A Delphi study to identify key gait patterns and their underlying causes in patients with Multiple Sclerosis

Around 60% of people with Multiple Sclerosis (PwMS) experience walking difficulties within 10 years of diagnosis1. Walking problems can be caused by diverse and interacting neurological impairments2. Spatiotemporal abnormalities in PwMS have been described clearly3, but the heterogeneity in etiology complicates describing typical gait patterns, including kinematic and kinetic deviations, in PwMS. A recent review showed that, amongst others, knee flexion in swing phase, ankle dorsiflexion at initial contact and ankle plantar flexion during pre-swing are decreased4. In the pediatric cerebral palsy population general gait subtypes have been shown to assist clinical decision making5. In the MS population practice variation in diagnosing and treating gait disorders may hamper (optimal) patient treatment. This practice variation between different physicians, centres and countries could be improved by clearly defined gait patterns in PwMS. To identify key gait patterns that are typical for PwMS, describe their characteristics and identify their underlying causes. A diverse international group of 20 physiotherapists, neurologists, rehabilitation physicians, biomechanical engineers and movement scientists with either clinical or scientifically relevant expertise within MS or gait analysis participated in an online Delphi study, including repeating questionnaires in a structured order6. The results of the current study are based on the first three rounds of our Delphi study, which focused on gathering information about gait patterns in PwMS, and the accompanying impairments and causes. The complete list of answers to the question: “which gait features and impairments contribute to gait disorders in MS patients” were grouped to create the final gait patterns based on common features and underlying impairments. To unify the given answers we used pre-existing kinematic and kinetic gait terminology. After 3 rounds consensus was reached. Six relevant and common gait patterns in MS were identified: 1) drop foot, 2) insufficient push-off, 3) stiff knee during swing, 4) knee hyperextension during stance, 5) flexion in midstance and 6) enhanced gait variability (Fig. 1). For each gait pattern the key characteristics and key potential could be defined.Download : Download high-res image (201KB)Download : Download full-size image The identification of gait patterns in MS may support clinical decision making and improves our understanding of disorders that underlie gait problems in PwMS. These gait patterns may help to improve diagnosing gait problems and improve treatment of these problems. Therefore, future Delphi rounds will focus on diagnostic and therapeutic measures for each of the gait patterns and their underlying causes.