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Hadouiri N, Fournel I, Thauvin-Robinet C, Jacquin-Piques A, Ornetti P, Gueugnon M. Walking test outcomes in adults with genetic neuromuscular diseases: a systematic literature review of their measurement properties. Eur J Phys Rehabil Med 2024; 60:257-269. [PMID: 38300152 PMCID: PMC11114158 DOI: 10.23736/s1973-9087.24.08095-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 12/11/2023] [Accepted: 01/19/2024] [Indexed: 02/02/2024]
Abstract
INTRODUCTION Neuromuscular diseases (NMDs) include a large group of heterogeneous diseases. NMDs frequently involve gait disorders, which affect quality of life. Several walking tests and tools have been described in the literature, but there is no consensus regarding the use of walking tests and tools in NMDs or of their measurement properties for walking outcomes. The aim of this review is to present an overview of walking tests, including their measurement properties when used in adults with inherited or genetic NMDs. The aim is to help clinicians and researchers choose the most appropriate test for their objective. EVIDENCE ACQUISITION A systematic review was conducted after consulting MEDLINE (via PubMed), EMBASE, Science direct, Google Scholar and Cochrane Central Register of Controlled Trials databases for published studies in which walking outcome measurement properties were assessed. The validity, reliability, measurement error and responsiveness properties were evaluated in terms of statistical methods and methodological design qualities using the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines. EVIDENCE SYNTHESIS We included 46 studies in NMDs. These studies included 15 different walking tests and a wide variety of walking outcomes, assessed with six types of walking tools. Overall, the 6MWT was the most studied test in terms of measurement properties. The methodological design and statistical methods of most studies evaluating construct validity, reliability and measurement error were "very good." The majority of outcome measurements were valid and reliable. However, studies on responsiveness as minimal important difference or minimal important change were lacking or were found to have inadequate methodological and statistical methods according to the COSMIN guidelines. CONCLUSIONS Most walking outcomes were found to be valid and reliable in NMDs. However, in view of the growing number of clinical trials, further studies are needed to clarify additional measurement properties.
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Affiliation(s)
- Nawale Hadouiri
- Department of Physical Medicine and Rehabilitation, Dijon-Bourgogne University Hospital, Dijon, France -
- UMR-Inserm 1231, Génétique des Anomalies du Développement (GAD), Bourgogne Franche-Comté University, Dijon, France -
- INSERM, CIC 1432, Clinical Investigation Center, Plurithematic Module, Technological Investigation Platform, Dijon-Bourgogne University Hospital, Dijon, France -
| | - Isabelle Fournel
- Clinical Investigation Center, CHU Dijon, Dijon, France
- INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France
| | - Christel Thauvin-Robinet
- UMR-Inserm 1231, Génétique des Anomalies du Développement (GAD), Bourgogne Franche-Comté University, Dijon, France
- Fédération Hospitalo-Universitaire Médecine Translationnelle et Anomalies du Développement (TRANSLAD), CHU Dijon Bourgogne, Dijon, France
- Centre de Référence Maladies Rares "Maladies neurogénétiques", CHU Dijon Bourgogne, Dijon, France
| | - Agnès Jacquin-Piques
- Centre de Compétences Maladies Rares "Maladies neuromusculaires", Department of Neurology, Dijon University Hospital, Dijon, France
| | - Paul Ornetti
- Department of Rheumatology, Dijon-Bourgogne University Hospital, Dijon, France
- INSERM, UMR1093-CAPS, Bourgogne Franche-Comté University, Dijon, France
| | - Mathieu Gueugnon
- INSERM, CIC 1432, Clinical Investigation Center, Plurithematic Module, Technological Investigation Platform, Dijon-Bourgogne University Hospital, Dijon, France
- INSERM, UMR1093-CAPS, Bourgogne Franche-Comté University, Dijon, France
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Russo RS, Gasperini S, Bubb G, Neuman L, Sloan LS, Diaz GA, Enns GM. Efficacy and safety of pegzilarginase in arginase 1 deficiency (PEACE): a phase 3, randomized, double-blind, placebo-controlled, multi-centre trial. EClinicalMedicine 2024; 68:102405. [PMID: 38292042 PMCID: PMC10825663 DOI: 10.1016/j.eclinm.2023.102405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 02/01/2024] Open
Abstract
Background Arginase 1 Deficiency (ARG1-D) is a rare debilitating, progressive, inherited, metabolic disease characterized by marked increases in plasma arginine (pArg) and its metabolites, with increased morbidity, substantial reductions in quality of life, and premature mortality. Effective treatments that can lower arginine and improve clinical outcomes is currently lacking. Pegzilarginase is a novel human arginase 1 enzyme therapy. The present trial aimed to demonstrate efficacy of pegzilarginase on pArg and key mobility outcomes. Methods This Phase 3 randomized, double-blind, placebo-controlled, parallel-group clinical trial (clinicaltrials.govNCT03921541, EudraCT 2018-004837-34), randomized patients with ARG1-D 2:1 to intravenously/subcutaneously once-weekly pegzilarginase or placebo in conjunction with their individualized disease management. It was conducted in 7 countries; United States, United Kingdom, Canada, Austria, France, Germany, Italy. Primary endpoint was change from baseline in pArg after 24 weeks; key secondary endpoints were change from baseline at Week 24 in Gross Motor Function Measure part E (GMFM-E) and 2-min walk test (2MWT). Full Analysis Set was used for the analyses. Findings From 01 May 2019 to 29 March 2021, 32 patients were enrolled and randomized (pegzilarginase, n = 21; placebo, n = 11). Pegzilarginase lowered geometric mean pArg from 354.0 μmol/L to 86.4 μmol/L at Week 24 vs 464.7 to 426.6 μmol/L for placebo (95% CI: -67.1%, -83.5%; p < 0.0001) and normalized levels in 90.5% of patients (vs 0% with placebo). In addition, clinically relevant functional mobility improvements were demonstrated with pegzilarginase treatment. These effects were sustained long-term through additional 24 weeks of subsequent exposure. Pegzilarginase was well-tolerated, with adverse events being mostly transient and mild/moderate in severity. Interpretation These results support pegzilarginase as the first potential treatment to normalize pArg in ARG1-D and achieve clinically meaningful improvements in functional mobility. Funding Aeglea BioTherapeutics.
