Consensus on recommended evaluation tools in multiple sclerosis (CORE-MS): A Delphi study protocol on balance and gait assessment

Background and objectives Gait and balance impairments are common and disabling in People with Multiple Sclerosis (PwMS), significantly affecting mobility and quality of life. Although several clinical and instrumental tools exist to assess these functions, there is no consensus on the most appropriate measures for detecting changes at the clinical, movement quality, and neural levels. This study aims to establish expert consensus on the most appropriate tools for assessing gait and balance in PwMS to support an individualized approach to rehabilitation. Methods The process will begin with a focus group to gather initial feedback from a few experts, followed by a Delphi study consisting of iterative rounds of anonymous surveys with international experts to reach consensus on the most appropriate tools. The Delphi process will be conducted using an electronic platform to ensure anonymity and international participation. Experts will evaluate the proposed tools over several rounds until consensus is reached. The consensus threshold will be predefined, and statistical measures of agreement will guide the analysis. Discussion and conclusion By identifying a core set of outcome measures covering clinical, movement quality, and neural aspects, this study aims to address the current fragmentation in clinical practice and research in PwMS. This comprehensive approach will improve the assessment of gait and balance and facilitate the design of tailored rehabilitation interventions that meet the specific needs and recovery potential of each patient. In addition, the study will establish a consensus-based framework for gait and balance assessment in MS rehabilitation, promoting consistency across clinical and research settings. The results are expected to inform future studies on patient stratification, treatment effectiveness, and precision rehabilitation strategies, ultimately leading to improved functional outcomes and quality of care.