# MScope: A Reliable Battery for Functional Status Assessment in Multiple Sclerosis
###### Abstract  
Multiple sclerosis (MS) is a neurodegenerative disease that often leads to severe disability. Although exercise, particularly strength training, improves health outcomes in MS, no standardized, reliable tool exists for functional assessment to inform tailored exercise prescriptions and patients' categorization. This study aimed to validate the reliability of the MScope battery, a comprehensive tool incorporating structural, functional, and neuromuscular assessments to objectively evaluate patients with MS. A reproducibility study was conducted with 40 MS patients who completed the MScope battery twice, 72 h apart. Tests included structural (muscle thickness of the vastus lateralis and rectus femoris), functional (sit-to-stand, timed up-and-go, 10 m and six-minute walking test), and neuromuscular tests (isometric strength during the squat and leg extension exercises and handgrip strength). Intraclass correlation coefficients (ICCs), Bland-Altman plots, and the coefficient of variation (CV) were used to evaluate intra- and inter-day reliability. The MScope battery showed high intra- and inter-day reliability, with ICC values ranging from 0.79 to 0.99. Muscle thickness measurements, along with handgrip strength, demonstrated excellent reliability (ICC > 0.9, CV < 5%). Functional tests, including the timed up-and-go, 10 m walk, and sit-to-stand variations, maintained consistent scores (ICC > 0.85, CV < 10%). The six-minute walking test exhibited excellent inter-day reliability (ICC = 0.94, CV < 4%). Neuromuscular assessments showed strong reliability with minor day-to-day variability (ICC = 0.75-0.95, CV < 8%). The battery's overall consistency supports its use as a reliable tool for assessing functional status in MS patients. e _Applied sciences_  
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<ccs2012> <concept> <disability across all clinical forms in which it manifests. Consequently, there is a pressing need to develop more effective tools to combat this disease [4]. Physical exercise has emerged as a non-pharmacological adjuvant therapy that allows patients with MS (PwMS) to improve both their physical and psychological health [5]. The evidence indicates that strength training increases muscle mass [3], improves balance and gait [6], reduces fatigue [7], and even promotes neuroplasticity in PwMS [8]. Furthermore, the effects of strength training have been shown to be more pronounced than those of other exercise-based strategies such as moderate-intensity aerobic exercise [3]. Recently, a neuroprotective effect of high-intensity strength training has been demonstrated [9], with a reduction in the serum concentration of neurofilaments (a neuronal cytoskeletal protein considered a biomarker of axonal damage) [10]. Collectively, these findings indicate that physical exercise may enhance functional capacity, autonomy, and quality of life in PwMS [9]. However, prescribing physical exercise effectively requires assessments to classify and identify a patient's health status, ultimately enabling personalized training [3]. Despite this need, no standardized battery of tests or scientific consensus currently exists to provide a functional assessment framework that supports effective exercise prescription, patient categorization, or tracking of MS progression. A review of the literature reveals numerous disparate functional assessment tests, with only a few, such as the two-minute walking test [11; 12], the six-minute walking test (6 MWT) [13; 14; 15], the sit-to-stand test, both the 60 s (60 STST) and five-repetition (5 RSTST) versions [7; 11; 12; 16], the timed 25-foot walk (T25 FW) [12; 17], and the stair climbing test [7; 11; 12; 14], being commonly used. Moreover, only a limited number of tests, such as the timed up-and-go (TUG) [18] and 5 RSTST [19; 20; 21], have been validated through studies assessing their reliability and validity specifically in patients with MS or similar neurological conditions like stroke or Parkinson's disease.