The reliability and validity of the Figure of 8 walk test in mildly disabled persons with multiple sclerosis

Published:November 23, 2022DOI:


      • The F8WT has good reliability and validity in mildly disabled pwMS.
      • The F8WT is sensitive test that can detecte small changes in pwMS.
      • The F8WT evaluate gait skills and balance in pwMS.
      • The test can be easily used in inpatients and outpatients due to the short application time.



      Figure of 8 Walk Test (F8WT) assesses the multidirectional and adaptive requirements of both straight and curved path walking. The study aimed to examine the reliability, validity, and minimal detectable change (MDC) of the F8WT in patients with Multiple Sclerosis (pwMS).


      45 mildly disabled pwMS (10 male, 35 female) were included in the study. Reliability of F8WT test was evaluated with Intraclass Correlation Coefficient (ICC). MDC estimates were calculated using baseline data. The correlation between the F8WT and Berg Balance Scale (BBS), The Timed Up and Go test (TUG), The Timed 25-Foot Walk Test (T25FW), The Four Square Step Test (FSST) was used for the validity.


      The intra-rater (ICC 0.980–0.983) and inter-rater (ICC 0.976–0.985) reliability of the F8WT was determined to be excellent. MDC values for intra-rater were 1.04–1.08 s, and MDC values for inter-rater were 1.16–0.99 s. The correlation with F8WT and BBS (p = 0.000, r = -0.702), TUG (p = 0.000, r = 0.854), T25FW (p = 0.000, r = 0.784), FSST (p = 0.000, r = 0.748) was found to be statistically significant.


      The F8WT has good reliability and validity in mildly disabled pwMS. According to the MDC results, small differences in pwMS can be adequately detected with F8WT. Therefore, it may be a clinically suitable test for detecting balance and walking.


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        • Altman D.G.
        • Bland J.M.
        Standard deviations and standard errors.
        Br. Med. J. 2005; 331: 903
        • Barker K.L.
        • Batting M.
        • Schlüssel M.
        • et al.
        The reliability and validity of the Figure of 8 Walk test in older people with knee replacement: does the setting have an impact?.
        Physiotherapy. 2019; 105: 76-83
        • Cattaneo D.
        • Regola A.
        • Meotti M.
        Validity of six balance disorders scales in persons with multiple sclerosis.
        Disabil. Rehabil. 2006; 28: 789-795
        • Courtine G.
        • Schieppati M.
        Human walking along a curved path. I. Body trajectory, segment orientation and the effect of vision.
        Eur. J. Neurosci. 2003; 18: 177-190
        • Downs S.
        • Marquez J.
        • Chiarelli P.
        The Berg Balance Scale has high intra-and inter-rater reliability but absolute reliability varies across the scale: a systematic review.
        J. Physiother. 2013; 59: 93-99
        • Gijbels D.
        • Alders G.
        • Van Hoof E.
        • et al.
        Predicting habitual walking performance in multiple sclerosis: relevance of capacity and self-report measures.
        Mult. Scler. 2010; 16: 618-626
        • Haley S.M.
        • Fragala-Pinkham M.A.
        Interpreting change scores of tests and measures used in physical therapy.
        Phys. Ther. 2006; 86: 735-743
        • Hess R.J.
        • Brach J.S.
        • Piva S.R.
        • et al.
        Walking skill can be assessed in older adults: validity of the Figure-of-8 Walk Test.
        Phys. Ther. 2010; 90: 89-99
        • Koo T.K.
        • Li M.Y.
        A guideline of selecting and reporting intraclass correlation coefficients for reliability research.
        J. Chiropr. Med. 2016; 15: 155-163
        • Lassmann H.
        The pathology of multiple sclerosis and its evolution.
        Philos. Trans. R. Soc. Lond. B Biol. Sci. 1999; 354: 1635-1640
        • Learmonth Y.C.
        • Paul L.
        • McFadyen A.K.
        • et al.
        Reliability and clinical significance of mobility and balance assessments in multiple sclerosis.
        Int. J. Rehabil. Res. 2012; 35: 69-74
        • Lexell J.E.
        • Downham D.Y.
        How to assess the reliability of measurements in rehabilitation.
        Am. J. Phys. Med. Rehabil. 2005; 84: 719-723
        • Matsuda P.N.
        • Shumway-Cook A.
        • Bamer A.M.
        • et al.
        Falls in multiple sclerosis.
        PM R. 2011; 3: 624-632
        • McConvey J.
        • Bennett S.E.
        Reliability of the Dynamic Gait Index in individuals with multiple sclerosis.
        Arch. Phys. Med. Rehabil. 2005; 86: 130-133
        • Moore J.L.
        • Potter K.
        • Blankshain K.
        • et al.
        A core set of outcome measures for adults with neurologic conditions undergoing rehabilitation: a clinical practice guideline.
        J. Neurol. Phys. Ther. 2018; 42: 174
        • Motl R.W.
        • Learmonth Y.C.
        Neurological disability and its association with walking impairment in multiple sclerosis: brief review.
        Neurodegener. Dis. Manag. 2014; 4: 491-500
        • Orendurff M.S.
        • Segal A.D.
        • Berge J.S.
        • et al.
        The kinematics and kinetics of turning: limb asymmetries associated with walking a circular path.
        Gait Posture. 2006; 23: 106-111
        • Portney L.G.
        • Watkins M.P.
        Foundations of Clinical research: Applications to Practice. 892. Pearson/Prentice Hall Upper Saddle River, NJ2009
        • Sahin F.
        • Yilmaz F.
        • Ozmaden A.
        • et al.
        Reliability and validity of the Turkish version of the Berg Balance Scale.
        J. Geriatr. Phys. Ther. 2008; 31: 32-37
        • Santisteban L.
        • Teremetz M.
        • Irazusta J.
        • et al.
        Outcome measures used in trials on gait rehabilitation in multiple sclerosis: a systematic literature review.
        PLoS One. 2021; 16e0257809
        • Soke F.
        • Erkoc Ataoglu N.E.
        • Ozcan Gulsen E.
        • et al.
        The psychometric properties of the figure-of-eight walk test in people with Parkinson's disease.
        Disabil. Rehabil. 2022; 22: 1-9
        • Wagner J.M.
        • Norris R.A.
        • Van Dillen L.R.
        • et al.
        Four Square Step Test in ambulant persons with multiple sclerosis: validity, reliability, and responsiveness.
        Int. J. Rehabil. Res. 2013; 36: 253-259
        • Weir J.P.
        Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM.
        J. Strength Cond. Res. 2005; 19: 231-240
        • Wong S.S.
        • Yam M.S.
        • Ng S.S.
        The Figure-of-Eight Walk test: reliability and associations with stroke-specific impairments.
        Disabil. Rehabil. 2013; 35: 1896-1902