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Reliability and validity of the 12-item multiple sclerosis walking scale in adults with chronic cervical or thoracic incomplete spinal cord injury

Spinal Cord volume 64, pages 53–59 (2026)Cite this article

Subjects

Abstract

Study Design

Multicenter clinical trial.

Objectives

Timed walking tests are commonly used in clinical and research settings to evaluate walking function in people with spinal cord injury (PwSCI), but they usually do not capture the people’s subjective walking experience. The 12-item Multiple Sclerosis Walking Scale (12-WS) is widely used to assess self-perceived walking ability in people with multiple sclerosis (PwMS), but no comparable tool exists for SCI. This study aimed to assess the reliability and validity of the 12-WS in people with cervical or thoracic incomplete SCI (PwiSCI).

Setting

Balgrist University Hospital, Zurich, Switzerland; Swiss Paraplegic Centre Nottwil, Switzerland.

Methods

In this clinical trial, 67 PwiSCI (more than 6 months post-injury, AIS C/D) completed the 12-WS and different clinically established gait assessments. Participants completed the 12-WS a second time within a maximum interval of 8 weeks. Results were compared to a cohort of 22 PwMS.

Results

The test–retest reliability of the 12-WS was excellent (ICC = 0.91; p < 0.001). Internal consistency was high (Cronbach’s Alpha α = 0.95). SEM and MDC95 were 6.5 and 18.1%, respectively. Strong correlations were found with all gait assessments (ρ = ± 0.62 to ± 0.67; p < 0.001), except for two items (running and cognitive effort), which showed weaker associations. Results for iSCI were consistent with those for the MS cohort.

Conclusions

The 12-WS is a reliable and valid patient-reported outcome measure for evaluating walking function in PwSCI. It complements objective gait assessments and supports a comprehensive evaluation of walking function.

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Fig. 1: Results of convergent validity in iSCI.
Fig. 2: Spearman correlations assessing the relationship between single 12-WS items and gait outcomes.

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Data availability

All Standard Operating Procedures (SOPs) of the gait assessments and questionnaires used are available from the authors. The key inclusion criteria and outcome evaluations are established standards. De-identified data from this study are available upon reasonable request by contacting the corresponding author.

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Acknowledgements

We thank the participants for their contribution to this study. Our gratitude goes to Iris Krüsi for her support in preparing the study protocol and all ethics documents. We also thank the Clinical Trial Unit of the Swiss Paraplegic Research for their support throughout the study process.

Funding

This study was funded by the Swiss National Science Foundation (SNF, Grant number 184786) and the Swiss Paraplegic Research (SPF).

Author information

Author notes

  1. These authors contributed equally: Sabrina Imhof, Sibylle Achermann.

Authors and Affiliations

  1. Swiss Paraplegic Research, Guido A. Zäch Str. 4, 6207, Nottwil, Switzerland

    Sabrina Imhof, Sibylle Achermann, Inge Eriks Hoogland & Björn Zörner

  2. Spinal Cord Injury Research Center, University Hospital Balgrist, Lengghalde 5, 8008, Zurich, Switzerland

    Sabrina Imhof & Sibylle Achermann

  3. University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland

    Maria Rasenack

  4. Swiss Paraplegic Centre, Guido A. Zäch Str. 1, 6207, Nottwil, Switzerland

    Inge Eriks Hoogland & Björn Zörner

  5. Department of Health Sciences and Medicine, University Lucerne, Lucerne, Switzerland

    Inge Eriks Hoogland

Authors
  1. Sabrina Imhof
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  2. Sibylle Achermann
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  3. Maria Rasenack
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  4. Inge Eriks Hoogland
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  5. Björn Zörner
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Contributions

All coauthors have significantly contributed to the study, reviewed the manuscript and agreed on publication. Author contributions are listed according to the Contributor Role Taxonomy (CRediT). S.I.: Conceptualization, methodology, formal analysis, investigation, data curation, writing-original draft, writing-review and editing, visualization. S.A.: Conceptualization, methodology, formal analysis, investigation, data curation, writing-original draft, writing-review and editing, visualization. M.R.: investigation, writing-review and editing. I.E.H.: investigation, writing-review and editing. B.Z.: Conceptualization, methodology, formal analysis, investigation, writing-original draft, writing-review and editing, visualization, supervision, funding acquisition.

Corresponding author

Correspondence to Björn Zörner.

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Imhof, S., Achermann, S., Rasenack, M. et al. Reliability and validity of the 12-item multiple sclerosis walking scale in adults with chronic cervical or thoracic incomplete spinal cord injury. Spinal Cord 64, 53–59 (2026). https://doi.org/10.1038/s41393-025-01147-0

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