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November 13, 2018; 91 (20) Article

Responsiveness and meaningful improvement of mobility measures following MS rehabilitation

Ilse Baert, Tori Smedal, Alon Kalron, Kamila Rasova, Adnan Heric-Mansrud, Rainer Ehling, Iratxe Elorriaga Minguez, Una Nedeljkovic, Andrea Tacchino, Peter Hellinckx, Greet Adriaenssens, Gosia Stachowiak, Klaus Gusowski, Davide Cattaneo, Sophie Borgers, Jeffrey Hebert, Ulrik Dalgas, Peter Feys
First published October 17, 2018, DOI: https://doi.org/10.1212/WNL.0000000000006532
Ilse Baert
From the REVAL Rehabilitation Research Center (I.B., P.F.), BIOMED Biomedical Research Institute, Faculty of Medicine & Life Sciences, Hasselt University, Belgium; Haukeland University Hospital (Norwegian MS Competence Centre and Department of Physiotherapy) (T.S.), Bergen, Norway; Department of Physical Therapy (A.K.), Sackler Faculty of Medicine, Tel-Aviv University; Multiple Sclerosis Center (A.K.), Sheba Medical Center, Tel-Hashomer, Israel; Department of Rehabilitation, Third Faculty of Medicine (K.R.), Charles University and Faculty Hospital Royal Vineyards, Prague, Czech Republic; Multiple Sclerosis Center (A.H.-M.), Hakadal AS, Norway; Department of Neurology (R.E.), Clinic for Rehabilitation Münster, Austria; Eugenia Epalza Rehabilitation Center (I.E.M.), Bilbao, Spain; Clinical Center in Belgrado (U.N.), Serbia; Italian Multiple Sclerosis Foundation (FISM) (A.T.), Scientific Research Area, Genoa, Italy; National MS Center (P.H.), Melsbroek; AZ Klina (G.A.), Campus De Mick, Rehabilitation, Brasschaat, Belgium; John Paul II Rehabilitation Centre for People with Multiple Sclerosis (G.S.), Borne Sulinowo, Poland; Neurological Rehabilitation Centre Quellenhof (K.G.), Sana AG, Germany; IRCSS Fondazione Don Carlo Gnocchi (D.C.), Milan, Italy; Rehabilitation and MS Center Overpelt (S.B.), Belgium; University of Colorado–Anschutz Medical Campus (J.H.); and Section of Sport Science (U.D.), Department Public Health, Aarhus University, Denmark.
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Tori Smedal
From the REVAL Rehabilitation Research Center (I.B., P.F.), BIOMED Biomedical Research Institute, Faculty of Medicine & Life Sciences, Hasselt University, Belgium; Haukeland University Hospital (Norwegian MS Competence Centre and Department of Physiotherapy) (T.S.), Bergen, Norway; Department of Physical Therapy (A.K.), Sackler Faculty of Medicine, Tel-Aviv University; Multiple Sclerosis Center (A.K.), Sheba Medical Center, Tel-Hashomer, Israel; Department of Rehabilitation, Third Faculty of Medicine (K.R.), Charles University and Faculty Hospital Royal Vineyards, Prague, Czech Republic; Multiple Sclerosis Center (A.H.-M.), Hakadal AS, Norway; Department of Neurology (R.E.), Clinic for Rehabilitation Münster, Austria; Eugenia Epalza Rehabilitation Center (I.E.M.), Bilbao, Spain; Clinical Center in Belgrado (U.N.), Serbia; Italian Multiple Sclerosis Foundation (FISM) (A.T.), Scientific Research Area, Genoa, Italy; National MS Center (P.H.), Melsbroek; AZ Klina (G.A.), Campus De Mick, Rehabilitation, Brasschaat, Belgium; John Paul II Rehabilitation Centre for People with Multiple Sclerosis (G.S.), Borne Sulinowo, Poland; Neurological Rehabilitation Centre Quellenhof (K.G.), Sana AG, Germany; IRCSS Fondazione Don Carlo Gnocchi (D.C.), Milan, Italy; Rehabilitation and MS Center Overpelt (S.B.), Belgium; University of Colorado–Anschutz Medical Campus (J.H.); and Section of Sport Science (U.D.), Department Public Health, Aarhus University, Denmark.
