The cost of imbalance: how balance problems drive energy cost of walking in persons with multiple sclerosis.

This was a cross-sectional study, so it cannot show that poor balance caused higher energy cost or that treating balance will lower energy cost. Only 20 participants had complete data, and the group mostly had minimal to mild walking difficulty, with a median MS Walking Scale score of 47.9 out of 60 and median EDSS 3.3, so it may not apply to people who need walking aids or have more severe MS. Five participants were excluded from the stability and gait parameter analysis because they held onto the treadmill handrail, one participant did not have energy cost data because of anxiety about the oxygen mask, and one participant did not complete the fast walking trial. The balance board score and the treadmill stability measure were only weakly related and the correlation did not reach significance, so they may not be interchangeable measures of balance. Results came from treadmill walking, and the split-belt treadmill may change step width and not fully reflect community walking with uneven ground, perturbations, and dual-task demands.

The authors declared no conflicts of interest. The study did not receive a specific grant from public, commercial, or not-for-profit sectors.

Do not conclude that improving balance alone will lower energy cost of walking in MS. This study only observed an association, and the association changed with walking speed, so it does not test whether treating balance changes energy cost.