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DOI: 10.1016/j.sedeng.2019.05.001
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Available online 21 September 2019
Twelve item multiple sclerosis walking scale: analysis through nursing diagnoses
Escala de movilidad de 12 items para esclerosis múltiple: análisis mediante diagnósticos de enfermería
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Marina González del Rioa,
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mgonzalez@idibgi.org

Corresponding author.
, Miguel Merchan Ruiza,b
a Unitat de Neuroimmunologia i Esclerosi Múltiple Territorial de Girona (UNIEM-TG), Institut d’Investigació Biomèdica de Girona (IDIBGI), Spain
b Institut d’Assistència Sanitària, Parc Hospitalari Martí i Julià, Hospital Santa Caterina, Salt, Girona, Spain
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Received 29 March 2019. Accepted 15 May 2019
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Tables (2)
Table 1. Relationship between the ND and the MSWS-12 items.
Table 2. Differences between day 15 and month 6 in the results obtained from the MSWS-12.
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Abstract
Introduction

Altered gait is one of the most common symptoms of multiple sclerosis. Fampridine is recommended to control this symptom. Its clinical benefits are assessed by timed and subjective tests, such as the 12-item MS walking scale (MSWS-12). Determining patients’ responses using the MSWS-12 enables nurses to identify, evaluate and monitor NANDA diagnoses relating to mobility.

Aim

To analyse the effectiveness of the MSWS-12 in relation to NANDA diagnoses in monitoring subjects with MS who are responders to fampridine.

Methods

Observational, descriptive and retrospective study from October 2017 to September 2018 In Girona’s Unitat de Neuroimmunologia i Esclerosi Múltiple Territorial. A total of 17 fampridine responders were included in the study. Variables: age, sex, EDSS and baseline MSWS-12 scores, at 15 days, and at 6 months.

Results

An increased total MSWS-12 score was observed between 15 days and 6 months of: impaired walking x̄=1.9 (p=.076); impaired standing x̄=.2 (p=.637); fatigue x̄=.9 (p=.209); risk of falling x̄=.6 (p=.270).

Conclusion

Impaired walking and fatigue had a greater tendency to worsen over time. Risk of falling and impaired standing had a more stable score. The MSWS-12 in relation to NANDA diagnoses is a useful tool for nurses to monitor people with MS and altered gait.

Keywords:
Multiple sclerosis
Fampridine
Altered gait
NANDA diagnoses
12-item multiple sclerosis walking scale
Resumen
Introducción

La alteración de la marcha es uno de los síntomas más comunes en la esclerosis múltiple. Para controlar este síntoma se recomienda la prescripción fampridina. Sus beneficios clínicos se evalúan mediante pruebas cronometradas y pruebas subjetivas, como la escala de movilidad de 12 ítems para esclerosis múltiple (MSWS-12). Conocer la respuesta reportada por los pacientes mediante la MSWS-12 facilita a los profesionales de enfermería identificar, evaluar y monitorizar los diagnósticos NANDA relacionados con la movilidad.

Objetivo

Analizar la operatividad de la MSWS-12 relacionada con diagnósticos NANDA para el seguimiento de personas con EM respondedoras a fampridina.

Métodos

estudio observacional, descriptivo, retrospectivo desde octubre de 2017 a septiembre de 2018 en la Unitat de Neuroimmunologia i Esclerosi Múltiple Territorial de Girona. Se incluyeron un total de 17 sujetos respondedores a fampridina. Variables: edad, sexo, EDSS y la puntuación de los ítems de la MSWS-12 en los momentos basal, 15 días y 6 meses.

Resultados

Se observó un incremento de la puntuación total de la MSWS-12 entre los 15 días y los 6 meses de: deterioro de la ambulación x̄=1,9 (p=0,076); deterioro de la bipedestación x̄=0,2 (p=0,637); fatiga x̄=0,9 (p=0,209); riesgo de caídas x̄=0,6 (p=0,270).