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Alon Kalron
From the REVAL Rehabilitation Research Center (I.B., P.F.), BIOMED Biomedical Research Institute, Faculty of Medicine & Life Sciences, Hasselt University, Belgium; Haukeland University Hospital (Norwegian MS Competence Centre and Department of Physiotherapy) (T.S.), Bergen, Norway; Department of Physical Therapy (A.K.), Sackler Faculty of Medicine, Tel-Aviv University; Multiple Sclerosis Center (A.K.), Sheba Medical Center, Tel-Hashomer, Israel; Department of Rehabilitation, Third Faculty of Medicine (K.R.), Charles University and Faculty Hospital Royal Vineyards, Prague, Czech Republic; Multiple Sclerosis Center (A.H.-M.), Hakadal AS, Norway; Department of Neurology (R.E.), Clinic for Rehabilitation Münster, Austria; Eugenia Epalza Rehabilitation Center (I.E.M.), Bilbao, Spain; Clinical Center in Belgrado (U.N.), Serbia; Italian Multiple Sclerosis Foundation (FISM) (A.T.), Scientific Research Area, Genoa, Italy; National MS Center (P.H.), Melsbroek; AZ Klina (G.A.), Campus De Mick, Rehabilitation, Brasschaat, Belgium; John Paul II Rehabilitation Centre for People with Multiple Sclerosis (G.S.), Borne Sulinowo, Poland; Neurological Rehabilitation Centre Quellenhof (K.G.), Sana AG, Germany; IRCSS Fondazione Don Carlo Gnocchi (D.C.), Milan, Italy; Rehabilitation and MS Center Overpelt (S.B.), Belgium; University of Colorado–Anschutz Medical Campus (J.H.); and Section of Sport Science (U.D.), Department Public Health, Aarhus University, Denmark.
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Kamila Rasova
From the REVAL Rehabilitation Research Center (I.B., P.F.), BIOMED Biomedical Research Institute, Faculty of Medicine & Life Sciences, Hasselt University, Belgium; Haukeland University Hospital (Norwegian MS Competence Centre and Department of Physiotherapy) (T.S.), Bergen, Norway; Department of Physical Therapy (A.K.), Sackler Faculty of Medicine, Tel-Aviv University; Multiple Sclerosis Center (A.K.), Sheba Medical Center, Tel-Hashomer, Israel; Department of Rehabilitation, Third Faculty of Medicine (K.R.), Charles University and Faculty Hospital Royal Vineyards, Prague, Czech Republic; Multiple Sclerosis Center (A.H.-M.), Hakadal AS, Norway; Department of Neurology (R.E.), Clinic for Rehabilitation Münster, Austria; Eugenia Epalza Rehabilitation Center (I.E.M.), Bilbao, Spain; Clinical Center in Belgrado (U.N.), Serbia; Italian Multiple Sclerosis Foundation (FISM) (A.T.), Scientific Research Area, Genoa, Italy; National MS Center (P.H.), Melsbroek; AZ Klina (G.A.), Campus De Mick, Rehabilitation, Brasschaat, Belgium; John Paul II Rehabilitation Centre for People with Multiple Sclerosis (G.S.), Borne Sulinowo, Poland; Neurological Rehabilitation Centre Quellenhof (K.G.), Sana AG, Germany; IRCSS Fondazione Don Carlo Gnocchi (D.C.), Milan, Italy; Rehabilitation and MS Center Overpelt (S.B.), Belgium; University of Colorado–Anschutz Medical Campus (J.H.); and Section of Sport Science (U.D.), Department Public Health, Aarhus University, Denmark.
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Adnan Heric-Mansrud
From the REVAL Rehabilitation Research Center (I.B., P.F.), BIOMED Biomedical Research Institute, Faculty of Medicine & Life Sciences, Hasselt University, Belgium; Haukeland University Hospital (Norwegian MS Competence Centre and Department of Physiotherapy) (T.S.), Bergen, Norway; Department of Physical Therapy (A.K.), Sackler Faculty of Medicine, Tel-Aviv University; Multiple Sclerosis Center (A.K.), Sheba Medical Center, Tel-Hashomer, Israel; Department of Rehabilitation, Third Faculty of Medicine (K.R.), Charles University and Faculty Hospital Royal Vineyards, Prague, Czech Republic; Multiple Sclerosis Center (A.H.-M.), Hakadal AS, Norway; Department of Neurology (R.E.), Clinic for Rehabilitation Münster, Austria; Eugenia Epalza Rehabilitation Center (I.E.M.), Bilbao, Spain; Clinical Center in Belgrado (U.N.), Serbia; Italian Multiple Sclerosis Foundation (FISM) (A.T.), Scientific Research Area, Genoa, Italy; National MS Center (P.H.), Melsbroek; AZ Klina (G.A.), Campus De Mick, Rehabilitation, Brasschaat, Belgium; John Paul II Rehabilitation Centre for People with Multiple Sclerosis (G.S.), Borne Sulinowo, Poland; Neurological Rehabilitation Centre Quellenhof (K.G.), Sana AG, Germany; IRCSS Fondazione Don Carlo Gnocchi (D.C.), Milan, Italy; Rehabilitation and MS Center Overpelt (S.B.), Belgium; University of Colorado–Anschutz Medical Campus (J.H.); and Section of Sport Science (U.D.), Department Public Health, Aarhus University, Denmark.
