlation)

  • Adequate for Berg Balance Scale (Kendall tau coefficient = -0.37)
  • Adequate for Four Square Step Test (Kendall tau coefficient = 0.34)
  • Adequate for Timed Up and Go Cognitive (Kendall tau coefficient = 0.32)

(Sosnoff JJ et al, 2011; n = 13 people with MS; Spearman rho correlation between MSWS-12 and gait velocity as measured by an instrumented gait mat)

  • Adequate (rho = -0.50)

Predictive validity:

(Nilsagard Y et al, 2009; n = 76 people with MS; EDSS = 3.5 – 6.0; people who recorded at least one fall in the 3 month data collection period had an average of 75 on the MSWS-12 compared to 58 in non-fallers; OR = 1.03, Cl 95% 1.01 – 1.05)

Floor/Ceiling Effects

Multiple Sclerosis:

Floor Effects:

(Hobart JC et al, 2003; n = 602 people in community with MS; n = 54 with MS undergoing steroidal treatment)

  • Adequate for 13.0% of MS people in community at minimum possible score.
  • Adequate for 18.5% with steroidal treatment at minimum possible score.

 

Ceiling Effects:

(Hobart JC et al, 2003; n = 602 people in community with MS; n = 54 with MS undergoing steroidal treatment)

  • Adequate with 4.7% with maximum possible score for people with MS in community.
  • Excellent with 0% with maximum possible score undergoing steroidal treatment.

Responsiveness

Multiple Sclerosis:

(Hobart JC et al, 2003; n = 53 patients with MS undergoing steroid treatment compared to EDSS and T25FW)

  • Large change of effect size = 0.93 for MS steroid treatment.
  • Moderate change of effect size = 0.45 for EDSS.
  • Moderate change of effect size = 0.36 for T25FW.

(McGuigan C et al, 2004; the MSWS-12 changed more (mean = 19.3) in people who had a change of greater than or equal to 1 in EDSS scores than people who had no change in EDSS score in a 6 – 24 month period)

(Nilsagard et al, 2009; n = 76 with MS; EDSS = 3.5 to 6.0; A cut-off of greater than or equal to 75 had a sensitivity of 52 and a specificity of 82 in predicting fallers vs. non-fallers.

(Riazi A et al, 2004; n = 43 patients receiving rehabilitation for MS; n = 46 patients receiving steroid treatment)

  • Large change with effect size = 0.89 for MSWS-12 rehabilitation.
  • Large change with effect size = 0.85 for MSWS-12 steroid treatment.

Bibliography

 

Cavanaugh, J. T., Gappmaier, V. O., et al. (2011). "Ambulatory activity in individuals with multiple sclerosis." J Neurol Phys Ther 35(21475081): 26-33.

Filiatrault, J., Gauvin, L., et al. (2007). "Evidence of the psychometric qualities of a simplified version of the Activities-specific Balance Confidence scale for community-dwelling seniors." Arch Phys Med Rehabil 88(5): 664-672. Find it on PubMed

Goldman, M. D., Marrie, R. A., et al. (2008). "Evaluation of the six-minute walk in multiple sclerosis subjects and healthy controls." Mult Scler 14(17942508): 383-390.

Hobart, J. C., Riazi, A., et al. (2003). "Measuring the impact of MS on walking ability: the 12-Item MS Walking Scale (MSWS-12)." Neurology 60(12525714): 31-36.

Hutchinson, B., Forwell, S. J., et al. (2009). "Toward a consensus on rehabilitation outcomes in MS: gait and fatigue." International Journal of MS Care 11(2): 67-78.

McGuigan, C. and Hutchinson, M. (2004). "Confirming the validity and responsiveness of the Multiple Sclerosis Walking Scale-12 (MSWS-12)." Neurology 62(15184625): 2103-2105.

Motl, R. W., Dlugonski, D., et al. (2010). "Multiple Sclerosis Walking Scale-12 and oxygen cost of walking." Gait Posture 31(20226676): 506-510.

Motl, R. W., McAuley, E., et al. (2011). "Longitudinal measurement invariance of the Multiple Sclerosis Walking Scale-12." J Neurol Sci 305(21474149): 75-79.

Motl, R. W. and Snook, E. M. (2008). "Confirmation and extension of the validity of the Multiple Sclerosis Walking Scale-12 (MSWS-12)." J Neurol Sci 268(18061618): 69-73.

Nilsagård, Y., Gunnarsson, L. G., et al. (2007). "Self-perceived limitations of gait in persons with multiple sclerosis." Advances in Physiotherapy 9(3): 136-143.

Nilsagard, Y., Lundholm, C., et al. (2009). "Predicting accidental falls in people with multiple sclerosis -- a longitudinal study." Clin Rehabil 23(3): 259-269. Find it on PubMed

Riazi, A., Thompson, A. J., et al. (2004). "Self-efficacy predicts self-reported health status in multiple sclerosis." Mult Scler 10(14760954): 61-66.

Sosnoff, J. J., Weikert, M., et al. (2011). "Quantifying gait impairment in multiple sclerosis using GAITRite technology." Gait Posture 34(21531562): 145-147.

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