Conclusión

El deterioro de la ambulación y la fatiga presentan una mayor tendencia al empeoramiento en el tiempo. El riesgo de caídas y el deterioro de la bipedestación presentan una puntuación más estable. La MSWS-12 relacionada con diagnósticos NANDA es una herramienta útil para enfermería en el seguimiento de personas con EM con alteración de la marcha.

Palabras clave:
Esclerosis múltiple
Fampridina
Alteración de la marcha
Diagnósticos NANDA
Escala de movilidad de 12 ítems para esclerosis múltiple
Full Text
Introduction

Multiple sclerosis (MS) is a chronic, demyelinating, inflammatory, degenerative, immune-based disease which affects the central nervous system.1,2 It has been estimated that MS affects 2.3 million people worldwide, with a mean prevalence of 33 cases per 100,000 inhabitants.3 It is therefore considered to be the most common demyelinating disease and the primary cause of non-traumatic neurological disability in young adults between 20 and 40 years of age.

MS directly affects activity and quality of life: up to 90% of people diagnosed presented with altered gait. Difficulty in walking is perceived as highly disabling because it affects personal and social life, as well as their working environment.4–6 To improve ambulation speed, the prescription of sustained-release fampridine at a dose of 10mg/every 12h is recommended. The clinical benefits of the treatment are assessed before and after starting it, objectively through chronometered tests such as the Timed 25 Foot Walk Test (T25FW) and subjectively using the 12-Item Multiple Sclerosis Walking Scale (MSWS-12).7

The use of the MSWS-12 for assessment of response to treatment with fampridine is of the utmost interest in offering a comprehensive clinical approach. Awareness of the response reported by patients using this scale helps nursing professionals to identify, assess and monitor the NANDA8 diagnosis relating to mobility, and consequently customise healthcare in accordance with the needs of each individual patient.

Objectives

To analyse the effectiveness of the MSWS-12 in relation to NANDA diagnoses (impaired walking, impaired standing, fatigue and risk of falling) in monitoring subjects with MS over time who are responders to fampridine.

Method

An observational, descriptive, retrospective study was conducted from October 2017 to September 2018 in the Unitat de Neuroimmunologia i Esclerosi Múltiple Territorial in Girona. A total of 17 subjects were included, corresponding to patient responders during the 6 months of treatment with sustained-release fampridine on a dose of 10mg/every 12h.

The variables collected at the beginning, after 15 days and 6 months were: age, sex, level of disability using the Kurtzke Expanded Disability Status Scale (neurological scale which gives a score from 0 to 10 correlated with increase in scoring to a higher level of disability)9 and the evaluation of the MSWS-12 items.

The MSWS-12 is a self-administered scale where the patient is asked to what extent the MS has affected them in several aspects relating to their mobility during the last 2 weeks. The person must respond to each item with a score from 1 to 5, with 12 being the total minimum score (no affection) and 60 being the total maximum score (extreme affection).

Continuous variables were expressed as a mean and the categorical variables as percentages. In both cases the corresponding confidence interval (CI) of 95% was also calculated. The evolution of the items using the student’s t-test for the paired data were also evaluated. The significance level was established at p.05. Statistical analyses was conducted with the SPSS® version 23 statistical package.

The relationship between the 12 items of the MSWS-12 and the NANDA nursing diagnoses were based on the actual definition of the NANDA taxonomy (Table 1). Domain 4, class 2 and 3 for “impairment in walking” (ND-88 code) was selected, “impairment in standing” (ND-238 code) and “fatigue” (ND-93 code), and the domain 11, class 2 for “risk of falling” (ND-155-code). Of the 12 items making up the MSWS-12 item 2 was eliminated, which referred to a limited ability to run (none of the participants in the study could run and this was considered a variable which could lead to confusion).

Table 1.

Relationship between the ND and the MSWS-12 items.