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Rainer Ehling
From the REVAL Rehabilitation Research Center (I.B., P.F.), BIOMED Biomedical Research Institute, Faculty of Medicine & Life Sciences, Hasselt University, Belgium; Haukeland University Hospital (Norwegian MS Competence Centre and Department of Physiotherapy) (T.S.), Bergen, Norway; Department of Physical Therapy (A.K.), Sackler Faculty of Medicine, Tel-Aviv University; Multiple Sclerosis Center (A.K.), Sheba Medical Center, Tel-Hashomer, Israel; Department of Rehabilitation, Third Faculty of Medicine (K.R.), Charles University and Faculty Hospital Royal Vineyards, Prague, Czech Republic; Multiple Sclerosis Center (A.H.-M.), Hakadal AS, Norway; Department of Neurology (R.E.), Clinic for Rehabilitation Münster, Austria; Eugenia Epalza Rehabilitation Center (I.E.M.), Bilbao, Spain; Clinical Center in Belgrado (U.N.), Serbia; Italian Multiple Sclerosis Foundation (FISM) (A.T.), Scientific Research Area, Genoa, Italy; National MS Center (P.H.), Melsbroek; AZ Klina (G.A.), Campus De Mick, Rehabilitation, Brasschaat, Belgium; John Paul II Rehabilitation Centre for People with Multiple Sclerosis (G.S.), Borne Sulinowo, Poland; Neurological Rehabilitation Centre Quellenhof (K.G.), Sana AG, Germany; IRCSS Fondazione Don Carlo Gnocchi (D.C.), Milan, Italy; Rehabilitation and MS Center Overpelt (S.B.), Belgium; University of Colorado–Anschutz Medical Campus (J.H.); and Section of Sport Science (U.D.), Department Public Health, Aarhus University, Denmark.
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Iratxe Elorriaga Minguez
From the REVAL Rehabilitation Research Center (I.B., P.F.), BIOMED Biomedical Research Institute, Faculty of Medicine & Life Sciences, Hasselt University, Belgium; Haukeland University Hospital (Norwegian MS Competence Centre and Department of Physiotherapy) (T.S.), Bergen, Norway; Department of Physical Therapy (A.K.), Sackler Faculty of Medicine, Tel-Aviv University; Multiple Sclerosis Center (A.K.), Sheba Medical Center, Tel-Hashomer, Israel; Department of Rehabilitation, Third Faculty of Medicine (K.R.), Charles University and Faculty Hospital Royal Vineyards, Prague, Czech Republic; Multiple Sclerosis Center (A.H.-M.), Hakadal AS, Norway; Department of Neurology (R.E.), Clinic for Rehabilitation Münster, Austria; Eugenia Epalza Rehabilitation Center (I.E.M.), Bilbao, Spain; Clinical Center in Belgrado (U.N.), Serbia; Italian Multiple Sclerosis Foundation (FISM) (A.T.), Scientific Research Area, Genoa, Italy; National MS Center (P.H.), Melsbroek; AZ Klina (G.A.), Campus De Mick, Rehabilitation, Brasschaat, Belgium; John Paul II Rehabilitation Centre for People with Multiple Sclerosis (G.S.), Borne Sulinowo, Poland; Neurological Rehabilitation Centre Quellenhof (K.G.), Sana AG, Germany; IRCSS Fondazione Don Carlo Gnocchi (D.C.), Milan, Italy; Rehabilitation and MS Center Overpelt (S.B.), Belgium; University of Colorado–Anschutz Medical Campus (J.H.); and Section of Sport Science (U.D.), Department Public Health, Aarhus University, Denmark.
