2–1.4 m/s) [26]. The 2MWT, commonly used to measure walking capacity or endurance in persons with cardiac and pulmonary disease, assessed endurance in these patients. The patient was instructed to cover as much BTSA1 ground as possible in 2 min walking at a comfortable speed using ambulation aids as used in their everyday life. Rest periods were allowed during the evaluation. The distance (in feet) covered was measured using a Trumeter Mini-Measure Distance-Measuring Wheel, a device that accurately measures up to 10,000 feet. The 2-minute timed walk test is a valid, reliable, and sensitive measure that is easy to administer [22, 27]. The limiting factors for the 2-minute timed walk test are pain,

mood, and cardiovascular fitness, which can influence the result [28]. The MAS was administered to measure learn more spasticity [29]. It is widely used, easy to administer, and has good validity but limited reliability

[30–32]. Research KPT-8602 molecular weight has shown that disability tends to be more related to weakness than spasticity [33]. Therefore, the association between ambulatory gains and spasticity changes were examined. MRC scale graded the lower extremity muscle strength (LEMMT). It is a widely used ordinal measure of power, with 0 = no movement to 5 = normal movement. It has established validity and reliability [34]. The major limitation of MRC grading is that the scale neither considers the range of motion (ROM) for which a movement can be performed nor defines the strength of resistance against which a movement can be performed [35]. The TFIM assessed MS-related disability. The TFIM is a reliable [36] and valid [37]

functional assessment instrument that is widely used in many rehabilitation settings [38] to measure the degree of disability [39]. The TFIM has 18 items; each item is scored on an ordinal scale ranging from 1 (‘total assist’: patient performs <25 % of task) to 7 (‘complete independence’). The resulting score indicates the level Acetophenone of assistance needed to achieve independence and ranges from 18 (totally dependent) to 126 (independent). Thus, increased disability is reflected in lower TFIM scores. 2.3 Statistical Analysis All data analyses for this paper were generated using SAS software, Version 9.2 of the SAS System for Windows (SAS Institute Inc., Cary, NC, USA). The significance level for all statistical tests was set a priori at p < 0.05. Paired t tests were used to compare the pre-treatment and 12-month follow-up assessments of spasticity, walking speed, walking capacity, and TFIM. Improvement of >20 % in walking speed was used to detect clinically meaningful change. Pearson correlation coefficients were examined to describe the relationship between 10M and 2MWT at initial evaluation and 12-month follow-up, as well as between changes in spasticity and ambulation. A ‘responder status’ was defined based on faster walking speed for three of the four visits during the treatment period [19].