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Multiple Sclerosis Editorial Should We Routinely Monitor Walking in Patients with Multiple Sclerosis? Francois Bethoux, MD Associate Staff/Director, Rehabilitation Services, The Mellen Center for MS Treatment and Research, The Cleveland Clinic, Cleveland, Ohio, US Abstract Walking is frequently affected by multiple sclerosis (MS), and mounting evidence demonstrates the impact of walking limitations on the lives of our patients, based on self-report measures and clinical assessments. While assessing the various aspects of walking can be complex and time-consuming, simple tools have been validated, which open the door to routine quantitative measurement of walking in the clinical management of our patients. The use of newer, widely available, and relatively affordable technologies, may improve the feasibility of such measurements, and potentially bring them into the patients’ own environment. Keywords Walking, outcome measurement, comprehensive management, multiple sclerosis Disclosure: Francois Bethoux, MD, has received honoraria for speaking and consulting, and research funding (paid to his institution) from Acorda Therapeutics. Consultation fees and research funding were also paid to Francois Bethoux’s institution by Innovative Neurotronics. No funding was received for the publication of this article. Received: September 22, 2014 Accepted: October 2, 2014 Citation: US Neurology, 2014;10(2):109–10 Correspondence: Francois Bethoux, MD, The Mellen Center for MS Treatment and Research, The Cleveland Clinic/Desk U10, 9500 Euclid Avenue, Cleveland OH 44195, USA. E: BETHOUF@ccf.org A growing body of evidence demonstrates the importance of walking limitations in multiple sclerosis (MS). At the same time, there is increasing pressure on health care providers to monitor the outcomes of their interventions. Owing to its impact on our patients’ functional status, quality of life, and health, walking appears as an essential parameter to measure and follow over time. However, there are practical obstacles and still unanswered questions regarding the measurement of walking in the management of MS. Walking is Commonly Affected by Multiple Sclerosis and Walking Limitations have an Impact on the Lives of our Patients It is a well-known fact that MS frequently affects walking. Indeed, widely used instruments purporting to measure the severity of MS-related disability, such as the Expanded Disability Status Scale (EDSS) and the MS Functional Composite (MSFC), incorporate some characterization of walking limitations, such as decreased walking speed or walking distance, or the need for assistive devices. Recent publications have provided figures confirming our empirical knowledge. For example, in a survey of over 1,000 individuals with MS, 41 % reported difficulty walking, and 13 % of those stated that they were unable to walk at least twice per week. 1 Another cross-sectional study from Europe found that 36 % of over 2,000 MS patients reported problems with walking or mobility. 2 That study also sought information from physicians. Quantitative measurement of walking with the Timed 25 Foot Walk (T25FW) was available for only 5 % of the patient sample (the physicians were instructed to provide these data if available, but not to perform the T25FW solely for the purpose © TO U CH MED ICA L MEDIA 201 4 of the study). This finding illustrates that, while walking limitations are commonly reported by patients, they are not frequently quantified using a validated measure. Associations between walking limitations and various aspects of the life of individuals with MS were observed both from the individuals’ perspective, and from clinical evaluations. For example, in the survey from Larocca mentioned above, a majority of individuals with walking limitations reported that this problem affected their daily life, and 70  % found that it was the most challenging aspect of their disease. 1 Several studies have shown correlations between quantitative measurements of walking (speed or distance) and major aspects of daily activities, (e.g. need for caregiver assistance, work/employment) 3 or health care utilization. 2 While these associations do not prove direct causality, and keeping in mind that other important consequences of MS (e.g. cognitive impairment) also impact functional status, they suggest that monitoring walking may provide information regarding our patients’ challenges and needs. Other negative consequences of walking limitations should not be ignored, such as comorbidities linked to immobility (e.g. osteoporosis and obesity), and injury from falling. Which Aspects of Walking should be Measured? Walking is defined by the World Health Organization as ‘…moving along a surface on foot, step by step, so that one foot is always on the ground, such as when strolling, sauntering, walking forwards, backwards, or sideways’). 4 The simplicity of this concept contrasts with the variety of means to identify and monitor walking limitations. These can be classified 109