Abstract
Reduced walking endurance is common in people with multiple sclerosis (PwMS), leading to reduced social participation and increased fall risk. This highlights the importance of identifying which gait aspects should be mostly targeted by rehabilitation to maintain/increase walking endurance in this population. A total of 56 PwMS and 24 healthy subjects (HSs) executed the 6 min walk test (6 MWT), a clinical measure of walking endurance, wearing three inertial sensors (IMUs) on their shanks and lower back. Five IMU-based digital metrics descriptive of different gait domains, i.e., double support duration, trunk sway, gait regularity, symmetry, and local dynamic instability, were computed. All metrics demonstrated moderate-high ability to discriminate between HSs and PwMS (AUC: 0.79-0.91) and were able to detect differences between PwMS at minimal (PwMS(mFR)) and moderate-high fall risk (PwMS(FR)). Compared to PwMS(mFR), PwMS(FR) walked with a prolonged double support phase (+100%), larger trunk sway (+23%), lower stride regularity (-32%) and gait symmetry (-18%), and higher local dynamic instability (+24%). Normative cut-off values were provided for all metrics to help clinicians in detecting abnormal scores at an individual level. The five metrics, entered into a multiple linear regression model with 6 MWT distance as the dependent variable, showed that gait regularity and the three metrics most related to dynamic balance (i.e., double support duration, trunk sway, and local dynamic instability) were significant independent contributors to 6 MWT distance, while gait symmetry was not. While double support duration and local dynamic instability were independently associated with walking endurance in both PwMS(mFR) and PwMS(FR), gait regularity and trunk sway significantly contributed to 6 MWT distance only in PwMS(mFR) and PwMS(FR), respectively. Taken together, the present results allowed us to provide hints for tailored rehabilitation exercises aimed at specifically improving walking endurance in PwMS.