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Una Nedeljkovic
From the REVAL Rehabilitation Research Center (I.B., P.F.), BIOMED Biomedical Research Institute, Faculty of Medicine & Life Sciences, Hasselt University, Belgium; Haukeland University Hospital (Norwegian MS Competence Centre and Department of Physiotherapy) (T.S.), Bergen, Norway; Department of Physical Therapy (A.K.), Sackler Faculty of Medicine, Tel-Aviv University; Multiple Sclerosis Center (A.K.), Sheba Medical Center, Tel-Hashomer, Israel; Department of Rehabilitation, Third Faculty of Medicine (K.R.), Charles University and Faculty Hospital Royal Vineyards, Prague, Czech Republic; Multiple Sclerosis Center (A.H.-M.), Hakadal AS, Norway; Department of Neurology (R.E.), Clinic for Rehabilitation Münster, Austria; Eugenia Epalza Rehabilitation Center (I.E.M.), Bilbao, Spain; Clinical Center in Belgrado (U.N.), Serbia; Italian Multiple Sclerosis Foundation (FISM) (A.T.), Scientific Research Area, Genoa, Italy; National MS Center (P.H.), Melsbroek; AZ Klina (G.A.), Campus De Mick, Rehabilitation, Brasschaat, Belgium; John Paul II Rehabilitation Centre for People with Multiple Sclerosis (G.S.), Borne Sulinowo, Poland; Neurological Rehabilitation Centre Quellenhof (K.G.), Sana AG, Germany; IRCSS Fondazione Don Carlo Gnocchi (D.C.), Milan, Italy; Rehabilitation and MS Center Overpelt (S.B.), Belgium; University of Colorado–Anschutz Medical Campus (J.H.); and Section of Sport Science (U.D.), Department Public Health, Aarhus University, Denmark.
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Andrea Tacchino
From the REVAL Rehabilitation Research Center (I.B., P.F.), BIOMED Biomedical Research Institute, Faculty of Medicine & Life Sciences, Hasselt University, Belgium; Haukeland University Hospital (Norwegian MS Competence Centre and Department of Physiotherapy) (T.S.), Bergen, Norway; Department of Physical Therapy (A.K.), Sackler Faculty of Medicine, Tel-Aviv University; Multiple Sclerosis Center (A.K.), Sheba Medical Center, Tel-Hashomer, Israel; Department of Rehabilitation, Third Faculty of Medicine (K.R.), Charles University and Faculty Hospital Royal Vineyards, Prague, Czech Republic; Multiple Sclerosis Center (A.H.-M.), Hakadal AS, Norway; Department of Neurology (R.E.), Clinic for Rehabilitation Münster, Austria; Eugenia Epalza Rehabilitation Center (I.E.M.), Bilbao, Spain; Clinical Center in Belgrado (U.N.), Serbia; Italian Multiple Sclerosis Foundation (FISM) (A.T.), Scientific Research Area, Genoa, Italy; National MS Center (P.H.), Melsbroek; AZ Klina (G.A.), Campus De Mick, Rehabilitation, Brasschaat, Belgium; John Paul II Rehabilitation Centre for People with Multiple Sclerosis (G.S.), Borne Sulinowo, Poland; Neurological Rehabilitation Centre Quellenhof (K.G.), Sana AG, Germany; IRCSS Fondazione Don Carlo Gnocchi (D.C.), Milan, Italy; Rehabilitation and MS Center Overpelt (S.B.), Belgium; University of Colorado–Anschutz Medical Campus (J.H.); and Section of Sport Science (U.D.), Department Public Health, Aarhus University, Denmark.
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Peter Hellinckx
From the REVAL Rehabilitation Research Center (I.B., P.F.), BIOMED Biomedical Research Institute, Faculty of Medicine & Life Sciences, Hasselt University, Belgium; Haukeland University Hospital (Norwegian MS Competence Centre and Department of Physiotherapy) (T.S.), Bergen, Norway; Department of Physical Therapy (A.K.), Sackler Faculty of Medicine, Tel-Aviv University; Multiple Sclerosis Center (A.K.), Sheba Medical Center, Tel-Hashomer, Israel; Department of Rehabilitation, Third Faculty of Medicine (K.R.), Charles University and Faculty Hospital Royal Vineyards, Prague, Czech Republic; Multiple Sclerosis Center (A.H.-M.), Hakadal AS, Norway; Department of Neurology (R.E.), Clinic for Rehabilitation Münster, Austria; Eugenia Epalza Rehabilitation Center (I.E.M.), Bilbao, Spain; Clinical Center in Belgrado (U.N.), Serbia; Italian Multiple Sclerosis Foundation (FISM) (A.T.), Scientific Research Area, Genoa, Italy; National MS Center (P.H.), Melsbroek; AZ Klina (G.A.), Campus De Mick, Rehabilitation, Brasschaat, Belgium; John Paul II Rehabilitation Centre for People with Multiple Sclerosis (G.S.), Borne Sulinowo, Poland; Neurological Rehabilitation Centre Quellenhof (K.G.), Sana AG, Germany; IRCSS Fondazione Don Carlo Gnocchi (D.C.), Milan, Italy; Rehabilitation and MS Center Overpelt (S.B.), Belgium; University of Colorado–Anschutz Medical Campus (J.H.); and Section of Sport Science (U.D.), Department Public Health, Aarhus University, Denmark.
