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Assessment of the enhanced paper grip test for quantifying balance deficits in people with multiple sclerosis: A
Eva Žura1, Gregor Brecl Jakob2, Panagiotis Chatzistergos3
1Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia; University of Primorska, Faculty of Health Sciences, Izola, Slovenia.
Abstract:
This study assessed the reliability and applicability of the Enhanced Paper Grip Test (EPGT) for quantifying balance deficits in people with multiple sclerosis (MS). Thirty individuals with MS (mean age: 41.9 ± 9.66 years, mean Expanded Disability Status Scale (EDSS) score: 2.13 ± 0.94; mean disease duration: 8.3 ± 6.0 years) were recruited. The EPGT demonstrated excellent intra-visit reliability, with intraclass correlation coefficients (ICC) of 0.96 (95 % CI: 0.93-0.98) for the weaker side and 0.94 (95 % CI: 0.89-0.97) for the stronger side. Inter-visit reliability, assessed in 15 participants, also showed excellent ICCs (0.97-0.99), with coefficients of variation ranging from 4.23 % to 5.50 %. Additionally, high and statistically significant correlations were observed between EPGT performance and balance, as assessed by the modified Mini-BESTest (r = 0.81-0.87, p < 0.001). Small but statistically significant correlations were found between EPGT results and EDSS scores (r = -0.36 to -0.38, p < 0.05). These findings suggest that the EPGT can reliably assess foot/ankle strength and identify balance deficits in people with MS, with potential clinical application for monitoring disease progression and guiding rehabilitation interventions. The EPGT may provide a simple and effective method for identifying balance impairments in MS, potentially supporting early interventions and fall prevention strategies.
