Type |
Assessment Name |
Data Measured |
Limitations |
Mobility/Ambulation |
Direct observation |
Clinical examination
Kurtzke Expanded Disability Severity Scale29 |
Physician’s clinical interpretation of walking and mobility
Evaluates impairment and disability detected, followed by assessment of maximum walking distance and aids required. Scored 0-10 |
The use of aids is dependent on psychosocial factors26 |
|
Multiple Sclerosis Functional Composite (MSFC)30 |
Evaluates walking with a timed 25-foot walk, upper extremity function with nine-hole peg test, and cognitive function with paced auditory serial addition test |
|
|
Dynamic Gait Index (DGI)31 |
8-part evaluation examining gait, balance, and fall risk; Functional Gait assessment (FGA) and 4-Item Dynamic Gait Index are variations |
|
|
25-ft Timed Walk25 |
Gait speed |
Only a measure of speed. Not effective for level of activity.26 Poor test for patients with minimal disease severity25 |
|
Six Spot Step Test (SSST)32 |
Ambulation, coordination, and balance. Patient walks from one end to the other of a delineated rectangular field, kicking cylindrical blocks out of their marked circles |
Requires specific testing field with setup25 |
|
2- or 6-min walk33,34 |
Distance traveled and walking stamina |
Highly variable depending on pain, mood, motivation26 |
|
Kinetic Gait Analysis |
Computer-analyzed gait analysis |
Costly, time consuming, not ideal for large groups26 |
|
Video Gait Analysis |
Video-based scoring system of gait35,36 |
|
|
Physiological Cost Index26 |
Ambulation/mobility given a score based on change between resting and active heart rate to measure energy consumption |
Not good for patients with dysautonomia related to MS37 |
|
Physiological Profile Approach (PPA)38 |
Clinical tests of vision, cutaneous sensation of the feet, leg muscle force, step reaction time, and postural sway. Scored 0-2 to assess risk of falls |
Time to perform: 30 min, equipment is needed, imprecise measure of physiologic mechanisms, not measuring functional tasks or balance control systems26 |
Self-reported |
Rivermead Mobility Index (RMI)39 |
Mobility-derived disability, ranging from ability to turn in bed to running, and an observation of standing without aid |
Relies on a patient’s subjective assessment26 |
|
Hauser Ambulation Index40 (Hauser) |
Semiquantitative scale (0-10) based on time to walk 25 feet and use of aids |
Relies on a patient’s subjective assessment, and the use of aids is also dependent on psychosocial factors26 |
|
Multiple Sclerosis Walking Scale (MSWS-12)41 |
12 questions with five responses regarding limitations of mobility |
Relies on a patient’s subjective assessment26 |
|
EuroQol-5 dimension Index (EQ-5D)42 |
Five descriptive questions including mobility, self-care, usual activities, pain/discomfort, and anxiety/depression with three potential responses |
|
|
UK Neurological Disability Scale (UKNDS)43 |
12 subsections including mobility, scored 0-5 based on use of aids |
Relies on a patient’s subjective assessment26 |
|
Functional Independence Measures (FIM)44 |
Includes 18 items with four levels of response, with sections for mobility and locomotion |
Relies on a patient’s subjective assessment26 |
|
Barthel Index45 |
Assesses activity including mobility, based on use of aids and ability to walk a distance or climb stairs |
Relies on a patient’s subjective assessment26 |
|
Short Form 36 (SF-36)46 |
8-part questionnaire about overall quality of life, but includes physical functioning and ambulation |
Relies on a patient’s subjective assessment,26 not specific to MS, floor and ceiling effects47 |
|
Multiple Sclerosis Quality of Life Inventory (MSQLI)30 |
Health Status Questionnaire (SF-36), plus nine symptom-specific measures: fatigue, pain, bladder function, bowel function, emotional status, perceived cognitive function, visual function, sexual satisfaction, and social relationships |
|
|
Multiple Sclerosis Quality of Life (MSQOL-54)47 |