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Greet Adriaenssens
From the REVAL Rehabilitation Research Center (I.B., P.F.), BIOMED Biomedical Research Institute, Faculty of Medicine & Life Sciences, Hasselt University, Belgium; Haukeland University Hospital (Norwegian MS Competence Centre and Department of Physiotherapy) (T.S.), Bergen, Norway; Department of Physical Therapy (A.K.), Sackler Faculty of Medicine, Tel-Aviv University; Multiple Sclerosis Center (A.K.), Sheba Medical Center, Tel-Hashomer, Israel; Department of Rehabilitation, Third Faculty of Medicine (K.R.), Charles University and Faculty Hospital Royal Vineyards, Prague, Czech Republic; Multiple Sclerosis Center (A.H.-M.), Hakadal AS, Norway; Department of Neurology (R.E.), Clinic for Rehabilitation Münster, Austria; Eugenia Epalza Rehabilitation Center (I.E.M.), Bilbao, Spain; Clinical Center in Belgrado (U.N.), Serbia; Italian Multiple Sclerosis Foundation (FISM) (A.T.), Scientific Research Area, Genoa, Italy; National MS Center (P.H.), Melsbroek; AZ Klina (G.A.), Campus De Mick, Rehabilitation, Brasschaat, Belgium; John Paul II Rehabilitation Centre for People with Multiple Sclerosis (G.S.), Borne Sulinowo, Poland; Neurological Rehabilitation Centre Quellenhof (K.G.), Sana AG, Germany; IRCSS Fondazione Don Carlo Gnocchi (D.C.), Milan, Italy; Rehabilitation and MS Center Overpelt (S.B.), Belgium; University of Colorado–Anschutz Medical Campus (J.H.); and Section of Sport Science (U.D.), Department Public Health, Aarhus University, Denmark.
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Gosia Stachowiak
From the REVAL Rehabilitation Research Center (I.B., P.F.), BIOMED Biomedical Research Institute, Faculty of Medicine & Life Sciences, Hasselt University, Belgium; Haukeland University Hospital (Norwegian MS Competence Centre and Department of Physiotherapy) (T.S.), Bergen, Norway; Department of Physical Therapy (A.K.), Sackler Faculty of Medicine, Tel-Aviv University; Multiple Sclerosis Center (A.K.), Sheba Medical Center, Tel-Hashomer, Israel; Department of Rehabilitation, Third Faculty of Medicine (K.R.), Charles University and Faculty Hospital Royal Vineyards, Prague, Czech Republic; Multiple Sclerosis Center (A.H.-M.), Hakadal AS, Norway; Department of Neurology (R.E.), Clinic for Rehabilitation Münster, Austria; Eugenia Epalza Rehabilitation Center (I.E.M.), Bilbao, Spain; Clinical Center in Belgrado (U.N.), Serbia; Italian Multiple Sclerosis Foundation (FISM) (A.T.), Scientific Research Area, Genoa, Italy; National MS Center (P.H.), Melsbroek; AZ Klina (G.A.), Campus De Mick, Rehabilitation, Brasschaat, Belgium; John Paul II Rehabilitation Centre for People with Multiple Sclerosis (G.S.), Borne Sulinowo, Poland; Neurological Rehabilitation Centre Quellenhof (K.G.), Sana AG, Germany; IRCSS Fondazione Don Carlo Gnocchi (D.C.), Milan, Italy; Rehabilitation and MS Center Overpelt (S.B.), Belgium; University of Colorado–Anschutz Medical Campus (J.H.); and Section of Sport Science (U.D.), Department Public Health, Aarhus University, Denmark.
