Discriminative ability, responsiveness, and interpretability of smoothness index of gait in people with multiple sclerosis

Authors

  • Stefano Filippo Castiglia Department of Medico – Surgical Sciences and Biotechnologies, “Sapienza” University of Rome, Latina - Italy and Department of Brain and Behavioral Sciences, University of Pavia, Pavia - Italy https://orcid.org/0000-0001-5329-5197
  • Fulvio Dal Farra Department of Information Engineering, University of Brescia, Brescia - Italy https://orcid.org/0000-0001-8431-600X
  • Dante Trabassi Department of Medico – Surgical Sciences and Biotechnologies, “Sapienza” University of Rome, Latina - Italy https://orcid.org/0000-0002-4739-3441
  • Andrea Turolla Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater University of Bologna, Bologna - Italy and Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna - Italy https://orcid.org/0000-0002-1609-8060
  • Mariano Serrao Department of Medico – Surgical Sciences and Biotechnologies, “Sapienza” University of Rome, Latina - Italy and Gait Analysis LAB Policlinico Italia, Roma - Italy https://orcid.org/0000-0003-3031-680X
  • Ugo Nocentini Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome - Italy https://orcid.org/0000-0001-7445-4441
  • Paolo Brasiliano Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Rome - Italy https://orcid.org/0000-0003-2545-3930
  • Elena Bergamini Department of Management, Information and Production Engineering, University of Bergamo, Dalmine - Italy https://orcid.org/0000-0002-9055-3981
  • Marco Tramontano Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater University of Bologna, Bologna - Italy and Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna - Italy https://orcid.org/0000-0001-6034-0638

DOI:

https://doi.org/10.33393/aop.2025.3289

Keywords:

IMUs, Sensor, Multiple sclerosis, Responsiveness, Smoothness, Gait

Abstract

Introduction: Gait impairments are common in People with Multiple Sclerosis (PwMS). Several studies have examined the clinometric properties of Inertial Measurement Units (IMUs), with LDLJa identified as a robust metric for gait smoothness. However, its responsiveness and interpretability have not been explored.

Methods: This cross-sectional study at IRCCS Santa Lucia Hospital enrolled 44 PwMS (age: 28-71; EDSS: 0-6) and 43 age- and gait-speed-matched healthy participants (HP). Two physiotherapists conducted assessments with five synchronized IMUs during a 10-meter walk at participants’ preferred speed. Data were collected at baseline (T0) and after 4 weeks of training (T1).

Results: Significant differences in log dimensionless jerk (LDLJa) were found between PwMS and HP in the AP (p < 0.001, d = 0.63), ML (p < 0.001, d = 1.08), and CC (p = 0.03, d = 0.68) directions. PwMS had lower LDLJaAP values (< -4.88) and LDLJaML values (< -5.40) with probabilities of 63% and 76%, respectively. ΔLDLJaML demonstrated good responsiveness to rehabilitation (AUC ~0.80), with improvements >4.02% representing the optimal MCID for clinical improvement in MiniBesTest.

Conclusion: Lower LDLJa values in the AP and ML directions characterize gait smoothness impairment in PwMS. LDLJa in the ML direction is responsive to balance-focused rehabilitation, highlighting its potential for tracking gait disorders and rehabilitation progress.

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