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Affiliation(s)
- Rossana Sanchez Russo
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, United States
| | - Serena Gasperini
- Paediatric Department, Fondazione IRCSS San Gerardo dei Tintori, Monza, Italy
| | - Gillian Bubb
- Aeglea BioTherapeutics, Inc., Austin, TX, United States
| | - Linda Neuman
- Aeglea BioTherapeutics, Inc., Austin, TX, United States
| | | | - George A. Diaz
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York City, NY, United States
| | - Gregory M. Enns
- Division of Medical Genetics, Department of Pediatrics, Stanford University School of Medicine and Lucille Packard Children's Hospital, Stanford, CA, United States
| | - PEACE Investigators
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, United States
- Paediatric Department, Fondazione IRCSS San Gerardo dei Tintori, Monza, Italy
- Aeglea BioTherapeutics, Inc., Austin, TX, United States
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York City, NY, United States
- Division of Medical Genetics, Department of Pediatrics, Stanford University School of Medicine and Lucille Packard Children's Hospital, Stanford, CA, United States
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Kanetzke NA, Westerdahl JE, Cho CC, Durham AN, Moerchen VA. Feasibility of a Child-Friendly 2-Minute Walk Test: A Crossover Randomized Controlled Trial. Phys Occup Ther Pediatr 2024:1-16. [PMID: 38247299 DOI: 10.1080/01942638.2024.2304765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/29/2023] [Indexed: 01/23/2024]
Abstract
AIMS Most studies that use the NIH Toolbox 2-Minute Walk Test with young children, modify the protocol, compromising the generalizability of outcomes. A standardizable protocol is needed. The purpose of this study was to compare the 2MWT performance of children ages 3-6 years on the standard NIH Toolbox protocol and on a modified protocol designed to support young children. METHODS Cross-over randomized controlled trial. Fifteen typically developing children ages 3-6 years were randomly assigned to the performance order of the NIH toolbox 2MWT protocol and the Modified Accessibility Path (MAP) 2MWT protocol. Outcome variables and statistical analyses included test completion (McNemar test), distance walked (Wilcoxon signed-rank test), and accuracy (general estimating equation model with Poisson distribution). RESULTS All children completed 2 min of walking with the MAP protocol. Only 40% of children completed the NIH Toolbox protocol, with 83% of these NIH completers bolstered by previous exposure to the MAP protocol. Collapsed across the order, children also had significantly fewer errors per lap with the MAP protocol (p < 0.0001), despite walking a significantly greater distance (p = 0.006). CONCLUSIONS These findings lend preliminary support for standardized application of a 2MWT with young children when the protocol is designed to be child-friendly.
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Affiliation(s)
- Nicholas A Kanetzke
- College of Health Professions & Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Jacqueline E Westerdahl
- College of Health Professions & Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Chris C Cho
- College of Health Professions & Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Adané N Durham
- College of Health Professions & Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Victoria A Moerchen
- College of Health Professions & Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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Cubillos Arcila DM, Dariva Machado G, Martins VF, Leotti VB, Schüle R, Peyré-Tartaruga LA, Saute JAM. Long-term progression of clinician-reported and gait performance outcomes in hereditary spastic paraplegias. Front Neurosci 2023; 17:1226479. [PMID: 37811319 PMCID: PMC10556702 DOI: 10.3389/fnins.2023.1226479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 08/22/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Hereditary spastic paraplegias (HSPs) are a heterogeneous group of neurodegenerative diseases in which little is known about the most appropriate clinical outcome assessments (COAs) to capture disease progression. The objective of this study was to prospectively determine disease progression after 4.5 years of follow-up with different clinician-reported (ClinRO) and gait performance outcomes (PerFOs). Methods Twenty-six HSP patients (15 SPG4, 5 SPG7, 4 SPG5, 2 SPG3A) participated in this single-center cohort study in which the ClinRO: Spastic Paraplegia Rating Scale; and the PerFOs: 10-meters walking test and timed-up and go (TUG), at self-selected and maximal walking speeds; Locomotor Rehabilitation Index; and 6-min walking test were performed at baseline and after 1.5 (18 patients) and 4.5 (13 patients) years. Results In the 3-year interval between the second and third assessments, significant progressions were only found in PerFOs, while in the overall 4.5 years of follow-up, both PerFOs and ClinROs presented significant progressions. The progression slopes of COAs modeled according to the disease duration allowed the estimation of the annual progression of the outcomes and sample size estimations for future clinical trials of interventions with different effect sizes. TUG at maximal walking speed was the only COA capable of differentiating subjects with a worse compared to a stable/better impression of change and would require the smallest sample size if chosen as the primary endpoint of a clinical trial. Discussion These findings indicate that both performance and clinician-reported outcomes can capture long-term progression of HSPs, with some PerFOs presenting greater sensitivity to change. The presented data are paramount for planning future disease-modifying and symptomatic therapy trials for this currently untreatable group of diseases.