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Klaus Gusowski
From the REVAL Rehabilitation Research Center (I.B., P.F.), BIOMED Biomedical Research Institute, Faculty of Medicine & Life Sciences, Hasselt University, Belgium; Haukeland University Hospital (Norwegian MS Competence Centre and Department of Physiotherapy) (T.S.), Bergen, Norway; Department of Physical Therapy (A.K.), Sackler Faculty of Medicine, Tel-Aviv University; Multiple Sclerosis Center (A.K.), Sheba Medical Center, Tel-Hashomer, Israel; Department of Rehabilitation, Third Faculty of Medicine (K.R.), Charles University and Faculty Hospital Royal Vineyards, Prague, Czech Republic; Multiple Sclerosis Center (A.H.-M.), Hakadal AS, Norway; Department of Neurology (R.E.), Clinic for Rehabilitation Münster, Austria; Eugenia Epalza Rehabilitation Center (I.E.M.), Bilbao, Spain; Clinical Center in Belgrado (U.N.), Serbia; Italian Multiple Sclerosis Foundation (FISM) (A.T.), Scientific Research Area, Genoa, Italy; National MS Center (P.H.), Melsbroek; AZ Klina (G.A.), Campus De Mick, Rehabilitation, Brasschaat, Belgium; John Paul II Rehabilitation Centre for People with Multiple Sclerosis (G.S.), Borne Sulinowo, Poland; Neurological Rehabilitation Centre Quellenhof (K.G.), Sana AG, Germany; IRCSS Fondazione Don Carlo Gnocchi (D.C.), Milan, Italy; Rehabilitation and MS Center Overpelt (S.B.), Belgium; University of Colorado–Anschutz Medical Campus (J.H.); and Section of Sport Science (U.D.), Department Public Health, Aarhus University, Denmark.
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Davide Cattaneo
From the REVAL Rehabilitation Research Center (I.B., P.F.), BIOMED Biomedical Research Institute, Faculty of Medicine & Life Sciences, Hasselt University, Belgium; Haukeland University Hospital (Norwegian MS Competence Centre and Department of Physiotherapy) (T.S.), Bergen, Norway; Department of Physical Therapy (A.K.), Sackler Faculty of Medicine, Tel-Aviv University; Multiple Sclerosis Center (A.K.), Sheba Medical Center, Tel-Hashomer, Israel; Department of Rehabilitation, Third Faculty of Medicine (K.R.), Charles University and Faculty Hospital Royal Vineyards, Prague, Czech Republic; Multiple Sclerosis Center (A.H.-M.), Hakadal AS, Norway; Department of Neurology (R.E.), Clinic for Rehabilitation Münster, Austria; Eugenia Epalza Rehabilitation Center (I.E.M.), Bilbao, Spain; Clinical Center in Belgrado (U.N.), Serbia; Italian Multiple Sclerosis Foundation (FISM) (A.T.), Scientific Research Area, Genoa, Italy; National MS Center (P.H.), Melsbroek; AZ Klina (G.A.), Campus De Mick, Rehabilitation, Brasschaat, Belgium; John Paul II Rehabilitation Centre for People with Multiple Sclerosis (G.S.), Borne Sulinowo, Poland; Neurological Rehabilitation Centre Quellenhof (K.G.), Sana AG, Germany; IRCSS Fondazione Don Carlo Gnocchi (D.C.), Milan, Italy; Rehabilitation and MS Center Overpelt (S.B.), Belgium; University of Colorado–Anschutz Medical Campus (J.H.); and Section of Sport Science (U.D.), Department Public Health, Aarhus University, Denmark.
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Sophie Borgers
From the REVAL Rehabilitation Research Center (I.B., P.F.), BIOMED Biomedical Research Institute, Faculty of Medicine & Life Sciences, Hasselt University, Belgium; Haukeland University Hospital (Norwegian MS Competence Centre and Department of Physiotherapy) (T.S.), Bergen, Norway; Department of Physical Therapy (A.K.), Sackler Faculty of Medicine, Tel-Aviv University; Multiple Sclerosis Center (A.K.), Sheba Medical Center, Tel-Hashomer, Israel; Department of Rehabilitation, Third Faculty of Medicine (K.R.), Charles University and Faculty Hospital Royal Vineyards, Prague, Czech Republic; Multiple Sclerosis Center (A.H.-M.), Hakadal AS, Norway; Department of Neurology (R.E.), Clinic for Rehabilitation Münster, Austria; Eugenia Epalza Rehabilitation Center (I.E.M.), Bilbao, Spain; Clinical Center in Belgrado (U.N.), Serbia; Italian Multiple Sclerosis Foundation (FISM) (A.T.), Scientific Research Area, Genoa, Italy; National MS Center (P.H.), Melsbroek; AZ Klina (G.A.), Campus De Mick, Rehabilitation, Brasschaat, Belgium; John Paul II Rehabilitation Centre for People with Multiple Sclerosis (G.S.), Borne Sulinowo, Poland; Neurological Rehabilitation Centre Quellenhof (K.G.), Sana AG, Germany; IRCSS Fondazione Don Carlo Gnocchi (D.C.), Milan, Italy; Rehabilitation and MS Center Overpelt (S.B.), Belgium; University of Colorado–Anschutz Medical Campus (J.H.); and Section of Sport Science (U.D.), Department Public Health, Aarhus University, Denmark.
