Assessment of the Enhanced Paper Grip Test for Quantifying Balance Deficits in People with Multiple Sclerosis: A Reliability and Applicability Study

TY - JOUR

T1 - Assessment of the Enhanced Paper Grip Test for Quantifying Balance Deficits in People with Multiple Sclerosis

T2 - A Reliability and Applicability Study

AU - Žura, Eva

AU - Brecl Jakob, Gregor

AU - Chatzistergos, Panagiotis

AU - Kozinc, Žiga

N1 - Publisher Copyright: © 2025 Elsevier B.V.

PY - 2025/3

Y1 - 2025/3

N2 - 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.

AB - 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.

KW - Balance assessment

KW - multiple sclerosis

KW - foot and ankle strength

KW - miniBEST test

KW - Multiple sclerosis

KW - Foot and ankle strength

UR - https://www.scopus.com/pages/publications/85217022369

U2 - 10.1016/j.msard.2025.106321

DO - 10.1016/j.msard.2025.106321

M3 - Article

C2 - 39921991

SN - 2211-0348

VL - 95

JO - Multiple Sclerosis and Related Disorders

JF - Multiple Sclerosis and Related Disorders

M1 - 106321

ER -