Black MS patients in US score poorly on walking, physical ability tests

Black people with multiple sclerosis (MS) scored lower on tests of walking and physical function than did white patients, regardless of social determinants of health such as education or income, a U.S. study reported.

These findings add to a growing understanding of how MS manifests in Black people, and they provide grounds for developing interventions that could help the physical function of all patients, according to a press release from the National MS Society, which supported the research.

The study, “Walking and physical performance in black and white adults with multiple sclerosis controlling for social determinants of health,” was published in Multiple Sclerosis and Related Disorders.

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February 22, 2024 News by Margarida Maia, PhD

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MS develops due to damaging immune system attacks in the brain and spinal cord, causing damage. A range of disease symptoms follows, from blurred or poor vision and fatigue to difficulty walking or frequent stumbling due to balance and coordination problems.

There is evidence that the disease’s course differs in Black patients, who tend to have more severe MS symptoms and faster disability progression. Black people also are more likely to experience problems with balance and coordination.

It’s possible that these differences may arise from disparities in social determinants of health, or factors that affect a person’s overall health and well-being. These factors include income, employment, and education, which can markedly influence behaviors and access to healthcare, among other aspects that impact health outcomes.

Researchers, led by those at the University of Chicago, investigated whether walking and physical function vary with race among people with MS, and how their abilities compare with the general population, while considering social determinants of health.

The study included 208 MS patients (141 white, 67 Black) and 95 healthy adults (59 white, 36 Black). There were significant differences in sex, age, years of education, marital status, income, and disease duration between Black and white people, and in employment and income between those with and without MS.

Race and MS status ‘independently influenced’ test outcomes of study

MS patients overall did worse on tests of walking and physical function than healthy adults. Black people also had poorer results than did white people, even after considering income, employment, and education, as well as other factors such as age and sex.

In a timed 25-foot walk test, which measures how quickly a person can walk 25 feet, the average walking speed was slower for Black people with MS than for white patients (4.8 vs. 5.5 feet per second). On average, Black patients also did worse in a six-minute walk test, which measures the distance covered over six minutes (1,359 vs. 1,505 feet).

In the timed up-and-go test, people are asked to stand up from a chair, walk along a line for three meters (about 10 feet), turn, walk back, and sit down again. Black patients took longer to complete the test than white patients (nine vs. eight seconds), indicating poorer mobility.

Healthy people completed this timed test in a mean of six (white adults) and seven (Black adults) seconds.

Finally, all underwent a short physical performance battery that is designed to assess balance, gait speed, and muscle strength in the lower limbs. The maximum score is 12 points, with higher scores indicating better physical function. Among MS patients, who scored lower as a group than healthy people, those who were Black had the lowest scores — an average of nine points, while white patients had an average of 10 points.

All test scores were significantly poorer for MS patients than for healthy adults, and the results did not seem to be affected by race. Black people, however, tended to have worse scores across tests than did white participants, regardless of their disease status.

“The findings indicated that Race and MS Status independently influenced walking and physical function outcomes in the study sample, independent of [social determinants of health],” the team wrote.

While the study focused on walking and physical function, its findings suggest that race should be considered with rehabilitation approaches, independent of demographic and social determinants of health.

However, all patients in the study “were diagnosed with MS for 10 years or longer, and the findings might not be generalized” to newly diagnosed patients, the researchers wrote, noting the importance of further studies into walking and physical function among Black people with MS.