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Affiliation(s)
- Diana Maria Cubillos Arcila
- Graduate Program in Medicine, Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Exercise Research Laboratory, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Gustavo Dariva Machado
- Division of Medical Genetics, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Valéria Feijó Martins
- Graduate Program in Human Movement Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Vanessa Bielefeldt Leotti
- Biostatistics Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Department of Statistics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Rebecca Schüle
- Division of Neurodegenerative Diseases, Department of Neurology, Heidelberg University, Heidelberg, Germany
| | - Leonardo Alexandre Peyré-Tartaruga
- Exercise Research Laboratory, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Graduate Program in Human Movement Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Jonas Alex Morales Saute
- Graduate Program in Medicine, Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Division of Medical Genetics, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Division of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Neurogenetics, Clinical Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Department of Internal Medicine, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Gacto-Sánchez M, Lozano-Meca JA, Lozano-Guadalajara JV, Montilla-Herrador J. Concurrent validity of the 2-and 6-minute walk test in knee osteoarthritis. Knee 2023; 43:34-41. [PMID: 37269795 DOI: 10.1016/j.knee.2023.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/14/2023] [Accepted: 05/11/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND The 6-Minute Walk Test (6MWT) is frequently used for the assessment of walking distances in several conditions, as knee osteoarthritis, but it can be both time-consuming for the researcher or clinician, and exhausting of painful for the subject suffering from this condition. The objective of our study was to analyze the concurrent validity of the 2-Minute Walk Test (2MWT) for patients with knee osteoarthritis compared to the 6-Minute Walk Test (6MWT). METHODS Cross-sectional validation study. Scores from the 6MWT of 42 ambulatory patients affected by knee osteoarthritis were compared to those from the shorter 2MWT. An initial correlation test was used to assess correlation between both measures, and a subsequent univariate regression analysis was performed with the aim of comparing the estimated outcomes of the 6MWT versus the actual 6MWT. RESULTS The scores from the 2MWT and 6MWT showed excellent correlation (Pearson's correlation coefficient r = 0.976; p-value < 0.001); the predictive equation based on the scores from the 2MWT (R2 = 0.952, p-value < 0.001) estimates the 6MWT scores with a relative error of 3.23%. CONCLUSIONS The 2MWT may be a practical assessment tool in replacement for the 6MWT in clinical assessment due to its low burden on patients and as a means of improving efficiency in a timely manner.
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Affiliation(s)
- Mariano Gacto-Sánchez
- Department of Physical Therapy, Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), El Palmar, Murcia, Spain.
| | - José Antonio Lozano-Meca
- Department of Physical Therapy, Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), El Palmar, Murcia, Spain.
| | | | - Joaquina Montilla-Herrador
- Department of Physical Therapy, Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), El Palmar, Murcia, Spain.
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Speirs C, Dunlop MD, Roper M, Granat M. Beyond the Clinic: Maximum Free-Living Stepping as a Potential Measure of Physical Performance. SENSORS (BASEL, SWITZERLAND) 2023; 23:6555. [PMID: 37514849 PMCID: PMC10383089 DOI: 10.3390/s23146555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/27/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023]
Abstract
Measures of physical performance captured within a clinical setting are commonly used as a surrogate for underlying health or disease risk within an individual. By measuring physical behaviour within a free-living setting, we may be able to better quantify physical performance. In our study, we outline an approach to measure maximum free-living step count using a body-worn sensor as an indicator of physical performance. We then use this approach to characterise the maximum step count over a range of window durations within a population of older adults to identify a preferred duration over which to measure the maximum step count. We found that while almost all individuals (97%) undertook at least one instance of continuous stepping longer than two minutes, a sizeable minority of individuals (31%) had no periods of continuous stepping longer than six minutes. We suggest that the maximum step count measured over a six-minute period may be too sensitive to the adults' lack of opportunity to undertake prolonged periods of stepping, and a two-minute window could provide a more representative measure of physical performance.
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Affiliation(s)
- Craig Speirs
- PAL Technologies Ltd., Glasgow G4 0TQ, UK
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow G1 1XH, UK
| | - Mark D Dunlop
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow G1 1XH, UK
| | - Marc Roper
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow G1 1XH, UK
| | - Malcolm Granat
- School of Health and Society, University of Salford, Salford M6 6PU, UK
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Leon Machado L, Lucas K, Behrman AL. Activity-Based Restorative Therapy Promotes Progression from Asymmetry to Symmetry in Posture and Gait in a Child with Chronic, Incomplete Spinal Cord Injury. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10030594. [PMID: 36980152 PMCID: PMC10047088 DOI: 10.3390/children10030594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/03/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023]
Abstract
Incomplete spinal cord injuries (ISCI) in pediatrics and adults can lead to asymmetric motor impairments exhibiting as asymmetries of posture and gait. Recently, rehabilitation guidelines for adults with neurologic injuries have focused on gaining a functional gait pattern as measured by speed and distance, even if asymmetry deficits persist. Activity-based restorative therapies (ABRT) take advantage of activity-dependent neuroplasticity to change an individual's neuromuscular capacity. This is a report of an ambulatory child with chronic ISCI presenting with significant postural and gait asymmetries who enrolled in an ABRT program. Across 79 ABRT sessions, the child gained symmetry during sitting, standing, and walking. Even though this child was a functional ambulator at enrollment, targeting symmetry of movements via improved neuromuscular capacity further enhanced her achievement of kinematically appropriate function for participation in daily activities.
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Affiliation(s)
- Laura Leon Machado
- Frazier Rehabilitation Institute, UofL Health, Louisville, KY 40202, USA
| | - Kathryn Lucas
- Department of Neurosurgery, University of Louisville, Louisville, KY 40202, USA
- Kentucky Spinal Cord Injury Research Center, Louisville, KY 40202, USA
- Kosair Charities Center for Pediatric NeuroRecovery, Louisville, KY 40202, USA
| | - Andrea L Behrman
- Department of Neurosurgery, University of Louisville, Louisville, KY 40202, USA
- Kentucky Spinal Cord Injury Research Center, Louisville, KY 40202, USA
- Kosair Charities Center for Pediatric NeuroRecovery, Louisville, KY 40202, USA
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Migliorelli C, Gómez-Martinez M, Subías-Beltrán P, Claramunt-Molet M, Idelsohn-Zielonka S, Mas-Hurtado E, Miralles F, Montolio M, Roselló-Ruano M, Medina-Cantillo J. Multidimensional Biomechanics-Based Score to Assess Disease Progression in Duchenne Muscular Dystrophy. SENSORS (BASEL, SWITZERLAND) 2023; 23:831. [PMID: 36679627 PMCID: PMC9861677 DOI: 10.3390/s23020831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 06/17/2023]
Abstract
(1) Background: Duchenne (DMD) is a rare neuromuscular disease that progressively weakens muscles, which severely impairs gait capacity. The Six Minute-Walk Test (6MWT), which is commonly used to evaluate and monitor the disease's evolution, presents significant variability due to extrinsic factors such as patient motivation, fatigue, and learning effects. Therefore, there is a clear need for the establishment of precise clinical endpoints to measure patient mobility. (2) Methods: A novel score (6M+ and 2M+) is proposed, which is derived from the use of a new portable monitoring system capable of carrying out a complete gait analysis. The system includes several biomechanical sensors: a heart rate band, inertial measurement units, electromyography shorts, and plantar pressure insoles. The scores were obtained by processing the sensor signals and via gaussian-mixture clustering. (3) Results: The 6M+ and 2M+ scores were evaluated against the North Star Ambulatory Assessment (NSAA), the gold-standard for measuring DMD, and six- and two-minute distances. The 6M+ and 2M+ tests led to superior distances when tested against the NSAA. The 6M+ test and the 2M+ test in particular were the most correlated with age, suggesting that these scores better characterize the gait regressions in DMD. Additionally, the 2M+ test demonstrated an accuracy and stability similar to the 6M+ test. (4) Conclusions: The novel monitoring system described herein exhibited good usability with respect to functional testing in a clinical environment and demonstrated an improvement in the objectivity and reliability of monitoring the evolution of neuromuscular diseases.
