Relationship Between Single- and Dual-Task Obstacle Crossing Performance and Fatigue and Disability in Multiple Sclerosis

Relationship Between Single- and Dual-Task Obstacle Crossing Performance and Fatigue and Disability Levels in Patients With Relapsing-Remitting Multiple Sclerosis

This cross-sectional observational study aims to investigate the relationship between obstacle crossing performance under single-task and dual-task conditions and the levels of fatigue and disability in individuals with Relapsing-Remitting Multiple Sclerosis (RRMS). Walking performance will be assessed under standard walking and obstacle crossing conditions with and without a concurrent cognitive task. The study will examine how increased task complexity affects walking performance and its association with fatigue, disability, cognition, and functional mobility.

Study Overview

• Status: Recruiting
• Conditions: Multiple Sclerosis

Detailed Description

Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system that frequently causes gait impairment, fatigue, cognitive dysfunction, and reduced functional mobility. Since daily activities often require simultaneous motor and cognitive performance, assessment under dual-task conditions provides clinically meaningful information beyond conventional gait evaluation.

Obstacle crossing represents a more demanding walking task than level walking and may better reflect mobility challenges encountered in everyday life. Although dual-task walking has been investigated in individuals with MS, studies examining obstacle crossing performance under both single-task and dual-task conditions and its relationship with fatigue and disability remain limited.

This cross-sectional observational study will include men and women aged 18 to 65 years with Relapsing-Remitting Multiple Sclerosis who are followed at the Neurology Outpatient Clinic of Kocaeli City Hospital. Participants will complete walking assessments under four conditions: single-task walking, dual-task walking, single-task obstacle crossing, and dual-task obstacle crossing. The dual-task condition will require participants to perform serial-3 subtraction while walking.

Clinical assessments including fatigue, walking limitation, cognition, health-related quality of life, and fear of movement will also be collected. The study aims to determine the association between obstacle crossing performance and fatigue and disability levels in individuals with RRMS.

• Study Type: Observational
• Enrollment (Estimated): 30

Contacts and Locations

• Study Contact: Name: Yunus Emre Kundakcı, Assoc. Prof.; Phone Number: +90 272 246 28 34|; Email: y.emre.kndkc@gmail.com

Study Locations

• Turkey (Türkiye)
  • Merkez
    • Afyonkarahisar, Merkez, Turkey (Türkiye), 03000
      • Recruiting
      • Afyonkarahisar Health Sciences University
      • Contact: Yunus E Kundakcı, Assoc. Prof.; Phone Number: +905078638878; Email: y.emre.kndkc@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Adults aged 18 to 65 years with Relapsing-Remitting Multiple Sclerosis who are followed at the Neurology Outpatient Clinic of Kocaeli City Hospital, have an EDSS score between 0 and 6, are clinically stable, and meet all eligibility criteria.

Description

Inclusion Criteria:

• Age between 18 and 65 years.
• Diagnosis of Multiple Sclerosis according to the 2017 McDonald criteria.
• Diagnosis of Relapsing-Remitting Multiple Sclerosis.
• Expanded Disability Status Scale (EDSS) score between 0 and 6.
• Clinically stable disease during the previous 6 months.
• Montreal Cognitive Assessment (MoCA) score of 26 or higher.
• Able to speak and understand Turkish.
• Able to provide written informed consent.

Exclusion Criteria:

• Multiple sclerosis relapse within the previous month.
• Physician-diagnosed psychiatric disorder.
• Neurological, orthopedic, cardiac, or pulmonary disease other than Multiple Sclerosis that could interfere with study assessments.
• Montreal Cognitive Assessment (MoCA) score below 26.

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Relapsing-Remitting Multiple Sclerosis; Adults aged 18 to 65 years with a diagnosis of Relapsing-Remitting Multiple Sclerosis (RRMS) according to the 2017 McDonald criteria, an Expanded Disability Status Scale (EDSS) score between 0 and 6, a Montreal Cognitive Assessment (MoCA) score of 26 or higher, and a clinically stable disease course during the previous 6 months. Participants will undergo observational assessments of walking, obstacle crossing performance, fatigue, cognition, functional mobility, and fear of movement. No intervention will be administered.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Dual-Task Cost During Obstacle Crossing	Walking performance will be assessed using the 10-Meter Walk Test under four conditions: single-task walking, dual-task walking with serial-3 subtraction, single-task obstacle crossing, and dual-task obstacle crossing with serial-3 subtraction. Walking time and cognitive task performance will be recorded. Dual-Task Cost (DTC, %) will be calculated to quantify the effect of performing a concurrent cognitive task during walking.	Baseline

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Tampa Scale for Kinesiophobia (TSK)	The Tampa Scale for Kinesiophobia (TSK) is a 17-item questionnaire used to assess fear of movement. Total scores range from 17 to 68, with higher scores indicating greater kinesiophobia.	Baseline
The Modified Fatigue Impact Scale (MFIS)	The Modified Fatigue Impact Scale (MFIS) evaluates the impact of fatigue on physical, cognitive, and psychosocial functioning during the previous month. Total scores range from 0 to 84, with higher scores indicating greater fatigue impact	Baseline
Multiple Sclerosis Walking Scale-12 (MSWS-12)	The Multiple Sclerosis Walking Scale-12 is a patient-reported outcome measure that evaluates the impact of multiple sclerosis on walking ability. Raw total scores range from 12 to 60, with higher scores indicating greater walking limitation.	Baseline
Monitoring My Multiple Sclerosis Scale (MMMS)	The Monitoring My Multiple Sclerosis Scale (MMMS) evaluates physical status, relationships, energy, and cognitive or mental status. Total scores range from 26 to 104, with higher scores indicating better health status and functioning.	Baseline
Fatigue Severity Scale (FSS)	The Fatigue Severity Scale (FSS) assesses the severity of fatigue and its impact on daily functioning. It consists of 9 items scored from 1 to 7. The total score is calculated as the mean of the 9 items, ranging from 1 to 7, with higher scores indicating greater fatigue severity.	Baseline

Collaborators and Investigators

• Sponsor: Afyonkarahisar Health Sciences University

Study record dates

Study Major Dates

• Study Start (Actual): March 20, 2026
• Primary Completion (Actual): July 25, 2026
• Study Completion (Estimated): February 20, 2027

Study Registration Dates

• First Submitted: July 26, 2026
• First Submitted That Met QC Criteria: July 26, 2026
• First Posted (Actual): July 30, 2026

Study Record Updates

• Last Update Posted (Actual): July 31, 2026
• Last Update Submitted That Met QC Criteria: July 30, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: Multiple sclerosis; Fatigue; Dual Task
• Additional Relevant MeSH Terms: Nervous System Diseases; Autoimmune Diseases; Immune System Diseases; Demyelinating Autoimmune Diseases, CNS; Autoimmune Diseases of the Nervous System; Demyelinating Diseases; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Multiple Sclerosis; Fatigue
• Other Study ID Numbers: 2026/2-122

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No