Comprehensive management of mobility impairment and complex symptoms in multiple sclerosis: A focus on walking

Multiple Sclerosis, the number one disabling neurologic disease in young adults, can be challenging to manage due to the complexity of the symptoms and comorbidities associated with the disease. There is a growing body of knowledge about the prevalence, impact, and management of MS symptoms which may affect mobility. However, little is known about how comorbidities and symptoms associated with the disease interact with mobility. To address these issues, a consensus conference was held on September 15, 2012. A panel of twentyfive experts from varied clinical disciplines and academic researchers reviewed evidence and current practice guidelines related to symptom management and mobility in MS. The symptoms of MS identified included: motor control (weakness and spasticity), cognition, and subjective symptoms (fatigue and pain). The comorbidities identified were bowel and bladder dysfunction, and osteoporosis. The objectives of the consensus conference were to: (1) review current practice related to symptoms and comorbidities impacting mobility in MS; (2) identify knowledge gaps about the interaction of symptoms and comorbidities with mobility; (3) propose operational clinical practice strategies to assess and manage symptoms and comorbidities in the context of mobility limitations; and (4) identify opportunities for future research. Prior to the meeting, pertinent literature selected by the program chairs as conveying information relevant to the topic and goals of the discussion, was disseminated to the expert panel for review. As most of the published evidence pertains to ambulation, the discussion was focused on walking. Following the day-long consensus conference, the panel issued consensusbased operational recommendations regarding the assessment and management (including pharmacologic and non-pharmacologic interventions) of walking impairment in the context of MS symptoms and comorbidities. The proposed framework and consensus recommendations can serve as a basis for the development and validation of clinical care protocols, and for the design of clinical research studies.