Research Article| Volume 379, P77-80, August 15, 2017

Self-reported maximum walking distance in persons with MS may affect the EDSS

  • Warren Berger
    University of Western Ontario (Western), London Health Sciences Centre, University Hospital, Department of Clinical Neurological Sciences, 339 Windermere Road, London, ON N5A 5A5, Canada
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  • Michael W.C. Payne
    St. Joseph's Health Care, Parkwood Institute, Physical Medicine and Rehabilitation, 550 Wellington Road, London, ON N6C 0A7, Canada
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  • Sarah A. Morrow
    Corresponding author at: London Health Sciences Center, University Hospital, Department of Clinical Neurological Sciences, LHSC-UH, 339 Windermere Road B10-006, London, ON N6A 5A5, Canada.
    University of Western Ontario (Western), London Health Sciences Centre, University Hospital, Department of Clinical Neurological Sciences, 339 Windermere Road, London, ON N5A 5A5, Canada

    St. Joseph's Health Care, Parkwood Institute, Department of Cognitive Neurology, 550 Wellington Road, London, ON N6C 0A7, Canada
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      • The EDSS is disproportionately influenced by the ability to walk.
      • Some PwMS do not accurately predict maximum walking distance.
      • In nearly half of cases, this inaccurate estimation changed EDSS score.
      • A formal walking assessment should be considered to increase the accuracy of EDSS scoring.



      In persons with MS (PwMS), the Expanded Disability Status Scale (EDSS) is used to monitor disability progression. Scores between 4.0 and 7.0 are determined by maximum walking distance. Self-estimation of this value is often employed in clinic settings.


      To examine the accuracy with which PwMS estimate their walking distance, and observe subsequent changes to the EDSS.


      This prospective cohort study recruited PwMS with previously recorded EDSS of 3.5–7.0. Participants estimated their maximum walking distance and then walked as far as they could along a pre-specified course. Each distance was converted to an EDSS score, the “estimated EDSS” and the “actual EDSS”. Chi-Square analysis was used to compare EDSS scores. Logistic regression was used to determine predictors of inaccurate estimations.


      Of the 66 PwMS in this study, 43.9% had a difference in the actual EDSS compared to the estimated EDSS. Median estimated EDSS was 4.75 (range 3.0–7.0); after walking assessment, median actual EDSS was 5.0 (range 3.0–7.0), which represented a significant difference [X2 (df 64, N = 66) = 206.9; p < 0.001]. Actual EDSS decreased in 9 PwMS (13.6%) and increased in 20 PwMS (30.3%). Logistic regression did not find any demographic/disease characteristic to be predictive of this discrepancy.


      Some PwMS do not accurately estimate maximum walking distance; only 56.1% of PwMS accurately estimated their actual EDSS.


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        • Statistics Canada
        Table 105–1300 - Neurological Conditions, by age Group and sex, Household Population Aged 0 and over.
        2010/2011 (accessed May 21, 2014)
        • Goodin D.
        The epidemiology of MS: insights into its pathogenesis.
        Handb. Clin. Neurol. 2014; 122: 231-266
        • Hohart J.
        • Lamping D.
        • Fitzpatrick R.
        • et al.
        The multiple sclerosis impact scale (MSIS - 29): a new patient based outcome measure.
        Brain. 2001; 124: 962-973
        • Larocca N.G.
        Impact of walking impairment in multiple sclerosis: perspectives of patients and care partners.
        Patient. 2011; 4: 189-201
        • Kurtzke J.F.
        Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS).
        Neurology. 1983; 33: 1444-1452
        • Stratford P.
        • Kennedy D.
        • Maly M.
        • et al.
        Quantifying self-report measures' overestimation of mobility scores postarthroplasty.
        Phys. Ther. 2010; 90: 1288-1301
        • Giantomaso T.
        • Makowksy L.
        • Ashowrth N.
        • et al.
        The validity of patient and physician estimates of walking distance.
        Clin. Rehabil. 2003; 17: 394-401
        • Duprez D.
        • De Backer T.
        • De Buyzere M.
        • et al.
        Estimation of walking distance in intermittent claudication: need for standardization.
        Eur. Heart J. 1999; 20: 641-644
      1. Wu S, Kappos L. Neurostatus, for a standardized neurological examination and assessment of Kurtzke's functional systems and expanded disability status scale in multiple sclerosis. [Computer Software] Version 1.1 Neurostatus Systesm AG, Murbacherstrasse 34, 4056 Basel, Switzerland.

        • Smith A.
        Symbol Digit Modalities Test. Manual.
        Western Psychological Services, Los Angeles1982
        • Honarmand K.
        • Feinstein A.
        Validation of the hospital anxiety and depression scale for use with multiple sclerosis patients.
        Mult. Scler. 2009; 15: 1518-1524
        • Krupp L.B.
        • LaRocca N.G.
        • Muir-Nash J.
        • Steinberg A.D.
        The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus.
        Arch. Neurol. 1989; 46: 1121-1123
        • Freedman M.
        • Selchen D.
        • Arnold D.
        • et al.
        Treatment optimization in MS: Canadian MS working group updated recommendations.
        Can. J. Neurol. Sci. 2013; 40: 307-323
        • Watson C.J.E.
        • et al.
        Estimates o4 distance by claudicants and vascular surgeons are inherently unreliable.
        Eur. J. Vasc. Endocasc. Surg. 1998; 16: 429-443
        • Feys P.
        • Bibby B.
        • Romberg A.
        • et al.
        Within day variability on short and long walking tests in person with multiple sclerosis.
        J. Neurol. Sci. 2014; 338: 183-187
        • Baert I.
        • Freeman J.
        • Smedal T.
        • et al.
        Responsiveness and clinically meaningful improvement, according to disability level, of five walking measured after rehabilitation in multiple sclerosis: a European multicenter study.
        Neurorehabil. Neural Repair. 2014; 28: 621-631