An international Delphi study to identify key gait patterns and their underlying causes in people with multiple sclerosis

The objectives of the current international Delphi study were (1) to identify key gait patterns that are typical for people with multiple sclerosis, (2) to describe their key characteristics, and (3) to identify their underlying causes.The objectives of the current international Delphi study were (1) to identify key gait patterns that are typical for people with multiple sclerosis, (2) to describe their key characteristics, and (3) to identify their underlying causes.

An international group of 20 physiotherapists, neurologists, rehabilitation physicians, biomechanical engineers, and movement scientists with either up-to-date clinical or scientifically relevant expertise with multiple sclerosis or gait analysis participated in a three-round Delphi study. A complete list of gait characteristics contributing to gait disorders in people with multiple sclerosis, and underlying impairments was composed. Subsequently, these were analyzed to identify common gait patterns and their main characteristics, and underlying key causes. To unify the given answers, we used pre-existing kinematic and kinetic gait terminology. The threshold for consensus was set at 67% agreement.agreement. 

After three Delphi rounds, consensus was reached for six gait patterns in multiple sclerosis: 1) drop foot; 2) insufficient push-off; 3) stiff knee during swing; 4) knee hyperextension during stance; 5) knee and hip flexion in midstance; and 6) enhanced gait variability. For each gait pattern at least 69% consensus was reached to define the key characteristics and key potential causes.

It was concluded that clear international consensus was reached on six gait patterns in people with multiple sclerosis, with their key gait characteristics and causes. The identification of these gait patterns in multiple sclerosis supports clinical decision making and improves our understanding of impairments that underlie walking problems in people with multiple sclerosis.

The standardization of these detailed gait patterns in multiple sclerosis will improve the understanding of impairments that underlie walking problems in people with multiple sclerosis. The identified gait patterns will also support clinical decision making and improve communication among physiotherapists and other healthcare providers regarding diagnosing and treatment of walking problems in people with multiple sclerosis.