The six spot step test is superior in detecting walking capacity impairments compared to short- and long-distance walk tests in persons with multiple sclerosis

Background: Walking capacity is important not only to persons with multiple sclerosis but also to clinical practice and research. The present study aims to compare the extent of impairments (relative to healthy controls) across three commonly used walking capacity outcomes in persons with multiple sclerosis. Methods: In a two-hospital cross-sectional study, walking capacity was assessed using the timed-25-footwalk-test (timed 25-ft walk test; ‘walking speed’), the six-minute-walk-test (‘walking endurance’) and the six-spot-step-test (‘walking balance and coordination’). Data were compared to normative reference data in healthy controls. Results: A total of 228 persons with multiple sclerosis (68% females) were involved in the study: age 53.7 ± 11.6 y (range 26–81 y); patient-determined-disease-steps 3 [IQR; 1; 4] (range 0–7); time since diagnosis 12.6 ± 9.9 y (range 0–49 y); MS-phenotype (relapse remitting MS, secondary progressive MS, primary progressive MS) 146/39/41; and co-morbidity n = 80 (35%). Compared to healthy controls, deficits were observed across all walking capacity outcomes (p < 0.001): timed 25-foot walk test −26 [−30; −23]%, 6 minute-walk-test −36 [−39; −32]% and six-spot-step-test −44 [−47; −40]%. Deficits differed across walking capacity outcomes (p < 0.001). Conclusion: Altogether, persons with multiple sclerosis performed substantially worse than healthy controls across all three walking capacity outcomes. The results showed that the six-spot-step-test was superior to the timed 25-foot walk test and the 6 minute-walk-test in detecting walking capacity impairments in persons with multiple sclerosis.