ND domain  ND class  ND code  Definition  MSWS-12 items 
N.º 4:  N.º 2: Activity and exercise  ND-88  Impaired ability to walk independently in the environment  Item 1: ability to walk 
Activity and rest    Impairment in walking    Item 3: ablity to climb up and downstairs 
        Item 6: distance able to walk 
        Item 10: walking slowed down 
        Item 11: walk smoothly 
    ND-238  Impaired ability to independently achieve and/or maintain an upright position of the body from feet to head  Item 4: standing when doing things more difficult 
    Impairment when standing    Item 5: balance when standing or walking 
  N.º 3: Balance of energy  ND-93  Overwhelming sustained sense of exhaustion and decreased capacity for mental and physical work  Item 7: increased effort when walking 
    Fatigue    Item 10: walking slowed down 
        Item 12: concentration on walking 
N.º 11: Safety and protection  N.º 2: Physical lesion  ND-155  Increased susceptibility to falling that may cause physical harm  Item 5: balance when standing or walking 
    Risk for falls    Item 8: need to use support when walking indoors 
        Item 9: need to use support when walking outdoors 
Results

Twelve women and 5 men, with an average age of 52.5 years of age participated (SD=10.24) and one EDSS of 5.5 (SD=.69). The evolution of the ND between days 15 ad 6 months of treatment showed an increased in the total score of: ND-88 1.9 (95% CI: −.221, 3.986) p=.076; ND-238 .2 (95% CI:−.8, 1.3) p=.637; ND-93 .9 (95% CI:―.6, 2.31) p=.209; ND-155 .6 (95% CI:−.5, 1.7) p=.270 (Table 2).

Table 2.

Differences between day 15 and month 6 in the results obtained from the MSWS-12.

  Paired differences
  Mean  Standard deviation  95% Difference confidence interval
      Inferior  Superior 
Impaired walking: 6 months-5 days  1.882  4.091  −.221  3.986 
Fatigue: 6 months-15 days  .88235  2.78124  −.54763  2.31233 
Risk for falls: 6 months15 days  .58824  2.12305  −.50334  1.67981 
Impaired standing: 6 months15 days  .23529  2.01648  −.80148  1.27207 
Discussion

The observational study conducted by Hobart et al. in 20189 for evaluation of MSWS-12 in people with MS treated with fampridine compared with placebo, showed that there were significant improvements after 2 weeks of treatment administration and its benefits continued for 24 weeks. These results coincide with those obtained in this study from a jointed viewpoint, but they presented differences on studying them in a more grouped form, which meant that specific changes could be detected in the NANDA nursing diagnoses relating to walking (ND-88 and ND-93).

A nursing care plan based on analysis of the MSWS-12 items grouped according to the NANDA diagnoses facilitated the establishment of a specific methodology on the outcomes (NOC) and interventions (NIC) to provide better nursing care, as demonstrated by a study conducted by Akkus and Akdemin in 201210 relating to the MSQOL-54 quality of life scale.

Conclusions

The results of the MSWS-12 indicate that impaired walking and fatigue had a greater tendency to worsen over time, and should therefore be the first NANDA diagnoses for nurses to consider. Risk of falling and impaired standing were NANDA diagnoses with a more stable score between 15 days and 6 months.

The MSWS-12 is a useful tool in nursing practice for monitoring people with MS with altered gait over time. However, a larger simple and longer length of monitoring would be encouraged, to compare the results obtained with the chronometered tests it (Timed 25-Foot Walk test, Timed Get Up and Go test and 2min Timed Walk test).

Financing

This Project did not receive any financing.

Acknowledgements

The authors of this article wish to thank Doctors Quintana Camps, Buxó Pujolras, Robles Cedeño, Mrs. Vilalta Altes and Doctor Ramió i Torrentà for their support and collaboration.

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Please cite this article as: González del Río M, Merchan Ruiz M. Escala de movilidad de 12 items para esclerosis múltiple: análisis mediante diagnósticos de enfermería. Rev Cient Soc Esp Enferm Neurol. https://doi.org/10.1016/j.sedene.2019.05.001

Copyright © 2019. Sociedad Española de Enfermería Neurológica
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