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Background   Individuals with multiple sclerosis (MS) experience deficits in motor and cognitive domains, resulting in impairment in dual-task walking ability. The goal of this study was to compare performance of forward walking and backward walking in single- and dual-task conditions in persons with MS to age- and sex-matched healthy controls. We also examined relationships between forward and backward walking to cognitive function, balance, and retrospective fall reports.Methods   All measures were collected in a single session. A 2 × 2 × 2 mixed model ANOVA was used to compare differences in forward and backward walking in single- and dual-task conditions between MS and healthy controls. Spearman correlations were used to examine relationships between gait and cognitive function, falls, and balance.Results   Eighteen individuals with relapsing-remitting MS and 14 age- and sex-matched healthy controls participated. Backward walking velocity revealed significant differences between groups for both single-task ( p  = 0.015) and dual-task ( p  = 0.014) conditions. Persons with MS demonstrated significant differences between single- and dual-task forward and backward walking velocities ( p  = 0.023;  p  = 0.004), whereas this difference was only apparent in the backward walking condition for healthy controls ( p  = 0.004). In persons with MS, there were significant differences in double support time between single- and dual-task conditions in both backward ( p  < 0.001) and forward ( p  = 0.001) directions. More falls at six months were significantly associated with shorter backward dual-task stride length ( r  = −0.490;  p  = 0.046) and slower velocity ( r  = −0.483;  p  = 0.050).Conclusion   Differences in MS and age- and sex-matched healthy controls are more pronounced during backward compared to forward walking under single- and dual-task conditions. Future work with a larger sample size is needed to validate the clinical utility of backward walking and dual-task assessments and mitigate the limited sensitivity of the current dual-task assessments that primarily rely upon forward walking.

Backward Walking and Dual-Task Assessment Improve Identification of Gait Impairments and Fall Risk in Individuals with MS