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Jeffrey Hebert
From the REVAL Rehabilitation Research Center (I.B., P.F.), BIOMED Biomedical Research Institute, Faculty of Medicine & Life Sciences, Hasselt University, Belgium; Haukeland University Hospital (Norwegian MS Competence Centre and Department of Physiotherapy) (T.S.), Bergen, Norway; Department of Physical Therapy (A.K.), Sackler Faculty of Medicine, Tel-Aviv University; Multiple Sclerosis Center (A.K.), Sheba Medical Center, Tel-Hashomer, Israel; Department of Rehabilitation, Third Faculty of Medicine (K.R.), Charles University and Faculty Hospital Royal Vineyards, Prague, Czech Republic; Multiple Sclerosis Center (A.H.-M.), Hakadal AS, Norway; Department of Neurology (R.E.), Clinic for Rehabilitation Münster, Austria; Eugenia Epalza Rehabilitation Center (I.E.M.), Bilbao, Spain; Clinical Center in Belgrado (U.N.), Serbia; Italian Multiple Sclerosis Foundation (FISM) (A.T.), Scientific Research Area, Genoa, Italy; National MS Center (P.H.), Melsbroek; AZ Klina (G.A.), Campus De Mick, Rehabilitation, Brasschaat, Belgium; John Paul II Rehabilitation Centre for People with Multiple Sclerosis (G.S.), Borne Sulinowo, Poland; Neurological Rehabilitation Centre Quellenhof (K.G.), Sana AG, Germany; IRCSS Fondazione Don Carlo Gnocchi (D.C.), Milan, Italy; Rehabilitation and MS Center Overpelt (S.B.), Belgium; University of Colorado–Anschutz Medical Campus (J.H.); and Section of Sport Science (U.D.), Department Public Health, Aarhus University, Denmark.
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Ulrik Dalgas
From the REVAL Rehabilitation Research Center (I.B., P.F.), BIOMED Biomedical Research Institute, Faculty of Medicine & Life Sciences, Hasselt University, Belgium; Haukeland University Hospital (Norwegian MS Competence Centre and Department of Physiotherapy) (T.S.), Bergen, Norway; Department of Physical Therapy (A.K.), Sackler Faculty of Medicine, Tel-Aviv University; Multiple Sclerosis Center (A.K.), Sheba Medical Center, Tel-Hashomer, Israel; Department of Rehabilitation, Third Faculty of Medicine (K.R.), Charles University and Faculty Hospital Royal Vineyards, Prague, Czech Republic; Multiple Sclerosis Center (A.H.-M.), Hakadal AS, Norway; Department of Neurology (R.E.), Clinic for Rehabilitation Münster, Austria; Eugenia Epalza Rehabilitation Center (I.E.M.), Bilbao, Spain; Clinical Center in Belgrado (U.N.), Serbia; Italian Multiple Sclerosis Foundation (FISM) (A.T.), Scientific Research Area, Genoa, Italy; National MS Center (P.H.), Melsbroek; AZ Klina (G.A.), Campus De Mick, Rehabilitation, Brasschaat, Belgium; John Paul II Rehabilitation Centre for People with Multiple Sclerosis (G.S.), Borne Sulinowo, Poland; Neurological Rehabilitation Centre Quellenhof (K.G.), Sana AG, Germany; IRCSS Fondazione Don Carlo Gnocchi (D.C.), Milan, Italy; Rehabilitation and MS Center Overpelt (S.B.), Belgium; University of Colorado–Anschutz Medical Campus (J.H.); and Section of Sport Science (U.D.), Department Public Health, Aarhus University, Denmark.
