Relıabılıty and Valıdıty of the Supıne-to-stand Test Wıth Multiple Sclerosis

Background: Supine-to-Stand Test (SST) requires muscle strength, flexibility, and dynamic balance and can be used as a marker of functional motor competence in patients with Multiple Sclerosis (pwMS).

Objectives: To investigate the reliability and validity of SST in pwMS. Methods: Muscle strength was measured using digital goniometer for plantar and dorsiflexor in pwMS (n=44). Manual dexterity was assessed through the 9-hole Peg Test (9HPT). Balance was evaluated using with Berg Balance Test (BBT). Walking speed was assessed using Six-minute Walk test (6MWT). Timed up and go test (TUG), Activity-spesific Balance Confidence scale was used for fear of falling. Quality of life was assessed with MSQOL-54.

Results: The test's intraclass correlation was 0.984 (95% CI 0.801-0.995). Significant moderate correlations were found between SST and BBT (r=-0.547, p=0.001), TUG (r=0.619, p\<0.001), and 6MWT (r=-0.642, p\<0.001). A moderate correlation was also found between dominant side plantar flexor strength and SST (r=0.349, p=0.043), but not non-dominant side and bilaterally dorsi flexors (p\>0.05). Additionally, no significant correlation was found between SST and bilaterally 9HPT, MSQOL-54 (p\>0.05).

Conclusion: This study establishes SST as a reliable and valid tool for assessing functional motor competence in pwMS.

Multiple Sclerosis (MS) is a demyelinating, inflammatory, neurodegenerative and progressive disease that causes varying degrees of disability in mobility and functional activities and affects social participation . Common symptoms in MS patients are usually; tone changes, loss of strength in the lower extremities, spasticity, balance and coordination problems, problems, falls, and walking problems . It becomes very difficult for patients with MS (pwMS) to transition between movements and positions considering these symptoms .

The ability to stand from a supine position is the basis for people's ability to get out of bed every day. This activity is very important in situations such as being able to stand by controlling movement while standing and getting up after falls . Supine-to-stand ability requires muscle strength, flexibility, and dynamic balance . The movement includes complex sub- sequential patterns such as sit-to-stand. Factors such as duration, quality of the subsections, and sitting balance also affect supine-to-stand ability . Besides, supine-to-stand ability is seen as indicator for establishing and maintaining bipedal independence. It is evaluated in the pediatric group as fundamental movement skills and motor competence in relation to functional capacity . Therefore, it is essential to determine the clinical applicability of the supine-to stand test (SST) for assessing the competence of pwMS to perform the supine-to-stand task.

SST ability was assessed in different neurological diseases. SST duration has been measured in children with developmental disorders between 4-7 years old . It has been used to assess frailty in patients with Parkinson's disease . Its validity and reliability have recently been tested in patients with stroke . Considering the balance, falls and coordination complaints of MS patients, there is a need to measure SST ability and investigate it with other clinical tests. In particular, not being able to stand up after falling problems and staying in a supine position causes loss of motivation and decreases in quality of life for patients. In order to prevent this problem in neurological diseases, it is necessary to evaluate and treat it by working functionally as a result of this evaluation. In MS patients, especially as the EDSS level increases, balance problems and walking problems increase and muscle strength decreases. In these cases, problems of transition between positions and movements come to the fore.

Therefore, SST test can be used as a marker to show functional motor competence of MS patients. SST can be a quick and easy measurement tool to evaluate the effectiveness of rehabilitation. The aim of this study was to investigate the reliability and validity of SST in pwMS.

Eligibility Criteria:
Inclusion Criteria:

* being diagnosed with revised 2017 McDonald criteria,
* aged older than 18 years,
* ability to walk with or without aid,
* no medication changes in the last 2 months,
* volunteering to participate in the research,
* not having any obstacles to verbal and cognitive communication.

Exclusion Criteria:

* having orthopedic, psychological, and other neurological disorders, having had -a relapse in the past 3 months
* having pregnancy.