Assessment of the enhanced paper grip test for quantifying balance deficits in people with multiple sclerosis: A reliability and applicability study

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