{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T09:49:08Z","timestamp":1773654548270,"version":"3.50.1"},"reference-count":25,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T00:00:00Z","timestamp":1773619200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Objective: To determine which physical clinical test best differentiates minimally impaired people with MS (pwMS) from healthy controls and to compare the discriminatory value of upper limb clinical assessments with sensor-based gait and postural control measures. Methods: Forty-one participants (21 pwMS, 20 matched healthy controls) completed a single testing session including upper limb clinical assessments (Nine-Hole Peg Test [9HPT], grip strength), gait (Timed 25-Foot Walk, Six-Minute Walk Test, and cognitive\u2013walking dual task), and static balance assessments using wearable inertial sensors (APDM Mobility Lab system). Dual-task costs (DTCs) were calculated for gait parameters. Between-group comparisons were performed using independent t-tests. Pearson correlation analyses were conducted to examine interrelationships among gait variables, and a parsimonious binary logistic regression model was constructed, including non-dominant 9HPT and dual-task walking speed. Receiver operating characteristic (ROC) analyses were performed to evaluate discriminative performance and determine the optimal 9HPT cutoff. Results: PwMS performed significantly slower on the 9HPT for both hands (p \u2264 0.006) and demonstrated reduced walking performance and higher gait DTCs (p \u2264 0.041) compared with controls. No significant group differences were observed in grip strength or sensor-based postural control. In multivariable analysis, the overall model was significant (p &lt; 0.001; Nagelkerke R2 = 0.49), and the non-dominant 9HPT remained the only independent predictor of group status (OR = 1.75, 95% CI [1.17\u20132.61]), whereas dual-task walking speed was not significant after adjustment. ROC analysis demonstrated good discriminative ability for the non-dominant 9HPT (AUC = 0.84, 95% CI [0.71\u20130.97]) and acceptable discrimination for dual-task walking speed (AUC = 0.75, 95% CI [0.60\u20130.90]). The optimal 9HPT cutoff was \u226521.4 s, yielding 71% sensitivity and 100% specificity in this cohort. Conclusions: Manual dexterity of the non-dominant hand may serve as a sensitive screening marker of early functional impairment in MS, demonstrating greater discriminatory value than sensor-based gait and balance measures. These findings support the inclusion of upper limb dexterity testing in the routine assessment of minimally impaired pwMS. Validation in larger, longitudinal cohorts is warranted.<\/jats:p>","DOI":"10.3390\/s26061866","type":"journal-article","created":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T08:41:26Z","timestamp":1773650486000},"page":"1866","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Manual Dexterity Shows Greater Discretionary Value than Sensor-Based Gait and Balance Measures in Identifying Early Functional Impairment in Multiple Sclerosis"],"prefix":"10.3390","volume":"26","author":[{"given":"Mousa","family":"Hujirat","sequence":"first","affiliation":[{"name":"School of Public Health, Gray Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv 6139001, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7999-0868","authenticated-orcid":false,"given":"Alon","family":"Kalron","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, School of Health Professions, Gray Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv 6139001, Israel"},{"name":"Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Ramat-Gan 5262100, Israel"},{"name":"Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv 6139001, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1502","DOI":"10.1016\/S0140-6736(08)61620-7","article-title":"Multiple sclerosis","volume":"372","author":"Compston","year":"2008","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1038\/nrneurol.2016.187","article-title":"Interactions between genetic, lifestyle and environmental risk factors for multiple sclerosis","volume":"13","author":"Olsson","year":"2017","journal-title":"Nat. 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