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Affiliation(s)
- Carolina Migliorelli
- Unit of Digital Health, Eurecat, Centre Tecnològic de Catalunya, 08005 Barcelona, Spain
| | | | - Paula Subías-Beltrán
- Unit of Digital Health, Eurecat, Centre Tecnològic de Catalunya, 08005 Barcelona, Spain
| | - Mireia Claramunt-Molet
- Unit of Digital Health, Eurecat, Centre Tecnològic de Catalunya, 08005 Barcelona, Spain
- Ephion Health, 08005 Barcelona, Spain
| | - Sebastian Idelsohn-Zielonka
- Unit of Digital Health, Eurecat, Centre Tecnològic de Catalunya, 08005 Barcelona, Spain
- Ephion Health, 08005 Barcelona, Spain
| | - Eudald Mas-Hurtado
- Unit of Digital Health, Eurecat, Centre Tecnològic de Catalunya, 08005 Barcelona, Spain
| | - Felip Miralles
- Unit of Digital Health, Eurecat, Centre Tecnològic de Catalunya, 08005 Barcelona, Spain
- Ephion Health, 08005 Barcelona, Spain
| | - Marisol Montolio
- Duchenne Parent Project, 28032 Madrid, Spain
- Department of Cell Biology, Fisiology and Immunology, Faculty of Biology, University of Barcelona, 08007 Barcelona, Spain
| | - Marina Roselló-Ruano
- Duchenne Parent Project, 28032 Madrid, Spain
- Department of Cell Biology, Fisiology and Immunology, Faculty of Biology, University of Barcelona, 08007 Barcelona, Spain
| | - Julita Medina-Cantillo
- Unidad de Patología Neuromuscular, Servicio de Rehabilitación, Hospital Sant Joan de Déu Barcelona, Passeig Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Spain
- Investigación Aplicada en Enfermedades Neuromusculares, Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
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Dunga S, Kavadichanda C, Bairwa D, Thabah MM, Negi VS. Performance of timed function tests as outcome measures in idiopathic inflammatory myopathy-results from a single-centre cohort. Rheumatology (Oxford) 2022; 62:290-299. [PMID: 35416957 DOI: 10.1093/rheumatology/keac244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 04/03/2022] [Accepted: 04/03/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To evaluate performance of timed function tests (TFTs) in assessing muscle strength and endurance as determined by Manual Muscle Testing 8 (MMT-8) and Functional Index 2 (FI-2), respectively, in idiopathic inflammatory myopathies (IIM). METHODS This cohort study included 42 IIM patients satisfying 2017 EULAR/ACR criteria. Patients were classified as active (n = 18) or inactive disease (n = 24) based on clinical status at baseline. MMT-8, FI-2, 30 s rise from chair test, 30 s 1 kg arm rise test and 2-min walking distance (2MWD) were administered at baseline, 3 months and 6 months. Pearson rank correlation analysis and receiver operating curves were performed to assess the performance of timed function tests. RESULTS All patients were followed up at 3 months and 39 completed 6 months' follow-up. All the three TFTs had excellent convergent (r > 0.7, P < 0.05) and divergent validity (P < 0.05). Only 2MWD had moderate to strong correlation with ΔMMT-8 at 3 and 6 months among those with active disease (P = 0.001). All the TFTs correlated with ΔFI-2 in active disease but only Δ2MWD correlated with ΔFI-2 in inactive disease at 6 months (r = 0.506, P = 0.036). At a cut-off of 5% improvement in MMT-8, 2MWD had an area under the curve (AUC) of 0.868 with 95% sensitivity with 2% improvement at 3 months. To detect a 10% ΔMMT-8, Δ2MWD at a cut of 8% and 7% had an AUC of 0.909 and 0.893 with a sensitivity of 92% at 3 and 6 months, respectively (P < 0.05). CONCLUSION 2MWD is a reliable indicator of muscle strength, endurance and treatment response. The 2MWD can be self-administered by patients, making it a potential patient-reported outcome measure.
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Affiliation(s)
- Saikumar Dunga
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Chengappa Kavadichanda
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Devender Bairwa
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Molly Mary Thabah
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Vir Singh Negi
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Functional and Symptomatic Clinical Trial Endpoints: The HFC-ARC Scientific Expert Panel. JACC. HEART FAILURE 2022; 10:889-901. [PMID: 36456063 DOI: 10.1016/j.jchf.2022.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/09/2022] [Accepted: 09/18/2022] [Indexed: 11/11/2022]
Abstract
The Heart Failure Academic Research Consortium is a partnership between the Heart Failure Collaboratory (HFC) and the Academic Research Consortium (ARC) composed of patients, academic investigators from the United States and Europe, the U.S. Food and Drug Administration, the National Institutes of Health, payers, and industry. Members discussed the measure, remote capture, and clinical utility of functional and quality-of-life endpoints for use in clinical trials of heart failure and cardiovascular therapeutics, with the goal of improving the efficiency of heart failure and cardiovascular clinical research, evidence generation, and thereby patient quality of life, functional status, and survival. Assessments of patient-reported outcomes and maximal and submaximal exercise tolerance are standardized and validated, but actigraphy remains inconsistent as a potential endpoint. This paper details those discussions and consensus recommendations.