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Peter Feys
From the REVAL Rehabilitation Research Center (I.B., P.F.), BIOMED Biomedical Research Institute, Faculty of Medicine & Life Sciences, Hasselt University, Belgium; Haukeland University Hospital (Norwegian MS Competence Centre and Department of Physiotherapy) (T.S.), Bergen, Norway; Department of Physical Therapy (A.K.), Sackler Faculty of Medicine, Tel-Aviv University; Multiple Sclerosis Center (A.K.), Sheba Medical Center, Tel-Hashomer, Israel; Department of Rehabilitation, Third Faculty of Medicine (K.R.), Charles University and Faculty Hospital Royal Vineyards, Prague, Czech Republic; Multiple Sclerosis Center (A.H.-M.), Hakadal AS, Norway; Department of Neurology (R.E.), Clinic for Rehabilitation Münster, Austria; Eugenia Epalza Rehabilitation Center (I.E.M.), Bilbao, Spain; Clinical Center in Belgrado (U.N.), Serbia; Italian Multiple Sclerosis Foundation (FISM) (A.T.), Scientific Research Area, Genoa, Italy; National MS Center (P.H.), Melsbroek; AZ Klina (G.A.), Campus De Mick, Rehabilitation, Brasschaat, Belgium; John Paul II Rehabilitation Centre for People with Multiple Sclerosis (G.S.), Borne Sulinowo, Poland; Neurological Rehabilitation Centre Quellenhof (K.G.), Sana AG, Germany; IRCSS Fondazione Don Carlo Gnocchi (D.C.), Milan, Italy; Rehabilitation and MS Center Overpelt (S.B.), Belgium; University of Colorado–Anschutz Medical Campus (J.H.); and Section of Sport Science (U.D.), Department Public Health, Aarhus University, Denmark.
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Responsiveness and meaningful improvement of mobility measures following MS rehabilitation
Ilse Baert, Tori Smedal, Alon Kalron, Kamila Rasova, Adnan Heric-Mansrud, Rainer Ehling, Iratxe Elorriaga Minguez, Una Nedeljkovic, Andrea Tacchino, Peter Hellinckx, Greet Adriaenssens, Gosia Stachowiak, Klaus Gusowski, Davide Cattaneo, Sophie Borgers, Jeffrey Hebert, Ulrik Dalgas, Peter Feys
Neurology Nov 2018, 91 (20) e1880-e1892; DOI: 10.1212/WNL.0000000000006532

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Abstract

Objective To determine responsiveness of functional mobility measures, and provide reference values for clinically meaningful improvements, according to disability level, in persons with multiple sclerosis (pwMS) in response to physical rehabilitation.

Methods Thirteen mobility measures (clinician- and patient-reported) were assessed before and after rehabilitation in 191 pwMS from 17 international centers (European and United States). Combined anchor- and distribution-based methods were used. A global rating of change scale, from patients' and therapists' perspective, served as external criteria when determining the area under the receiver operating characteristic curve (AUC), the minimally important change (MIC), and the smallest real change (SRC). Patients were stratified into 2 subgroups based on disability level (Expanded Disability Status Scale score ≤4 [n = 72], >4 [n = 119]).

Results The Multiple Sclerosis Walking Scale–12, physical subscale of the Multiple Sclerosis Impact Scale–29 (especially for the mildly disabled pwMS), Rivermead Mobility Index, and 5-repetition sit-to-stand test (especially for the moderately to severely disabled pwMS) were the most sensitive measures in detecting improvements in mobility. Findings were determined once the AUC (95% confidence interval) was above 0.5, MIC was greater than SRC, and results were comparable from the patient and therapist perspective.

Conclusions Responsiveness, clinically meaningful improvement, and real changes of frequently used mobility measures were calculated, showing great heterogeneity, and were dependent on disability level in pwMS.

Glossary

5STS=
5-Repetition Sit-to-Stand Test;
ABC=
Activities-specific Balance Confidence Scale;
AUC=
area under the curve;
BBS=
Berg Balance Scale;
CI=
confidence interval;
DGI=
Dynamic Gait Index;
EDSS=
Expanded Disability Status Scale;
FSMC=
Fatigue Scale for Motor and Cognitive functions;
FSST=
4-Square Step Test;
GRS=
global rating of change scale;
MDC95=
minimal detectable change;
MIC=
minimally important change;
MS=
multiple sclerosis;
MSIS-29phys=
physical subscale of the Multiple Sclerosis Impact Scale–29;
MSWS-12=
Multiple Sclerosis Walking Scale–12;
PRO=
patient reported outcome;
pwMS=
people with multiple sclerosis;
RE=
relative efficiency;
RMI=
Rivermead Mobility Index;
ROC=
receiver operating characteristic;
SDMT=
Symbol Digit Modalities Test;
SEM=
standard error of measurement;
SRC=
smallest real change;
TIS-modNV=
Trunk Impairment Scale–modified Norwegian version;
TUG=
Timed Up and Go

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Received March 5, 2018.
  • Accepted in final form August 2, 2018.
  • © 2018 American Academy of Neurology
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