12 subscales along with two summary scores, and two additional single-item measures, including physical function, role limitations—physical, role limitations—emotional, pain, emotional well-being, energy, health perceptions, social function, cognitive function, health distress, overall quality of life, and sexual function |
Relies on a patient’s subjective assessment26 |
|
Multiple Sclerosis Impact Scale48 |
29 questions regarding limitations secondary to MS (each scored 1-5) |
Relies on a patient’s subjective assessment26 |
|
Patient Determined Disease Steps (PDDS)49 |
Scored from 0 (normal) to 8 (bedridden), with scores between 3 and 7 specifically focused on patient-reported walking limitations |
Relies on a patient’s subjective assessment26 |
|
Functional Assessment of Multiple Sclerosis (FAMS)50 |
44 questions divided into six subscales: mobility, symptoms, emotional well-being (depression), general contentment, thinking/fatigue, and family/social well-being |
Relies on a patient’s subjective assessment |
|
Physical activity diary |
Patient records daily activity or recalls daily activity after each week |
Patient compliance can be poor, and time consuming for patients26 |
|
Activities-specific Balance Confidence Scale (ABC)51 |
16-item questionnaire in which respondents rate their confidence that they can maintain their balance in the course of daily activities. Scored 0-10 and averaged |
Subjective, does not identify type of balance problems, and not related to falls52 |
Activity trackers |
Pedometer |
Number of steps |
Not effective for qualitative assessment26 |
|
Accelerometer25,26 |
Steps, distance, energy expenditure |
Not effective for qualitative assessment26 |
Balance |
Direct observation |
Balance Evaluation Systems Test (BESTest)48 |
36 items, grouped into six systems: “Biomechanical Constraints,” “Stability Limits/Verticality,” “Anticipatory Postural Adjustments,” “Postural Responses,” “Sensory Orientation,” and “Stability in Gait.” Each item scored 0-4 and totaled |
Time to perform: 30 min, no studies of fall risk, equipment is needed52 |
|
Functional Reach53 |
Maximal distance a person can reach beyond the length of their arm while maintaining a fixed base of support in the standing position. A reach less than or equal to 6 inches predicts fall |
Only one task evaluated, does not identify type of balance problem26 |
|
Tinetti Gait and Balance54 |
14-item balance and 10-item gait test. Predicts the risk of having one fall in the next year |
Poor specificity, ceiling effect, does not identify type of balance problem52 |
|
Timed Up and Go (TUG)55 |
Time required for a person to rise from a chair, walk 3 m, turn around, walk back to the chair, and sit down |
Ceiling effect, only one functional task, does not identify type of balance problem52 |
|
Berg Functional Balance Scale56 |
14-item functional assessment including sitting, standing, and postural transitions. Items scored from 0 to 4 points |
Poor sensitivity, does not identify the type of balance problem, ceiling effect, does not test dynamic balance52 |
|
One-Leg Stance57 |
Eyes open and arms on the hips, patients stand unassisted on one leg. Participants unable to perform for at least 5 s are at increased risk for injurious fall |
Only one task of static balance is evaluated, no identification of the type of balance problem, not continuously related to falls52 |
Spasticity |
|
Ashworth Scale58 |
Muscle spasticity on a scale from 0 to 4 depending on tone, resistance, and range of motion |
Does not differentiate lower levels effectively. Evaluator error |
|
Modified Ashworth Scale59 |
Muscle spasticity on a scale including 0, 1, 1+, 2, 3, 4 evaluating tone, resistance, spastic catch, and range of motion |
Evaluator error |
|
Tardieu Scale60 |
Muscle reaction (0-5) at three different speeds (V1, V2, V3) |
Evaluator error |
|
Modified Tardieu Scale61 |
Muscle reaction (0-5) at three different speeds (V1, V2, V3), and accounts for Joint angle |
Evaluator error |
|
Multiple Sclerosis Spasticity Scale (MSSS-88)62 |
88 questions regarding the impact of spasticity on a patient’s overall function |
Based on the patient’s subjective response |