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Yoshioka W, Nishino I, Noguchi S. Recent advances in establishing a cure for GNE myopathy. Curr Opin Neurol 2022; 35:629-636. [PMID: 35959526 DOI: 10.1097/wco.0000000000001090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW GNE myopathy is a rare autosomal recessive disease caused by biallelic variants in the GNE gene, which encodes an enzyme involved in sialic acid biosynthesis. No drugs are approved for the treatment of GNE myopathy. Following proof-of-concept of sialic acid supplementation efficacy in mouse models, multiple clinical trials have been conducted. Here, we review clinical trials of sialic acid supplementation therapies and provide new insights into the additional clinical features of GNE myopathy. RECENT FINDINGS Clinical trials of sialic acid supplementation have been conducted in Europe, the USA, Japan, and South Korea. Some clinical trials of NeuAc-extended release tablets demonstrated amelioration of decline in upper extremity muscle strength; however, no significant improvement was observed in phase 3 trials in Europe and USA. A phase 2 trial of ManNAc showed slowed decline of both upper and lower extremity strength. GNE myopathy patient registries have been established in Europe and Japan, and have provided information on extramuscular manifestations such as thrombocytopenia, respiratory dysfunction, and sleep apnea syndrome. Sensitive and reliable biomarkers, and a disease-specific functional activity scale, have also been investigated. SUMMARY We discuss recent advances in establishing a GNE myopathy cure, and discuss other prospective therapeutic options, including gene therapy.
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Affiliation(s)
- Wakako Yoshioka
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Ogawa-Higashi, Kodaira
- Department of Clinical Genome Analysis, Medical Genome Center, NCNP, Tokyo, Japan
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Ogawa-Higashi, Kodaira
- Department of Clinical Genome Analysis, Medical Genome Center, NCNP, Tokyo, Japan
| | - Satoru Noguchi
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Ogawa-Higashi, Kodaira
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12
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Shieh V, Zampieri C, Sansare A, Collins J, Bulea TC, Jain M. Validation of Body-Worn Sensors for Gait Analysis During a 2-min Walk Test in Children. JOURNAL FOR THE MEASUREMENT OF PHYSICAL BEHAVIOUR 2022; 5:111-119. [PMID: 37538346 PMCID: PMC10398795 DOI: 10.1123/jmpb.2021-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Introduction Instrumented gait mat systems have been regarded as one of the gold standard methods for measuring spatiotemporal gait parameters. However, their portable walkways confine walking to a restricted area and limit the number of gait cycles collected. Wearable inertial sensors are a potential alternative that allow more natural walking behavior and have fewer space restrictions. The objective of this pilot study was to establish the concurrent validity of body-worn sensors against the portable walkway system in older children. Methods Twenty-one participants (10 males) 7-17 years old performed 2-min walk tests at a self-selected and fast pace in a 25-m-long hallway, while wearing three inertial sensors. Data collection were synchronized between devices and the portions of the walk when subjects passed on the walkway were used to compare gait speed, stride length, gait cycle duration, cadence, and double support time. Regression models and Bland-Altman analysis were completed to determine agreement between systems for the selected gait parameters. Results Gait speed, cadence, gait cycle duration, and stride length as measured by inertial sensors demonstrated strong agreement overall. Double support time was found to have lower validity due to a combined bias of age, height, weight, and walking pace. Conclusion These results support the validity of wearable inertial sensors in measuring gait speed, cadence, gait cycle duration, and stride length in children 7 years old and above during a 2-min walking test. Future studies are warranted with a broader age range to thoroughly represent the pediatric population.
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Affiliation(s)
- Vincent Shieh
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Cris Zampieri
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Ashwini Sansare
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - John Collins
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Thomas C Bulea
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Minal Jain
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
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13
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Papapetropoulos S, Pontius A, Finger E, Karrenbauer V, Lynch DS, Brennan M, Zappia S, Koehler W, Schoels L, Hayer SN, Konno T, Ikeuchi T, Lund T, Orthmann-Murphy J, Eichler F, Wszolek ZK. Adult-Onset Leukoencephalopathy With Axonal Spheroids and Pigmented Glia: Review of Clinical Manifestations as Foundations for Therapeutic Development. Front Neurol 2022; 12:788168. [PMID: 35185751 PMCID: PMC8850408 DOI: 10.3389/fneur.2021.788168] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/14/2021] [Indexed: 12/11/2022] Open
Abstract
A comprehensive review of published literature was conducted to elucidate the genetics, neuropathology, imaging findings, prevalence, clinical course, diagnosis/clinical evaluation, potential biomarkers, and current and proposed treatments for adult-onset leukoencephalopathy with axonal spheroids and pigmented glia (ALSP), a rare, debilitating, and life-threatening neurodegenerative disorder for which disease-modifying therapies are not currently available. Details on potential efficacy endpoints for future interventional clinical trials in patients with ALSP and data related to the burden of the disease on patients and caregivers were also reviewed. The information in this position paper lays a foundation to establish an effective clinical rationale and address the clinical gaps for creation of a robust strategy to develop therapeutic agents for ALSP, as well as design future clinical trials, that have clinically meaningful and convergent endpoints.
