1. The study examined the association between postural transition measures during the Timed Up and Go test (such as turning and sit-to-stand durations and velocities) and balance confidence, self-perceived walking limitations, and clinical disability in persons with multiple sclerosis. 2. The results showed that poorer performance on turning and turning-to-sitting postural transitions, as evidenced by longer durations and lower velocities, were associated with lower balance confidence, greater self-perceived walking limitations, and higher clinical disability. 3. In contrast, sit-to-stand transitions were not consistently associated with these outcomes and did not differ based on disability level, suggesting they may be less informative for understanding mobility challenges

1. Turning Time and Velocity are Associated with Balance Confidence and Self-Perceived Walking
Limitation in Multiple Sclerosis
Victoria A. Levasseur1,2, Gautam Adusumilli1, Samantha Lancia1, Megan Orchard1, PA-C, Robert T. Naismith, MD1, Joanne M. Wagner PT, PhD3
1Department of Neurology, Washington University in St. Louis
2School of Medicine, University of Missouri, Columbia
3Department of Physical Therapy and Athletic Training, Saint Louis University
Conclusions
Methods
Results
Subjects
Hypotheses
Background
• We hypothesized: (1) pwMS with greater impairments in postural transitions that incorporate turning would
report greater self-perceived limitations of balance and walking and (2) impairments in postural transitions
would increase with worsening disability
• Persons with multiple sclerosis (pwMS) report difficulty turning and transitioning between seated and
standing positions.
• The association between postural transition measures, mobility and clinical disability is poorly understood
in pwMS. There is evidence that pwMS with normal walking speed take longer to turn during the Timed
Up and Go (TUG) test compared to persons without disability.1,2 It remains unclear if postural transition
parameters differ across disability level and if greater impairments in postural transition are associated with
greater self-perceived limitations of balance and walking in pwMS.
• PwMS who had a more impaired turning and turn-to-sit described more difficulties with balance and walking.
• Transitioning from seated to standing was not associated with balance and walking problems or clinical disability.
• Most postural transition worsened with increasing disability.
• Considerable variability was observed for all postural transition parameters.
• Further studies should determine whether a rehabilitation approach targeting turning in MS could result in improved
balance confidence, decreased walking limitations, less falls, and increased independence.
Methods
• Spearman rho correlations assessed associations between postural transition parameters and the ABC,
MSWS-12v2, and EDSS.
• One-way ANOVAs between groups and Tukey’s post-hoc tests compared TUG parameters between mild
(EDSS 0=2.5, n = 61) vs. moderate (EDSS 3-4, n = 28) vs. severe (EDSS =4.5- 6.5, n = 9) disability
subgroups.
Total
(n
=
98)
Mild
(n
=
61)
Moderate
(n
=
28)
Severe
(n
=
9)
Age
in
years,
mean
±
SD
(range)
47
±
11
(22-­‐68)
44
±
11
(22-­‐66)
53.6
±
8.3
(33-­‐68)
52.6
±
11.3
(34-­‐63)
EDSS,
median
(range)
2.5
(0-­‐6.5)
2.
0
(0-­‐2.5)
3.0
(3-­‐4)
5.5
(4.5-­‐6.5)
Female,
n
(%)
79
(81)
50
(82)
22
(79)
7
(78)
Race
(Caucasian,
African-­‐
American,
Asian),
n
(%)
87/9/2
(89,9,2)
54/6/1
(89,10,2)
25/3/0
(89,11,0)
8/0/1
(89,0,11)
Type
of
MS
(RR/SP/PP),
n
(%)
94/1/3
(96,1,3)
60/1/0
(98,2,0)
26/1/1
(92,4,4)
8/0/1
(89,0,11)
Years
since
DX,
mean
±
SD
(range)
11
±
8
(1-­‐37)
9
±
7
(1-­‐16)
13.8
±
7.6
(2-­‐31)
12.3
±
13.1
(1-­‐37)
T25FWT
(s),
mean
±
SD
(range)
7.6
±
2.2
(3.9-­‐18.7)
6.8
±
1.5
(3.9-­‐10.9)
8.1
±
1.6
(5.6-­‐10.6)
1.5
±
4.1
(6.4-­‐18.7)
6MWT
(Q),
mean
±
SD
(range)
1405
±
310
(406-­‐2458)
1521
±
272
(980-­‐2458)
1270
±
185
(801-­‐1676)
850
±
390
(406-­‐1175)
MSWS-­‐12,
mean
±
SD
(range)
28.4
±
26.0
(0-­‐76)
16.9
±
20.5
(0-­‐71)
40.9
±
22.0
(0-­‐64)
68.0
±
8.5
(50-­‐76)
ABC,
mean
±
SD
(range)
76.6
±
20.7
(27-­‐100)
85.3
±
18.2
(28-­‐100)
69.6
±
17.2
(28-­‐96)
50.8
±
16.3
(27-­‐79)
7-­‐m
TUG,
mean
±
SD
(range)
17.3
±
4.8
(10.7-­‐43.2)
15.5
±
3.1
(10.7-­‐28.0)
18.8
±
3.0
(12.9-­‐24.9)
24.5
±
9.0
(16.8-­‐43.2)
Results
1. Balance confidence on the ABC decreased with longer turning duration and turn-to-sit duration, and
lower peak turning velocity and peak turn-to-sit velocity (all p < 0.001).
• Total duration, sit-to-stand,
turn, turn-to-sit
Time Domain
• Gait, sit-to-stand, turn, turn-
to-sit
Velocity Domain
• ABCSelf Reported
Balance Confidence
• MSWS-12v2Self Reported
Walking Limitation
• EDSSClinical Disability
Postural Transition Measures Clinical Disability and Self-Perceived Limitations
1Spain et al, 2012; 2Spain et al, 2014
5. Gait velocity during the TUG decreased and total duration increased with worsening disability.
3 trials of a 7 meter Timed Up and Go (TUG)
test while wearing 6 Opal body-worn motion
sensors (APDM®, Portland, Oregon, USA).
Mobility Lab software (APDM®, Portland,
Oregon, USA) measured TUG total duration
and postural transition parameters
7 meter Timed Up and Go (TUG) test
7m
7m
2. Self-perceived walking limitation on the MSWS-12 increased with longer turning duration (p = 0.01)
longer turn-to-sit duration (p < 0.001), lower turning velocity (p < 0.01) and lower turn-to-sit velocity
(p < 0.001).
3. Balance confidence decreased and self-perceived walking limitation increased with increased sit-to-
stand velocity (p < 0.05) but not sit-to-stand duration (p > 0.05).
4. Clinical disability increased with longer turning duration, longer turn-to-sit duration, lower turning
velocity and lower turn-to-sit velocity (p < 0.001).
6. PwMS with moderate or severe disability had greater impairments in turning and turn-to-sit postural
transitions compared to pwMS with mild disability. There were no differences (p > 0.05) in turning
and turn-to-sit postural transitions between pwMS with moderate or severe disability.
7. Sit-to-stand postural transitions did not differ across disability groups (p > 0.05)
p = 0.001
***
*
*
*
*p ≤ 0.001, **p ≤ 0.01, ***p ≤ 0.02
*
**
*p ≤ 0.001
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