Reliability and Validity of Glittre Activities Of Daily Living (ADL) Test in Multiple Sclerosis Patients


Patients with Multiple Sclerosis (MS) have reduced functional capacity due to clinical symptoms of the disease, resulting in decreased participation in daily living activities and reduced quality of life. Evaluation of functional capacity and activities of daily living is very important in order to determine appropriate rehabilitation programs and increase the participation of patients in daily life activities. However, although there are many scales evaluating functional capacity and activities of daily living in people with disabilities, there is no specific assessment scale specific to MS patients. Therefore, this study was planned to investigate whether the Glittre Daily Living Activities (GYA) Test, which was developed to measure functional capacity in chronic obstructive pulmonary disease, is a valid and reliable measurement tool in MS patients. For this purpose, a total of 53 participants (27 MS patients and 26 healthy participants) evaluated with Glittre GYA Test.

The relationship between Glittre GYA Test and 6-minute walk test, Notthingham Extended Daily Living Activities Index, Multiple Sclerosis Quality of Life Scale, Fatigue Severity Scale, Balance Assessment Systems Test (MiniBEST Test), Extended Disability Status Scale, 5 times sit-up test and grip strength evaluated with Pearson or Spearman correlation coefficient. For the known group validity, the difference between the patient and control groups compared with the test of the difference between the two means. For reliability, test retest performed. Reliability will be evaluated with the ıntraclass correlation coefficient.

Hypothesis 1: Glittre GYA Test is valid for evaluating functional capacity in MS patients.

Hypothesis 2: The Glittre GYA Test is associated with the Notthingham Extended Daily Living Activities Index.

Hypothesis 3: Glittre GYA Test is reliable in MS patients.

Hypothesis 4: Glittre GYA Test results in MS patients and healthy subjects are different.

Full Title of Study: “Reliability and Validity of Glittre Activities Of Daily Living (ADL) Test in Multiple Sclerosis”

Study Type

  • Study Type: Observational [Patient Registry]
  • Study Design
    • Time Perspective: Prospective
  • Study Primary Completion Date: October 15, 2019


  • Other: Measurement of functional exercise capacity
    • The Glittre Activities of Daily Living (ADL) Test was used to evaluate functional exercise capacity.

Arms, Groups and Cohorts

  • Multiple Sclerosis Patients
  • Healthy Subjects

Clinical Trial Outcome Measures

Primary Measures

  • Glittre Activities of Dailiy Living Test
    • Time Frame: 10 minute
    • Functional exercise capacity measurement

Secondary Measures

  • 6 minute walk test
    • Time Frame: 10 minute
    • Functional exercise capacity measurement
  • Nottingham Extended Daily Living Activities Index (NGGYAI)
    • Time Frame: 10 minute
    • Nottingham Extended Daily Living Activities Index (NGGYAI) was used to evaluate the daily living activities. In addition to the Turkish validity and reliability of the index, it has been reported that it is reliable and valid in MS patients. The scale consists of 22 questions covering mobility, kitchen, home and entertainment activities. A higher score 0-66 scale indicates a better activities of daily living.
  • Extended Disability Status Scale (EDSS)
    • Time Frame: minimum 30 minute
    • Expanded Disability Status Scale (EDSS) is the most commonly used scale to monitor disease stage and assess disability in multiple sclerosis patients. Eight functional systems (FS) are evaluated with EDSS (Visual functions, brain stem functions, pyramidal functions, cerebellar functions, sensory functions, bladder and bowel functions, cerebral functions and other). In addition, gait is also evaluated and a score between 0 (normal neurological status) and 10 (death due to MS) is determined by considering functional system scores and the level of independence of the patient in ambulation.
  • Fatigue Severity Scale
    • Time Frame: 10 minute
    • Fatigue severity scale was used to evaluate the severity of fatigue. The scale consists of 9 items. Patients are asked to choose one of the options from 1 to 7 for each item in the scale. The YSQ score is calculated by averaging the scores of the answers given to the nine items. A high score indicates an increase in the severity of fatigue.
  • Multiple Sclerosis Quality of Life İnstrument – 54 (MSQOL-54)
    • Time Frame: 15 minute
    • Multiple sclerosis quality of life instrument (MSQOL-54), which was developed for MS patients and was validated and reliable in Turkish, was used to evaluate the quality of life of the patients. The scale consists of 14 subheading and 54 items. Each subheading is evaluated out of 100 points and 100 points represent the best status and 0 points represent the worst. The scores of the patients according to their answers to each question are calculated under 14 subheading. Then, with a separate calculation, according to the scores obtained from 14 subheading, 2 separate scores are obtained as physical and mental.
  • Mini-BEST Test (Balance Assessment Systems Test)
    • Time Frame: 15-20 minute
    • Mini-BEST Test (Balance Assessment Systems Test) was used to evaluate the balance. Mini-BESTest is the shortest version of BESTest. Test include 4 subheading named preparatory movement, reactive postural control, sensory orientation and dynamic gait. Each subheading has its own total scoring. The total score of preparatory movement, reactive postural control and sensory orientation was 6, and the total score of the dynamic walking subheading was 10 points. The highest score in the test is 28. As the score decreases, the physical condition deteriorates. Each case tested has 3 points, 0-1-2, which are defined as severe, moderate and normal, respectively. One of these 3 points is selected based on the patient’s performance in the tested condition.
  • Grip force evaluation
    • Time Frame: 5 minute
    • Grip strength was measured by isometric hydraulic hand dynamometer (Jamar hand dynamometer). Before starting the measurement, the physiotherapist shows the patient the measurement position and how the grip is performed. The person to be evaluated is asked to grasp the dynamometer in the position shown and tighten it as strongly as possible.The test is repeated three times for the right and left hand. The average of 3 measurements per hand is used for further analysis.
  • The 5-repetition sit-to-stand test
    • Time Frame: 10 minute
    • This test has been shown to provide information about lower extremity muscle strength in MS patients. The 5-repetition sit-to-stand test is a measure of the time taken to complete five repetitions of the sit-to-stand movement.

Participating in This Clinical Trial

Inclusion Criteria

  • Between 18-65 years
  • Extended Disability Status Scale (EDSS) score of maximum 4.5
  • Not having any musculoskeletal surgery
  • No attacks during the last 3 months
  • Mini mental test score of 24 or higher
  • No walking aid or orthosis
  • No other neurological or orthopedic problems affecting the function
  • No peripheral vestibular problem.
  • No medicine changes have been made in the last 6 months

Exclusion Criteria

  • Patients who did not meet the inclusion criteria were excluded.

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: 65 Years

Are Healthy Volunteers Accepted: Accepts Healthy Volunteers

Investigator Details

  • Lead Sponsor
    • Hacettepe University
  • Provider of Information About this Clinical Study
    • Principal Investigator: Gözde KAYA, Research Assistant – Hacettepe University
  • Overall Official(s)
    • Nezire KÖSE, Prof., Principal Investigator, Hacettepe University
    • Rana KARABUDAK, Prof., Study Chair, Hacettepe University
    • Meryem A TUNCER, Prof., Study Chair, Haceetepe University
    • Kadriye ARMUTLU, Prof., Principal Investigator, Hacettepe University
    • Yeliz SALCI, Asts. Prof., Principal Investigator, Hacettepe University
    • Jale KARAKAYA, Assoc. Prof., Principal Investigator, Hacettepe University


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