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Affiliation(s)
- Spyros Papapetropoulos
- Vigil Neuroscience, Inc, Cambridge, MA, United States
- Massachusetts General Hospital, Boston, MA, United States
- *Correspondence: Spyros Papapetropoulos
| | | | - Elizabeth Finger
- Clinical Neurological Sciences, Western University, London, ON, Canada
| | - Virginija Karrenbauer
- Neurology Medical Unit, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - David S. Lynch
- National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | | | | | | | - Ludger Schoels
- Department of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research and Center of Neurology, University Hospital Tuebingen, Tuebingen, Germany
- German Research Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Stefanie N. Hayer
- Department of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research and Center of Neurology, University Hospital Tuebingen, Tuebingen, Germany
- German Research Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Takuya Konno
- Brain Research Institute, Niigata University, Niigata, Japan
| | - Takeshi Ikeuchi
- Brain Research Institute, Niigata University, Niigata, Japan
| | - Troy Lund
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
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14
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Ito T, Sugiura H, Ito Y, Noritake K, Ochi N. Relationship between the skeletal muscle mass index and physical activity of Japanese children: A cross-sectional, observational study. PLoS One 2021; 16:e0251025. [PMID: 34038448 PMCID: PMC8153420 DOI: 10.1371/journal.pone.0251025] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/19/2021] [Indexed: 02/07/2023] Open
Abstract
Regular physical activity is an important component of physical health of children and has been associated with increasing skeletal muscle mass and muscle strength. Children with low levels of physical activity may experience health problems, such as loss of muscle mass, later in life. Thus, it may be valuable to identify declining physical function in children who do not perform the recommended amount of physical activity. Therefore, we aimed to evaluate the relationship between the amount of physical activity performed for ≥60 min per day for ≥5 days per week and the skeletal muscle mass index and physical function in young children. In total, 340 typically developing children aged 6–12 years (175 girls; average age, 9.5±1.9 years) were included in this cross-sectional study. We evaluated the proportion of children performing the recommended minimum of 60 min of daily moderate-to-vigorous physical activity at least 5 days per week. The skeletal muscle mass and Gait Deviation Index scores, gait speed, grip strength, Five Times Sit-to-Stand test results, Timed Up-and-Go test results, one-leg standing time, and gait efficiency were evaluated. Multiple logistic regression analyses were performed to assess the association of moderate-to-vigorous physical activity with the skeletal muscle mass index, percent body fat, and physical function, after controlling for confounding factors (age and sex). A logistic regression analysis revealed that the skeletal muscle mass index was independently associated with moderate-to-vigorous physical activity (odds ratio, 2.34; 95% confidence interval, 1.17–4.71; P = 0.017). Performance of moderate-to-vigorous physical activity for ≥5 days per week for ≥60 min per day was associated with the skeletal muscle mass index score of Japanese children. Our findings highlighted the importance of performing moderate-to-vigorous physical activity for the development of skeletal muscle mass in children.
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Affiliation(s)
- Tadashi Ito
- Three-Dimensional Motion Analysis Room, Aichi Prefectural Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, Okazaki, Japan
- Department of Physical Therapy, Graduate School of Medicine, Nagoya University, Nagoya, Japan
- * E-mail:
| | - Hideshi Sugiura
- Department of Physical Therapy, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Yuji Ito
- Department of Pediatrics, Aichi Prefectural Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, Okazaki, Japan
| | - Koji Noritake
- Department of Orthopedic Surgery, Aichi Prefectural Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, Okazaki, Japan
| | - Nobuhiko Ochi
- Department of Pediatrics, Aichi Prefectural Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, Okazaki, Japan
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15
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Liguori S, Moretti A, Paoletta M, Gimigliano F, Iolascon G. Rehabilitation of Neuromuscular Diseases During COVID-19: Pitfalls and Opportunities. Front Neurol 2021; 12:626319. [PMID: 33679588 PMCID: PMC7933194 DOI: 10.3389/fneur.2021.626319] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/27/2021] [Indexed: 02/05/2023] Open
Abstract
The outbreak of COVID-19 caused by SARS-CoV-2 has spread worldwide with a huge impact on the healthcare system. Compared to the previous coronaviruses-related pandemics, COVID-19 is more transmissible with potential systemic involvement and peculiar neurological manifestations, such as Guillan-Barrè syndrome up to critical illness myopathy, occurring in the intensive care setting. In this clinical scenario, people living with a neuromuscular disease (NMD) represent a vulnerable category with a high risk of a severe course of COVID-19. Moreover, in the NMD population, the management of respiratory and muscular impairments after SARS-CoV-2 infection might be troubling in terms of both pharmacological and rehabilitative approaches. To date, rehabilitation is still an unmet need in this population with several implications on NMD progression with and without SARS-CoV-2 infection. In particular, rehabilitation intervention for patients with NMD after COVID-19 are lacking. Therefore, in the current paper, we analyze the critical issues of COVID-19 on NMDs patients and propose a home-based rehabilitation program targeted for this population after mild to moderate SARS-CoV-2 infection.
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Affiliation(s)
- Sara Liguori
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Marco Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Francesca Gimigliano
- Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
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16
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Nankaku M, Tanaka H, Ikeguchi R, Kikuchi T, Miyamoto S, Matsuda S. Effects of walking distance over robot-assisted training on walking ability in chronic stroke patients. J Clin Neurosci 2020; 81:279-283. [PMID: 33222930 DOI: 10.1016/j.jocn.2020.09.067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/18/2020] [Accepted: 09/28/2020] [Indexed: 11/19/2022]
Abstract
An understanding of the dose-response during training is important to identify the rehabilitation programs to obtain the improvement in chronic stroke patients. The purpose of this study was to determine whether distance-dose (distance walked across all sessions) during robot-assisted training affects the change of walking speed and distance in chronic stroke patients after intervention. Fifteen chronic stroke patients were enrolled in this study. The patients performed 8 gait training sessions using the Hybrid Assistive Limb (HAL) for 3 weeks. Gait speed, stride length, cadence, and 2-minute walk test (2MWT) were measured before and post-intervention. Total walking distance (distance walked across all sessions) in individual patients were also measured. Gait speed, stride length, cadence, and 2-minute walk test (2MWT) improved significantly after training. The average of walking distance for 8 sessions in individual patients was 3793.3 ± 2105.3 m. Moreover, the change of gait speed (r = 0.53) and 2MWT (r = 0.70) were positively correlated with the walking distance during 8 sessions. This study of finding demonstrated that greater total distance walked over all sessions of training using the HAL is directly associated with the better walking outcomes in patients with chronic stroke. Further researches with a larger number of patients and a control group are needed to quantify the study results more precisely.
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Affiliation(s)
| | - Hiroki Tanaka
- Rehabilitation Unit, Kyoto University Hospital, Japan
| | | | - Takayuki Kikuchi
- Department of Neurosurgery, Faculty of Medicine, Kyoto University, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Faculty of Medicine, Kyoto University, Japan
| | - Shuichi Matsuda
- Rehabilitation Unit, Kyoto University Hospital, Japan; Department of Orthropedic Surgery, Faculty of Medicine, Kyoto University, Japan
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17
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Blaschek A, Rodrigues M, Ille L, Idriess M, Well T, Warken B, Müller C, Hannibal I, Tacke M, Müller-Felber W, Vill K. Is Exercise-Induced Fatigue a Problem in Children with Duchenne Muscular Dystrophy? Neuropediatrics 2020; 51:342-348. [PMID: 32369835 DOI: 10.1055/s-0040-1708859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Duchenne muscular dystrophy (DMD) is a devastating X-linked muscular disorder. The number of studies investigating new therapeutic approaches is substantially increasing. This study aims to investigate the impact and diagnostic value of exercise-induced fatigue in DMD, which has been proposed as a suitable outcome parameter in other conditions like spinal muscular atrophy. PATIENTS AND METHODS A cohort of 55 DMD patients (49 of them treated with steroids and 9 with ataluren) underwent a total of 241 6MWT (mean 4.4 tests/patient) which were retrospectively analyzed. Exercise-induced fatigue was assessed by the ratio between the distance achieved in the sixth minute and the distance in the second minute of the 6MWT. In previous studies a quotient above 1 was defined as a sign of fatigue. RESULTS The average fatigue quotient in the whole cohort of patients was 1.0. In a further analysis no impact of age, steroid therapy, ataluren therapy, overall disability, and distance in the 6-minute walk test (6MWT) on fatigue in DMD patients could be shown. CONCLUSION Our data show that fatigue does not play a relevant role in DMD. Analysis of fatigue is not a useful outcome parameter in DMD studies. For this reason we suggest the 2MWT, which is better accepted by the patients, as an alternative to the commonly 6MWT.
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Affiliation(s)
- Astrid Blaschek
- Department of Pediatric Neurology and Developmental Medicine, Dr. v. Hauner Children's Hospital, Ludwig-Maximilians University, Munich, Germany
| | - Martin Rodrigues
- Department of Pediatric Neurology and Developmental Medicine, Dr. v. Hauner Children's Hospital, Ludwig-Maximilians University, Munich, Germany
| | - Lena Ille
- Department of Pediatric Neurology and Developmental Medicine, Dr. v. Hauner Children's Hospital, Ludwig-Maximilians University, Munich, Germany
| | - Mohammed Idriess
- Department of Pediatric Neurology and Developmental Medicine, Dr. v. Hauner Children's Hospital, Ludwig-Maximilians University, Munich, Germany
| | - Therese Well
- Department of Pediatric Neurology and Developmental Medicine, Dr. v. Hauner Children's Hospital, Ludwig-Maximilians University, Munich, Germany
| | - Birgit Warken
- Department of Pediatric Neurology and Developmental Medicine, Dr. v. Hauner Children's Hospital, Ludwig-Maximilians University, Munich, Germany
| | - Christine Müller
- Department of Pediatric Neurology and Developmental Medicine, Dr. v. Hauner Children's Hospital, Ludwig-Maximilians University, Munich, Germany
| | - Iris Hannibal
- Department of Pediatric Neurology and Developmental Medicine, Dr. v. Hauner Children's Hospital, Ludwig-Maximilians University, Munich, Germany
| | - Moritz Tacke
- Department of Pediatric Neurology and Developmental Medicine, Dr. v. Hauner Children's Hospital, Ludwig-Maximilians University, Munich, Germany
| | - Wolfgang Müller-Felber
- Department of Pediatric Neurology and Developmental Medicine, Dr. v. Hauner Children's Hospital, Ludwig-Maximilians University, Munich, Germany
| | - Katharina Vill
- Department of Pediatric Neurology and Developmental Medicine, Dr. v. Hauner Children's Hospital, Ludwig-Maximilians University, Munich, Germany
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18
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Ishihara T, Miyazaki A, Tanaka H, Matsuda T. Identification of the brain networks that contribute to the interaction between physical function and working memory: An fMRI investigation with over 1,000 healthy adults. Neuroimage 2020; 221:117152. [PMID: 32668299 DOI: 10.1016/j.neuroimage.2020.117152] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/30/2020] [Accepted: 07/05/2020] [Indexed: 12/14/2022] Open
Abstract
There is a growing consensus regarding the positive relationship between physical function and working memory; however, explanations of task-evoked functional activity regarding this relationship and its differences in physical function domains remain controversial. This study illustrates the cross-sectional relationships between cardiorespiratory fitness, gait speed, hand dexterity, and muscular strength with working memory task (N-back task) performance and the mediating effects of task-evoked functional activity in 1033 adults aged between 22 and 37 years. The results showed that cardiorespiratory fitness and hand dexterity were independently associated with N-back task performance to a greater extent and in contrast to gait speed and muscular strength. These relationships were mediated by task-evoked functional activity in a part of the frontoparietal network (FPN) and default mode network (DMN). Superior cardiorespiratory fitness could contribute to working memory performance by enhancing the compensational role of FPN-related broader region activation. Hand dexterity was associated with moderation of the interaction in terms of task-evoked activation between the FPN and DMN, which in turn, improved N-back task performance. Based on these findings, we conclude that cardiorespiratory fitness and hand dexterity have common and unique mechanisms enhancing working memory.
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Affiliation(s)
- Toru Ishihara
- Tamagawa University Brain Science Institute, Tokyo, Japan; Japan Society for the Promotion of Science, Tokyo, Japan
| | | | - Hiroki Tanaka
- Tamagawa University Brain Science Institute, Tokyo, Japan; Japan Society for the Promotion of Science, Tokyo, Japan
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19
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Fiuzat M, Lowy N, Stockbridge N, Sbolli M, Latta F, Lindenfeld J, Lewis EF, Abraham WT, Teerlink J, Walsh M, Heidenreich P, Bozkurt B, Starling RC, Solomon S, Felker GM, Butler J, Yancy C, Stevenson LW, O'Connor C, Unger E, Temple R, McMurray J. Endpoints in Heart Failure Drug Development: History and Future. JACC-HEART FAILURE 2020; 8:429-440. [PMID: 32278679 DOI: 10.1016/j.jchf.2019.12.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/12/2019] [Accepted: 12/19/2019] [Indexed: 10/24/2022]
Abstract
Heart failure (HF) patients experience a high burden of symptoms and functional limitations, and morbidity and mortality remain high despite successful therapies. The majority of HF drugs in the United States are approved for reducing hospitalization and mortality, while only a few have indications for improving quality of life, physical function, or symptoms. Patient-reported outcomes that directly measure patient's perception of health status (symptoms, physical function, or quality of life) are potentially approvable endpoints in drug development. This paper summarizes the history of endpoints used for HF drug approvals in the United States and reviews endpoints that measure symptoms, physical function, or quality of life in HF patients.
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Affiliation(s)
- Mona Fiuzat
- Duke University and Duke Clinical Research Institute, Durham, North Carolina; U.S. Food and Drug Administration, Silver Spring, Maryland.
| | - Naomi Lowy
- U.S. Food and Drug Administration, Silver Spring, Maryland
| | | | - Marco Sbolli
- Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Federica Latta
- Inova Heart and Vascular Institute, Falls Church, Virginia
| | - JoAnn Lindenfeld
- Heart Failure and Transplantation Section, Vanderbilt University, Nashville, Tennessee
| | - Eldrin F Lewis
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - William T Abraham
- Department of Medicine, Division of Cardiovascular Medicine, Ohio State University, Columbus, Ohio
| | - John Teerlink
- Division of Cardiology, San Francisco VA Medical Center, and University of California San Francisco, San Francisco, California
| | - Mary Walsh
- St. Vincent Heart Center, Indianapolis, Indiana
| | | | - Biykem Bozkurt
- Winters Center for Heart Failure, DeBakey VA Medical Center, Cardiovascular Research Institute, Baylor College of Medicine, Houston, Texas
| | - Randall C Starling
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Scott Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - G Michael Felker
- Duke University and Duke Clinical Research Institute, Durham, North Carolina
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson, Mississippi
| | - Clyde Yancy
- Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Lynne W Stevenson
- Heart Failure and Transplantation Section, Vanderbilt University, Nashville, Tennessee
| | | | - Ellis Unger
- U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Robert Temple
- U.S. Food and Drug Administration, Silver Spring, Maryland
| | - John McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
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20
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Kennedy RA, Carroll K, McGinley JL, Paterson KL. Walking and weakness in children: a narrative review of gait and functional ambulation in paediatric neuromuscular disease. J Foot Ankle Res 2020; 13:10. [PMID: 32122377 PMCID: PMC7052968 DOI: 10.1186/s13047-020-0378-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 02/18/2020] [Indexed: 12/18/2022] Open
Abstract
Background Weakness is the primary impairment in paediatric neuromuscular diseases, impacting gait and gait-related functional activities in ambulant children affected by these rare and often degenerative diseases. Gait speed is an indicator of health and disability, yet gait is a complex, multi-faceted activity. Using the International Classification of Function, Health and Disability (ICF) model, assessment of gait and functional ambulation should consider the impairments, activity limitations and participation restrictions due to disease, and factors related to the environment and the individual person. Methods This narrative review involved a literature search of databases including Medline, Embase and Pubmed from 1946 to October 2019. Inclusion criteria included assessments of gait, endurance and ambulatory function in paediatric (0–18 years) neuromuscular diseases. Results Fifty-two papers were identified reporting assessments of gait speed, timed function, endurance and ambulatory capacity, gait-related balance and qualitative descriptive assessments of gait function and effect of disease on gait and gait-related activities. Gait speed is an indicator of disability and children with neuromuscular disease walk slower than typically developing peers. Increasing disease severity and age were associated with slower walking in children with Duchenne muscular dystrophy and Charcot-Marie-Tooth disease. The six-minute walk test is used widely as a test of endurance and ambulatory capacity; six-minute walk distance was substantially reduced across all paediatric neuromuscular diseases. Endurance and ambulatory capacity was more limited in children with spinal muscular atrophy type 3, congenital muscular dystrophy and older boys with Duchenne muscular dystrophy. Only a few papers considered normalisation of gait parameters accounting for the effect on gait of height in heterogeneous groups of children and linear growth in longitudinal studies. Balance related to gait was considered in five papers, mainly in children with Charcot-Marie-Tooth disease. There was limited investigation of factors including distance requirements and terrain in children’s typical environments and personal factors related to self-perception of disease effect on gait and gait-related function. Conclusion Assessments of gait and functional ambulation are important considerations in documenting disease progression and treatment efficacy in the clinical setting; and in clinical trials of disease-modifying agents and physiotherapeutic interventions in paediatric neuromuscular diseases. There is a need for expert consensus on core gait and functional ambulation assessments for use in clinical and research settings.
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Affiliation(s)
- Rachel A Kennedy
- Department of Neurology, The Royal Children's Hospital, Parkville, Vic, Australia. .,Murdoch Children's Research Institute, Parkville, Vic, Australia. .,Department of Physiotherapy, The University of Melbourne, Parkville, Vic, Australia.
| | - Kate Carroll
- Department of Neurology, The Royal Children's Hospital, Parkville, Vic, Australia.,Murdoch Children's Research Institute, Parkville, Vic, Australia.,Department of Physiotherapy, The University of Melbourne, Parkville, Vic, Australia
| | - Jennifer L McGinley
- Murdoch Children's Research Institute, Parkville, Vic, Australia.,Department of Physiotherapy, The University of Melbourne, Parkville, Vic, Australia
| | - Kade L Paterson
- Department of Physiotherapy, The University of Melbourne, Parkville, Vic, Australia
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