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Fernández-Canosa S, Brocalero-Camacho A, Martínez-Medina A, Díez-Rodríguez E, Arias P, Oliviero A, Soto-León V. Fatigue insights from walking tests in spinal cord injury and multiple sclerosis individuals. Sci Rep 2024; 14:4761. [PMID: 38413793 PMCID: PMC10899186 DOI: 10.1038/s41598-024-55238-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 02/21/2024] [Indexed: 02/29/2024] Open
Abstract
In the last decade, fatigue in clinical populations has been re-conceptualized, including dimensions such as perceived fatigue (trait and state fatigue) and fatigability. The aim of this study was to evaluate different expressions of fatigue in Spinal Cord Injury (SCI) and Multiple Sclerosis (MS) participants compared to able-bodied controls, during activities of daily living, especially during gait. A total of 67 participants were included in this study (23 with SCI, 23 with MS, and 21 able-bodied controls). All participants performed two functional tests (6-Minute Walk Test and 10-Meter Walk Test) and they completed the Fatigue Severity Scale (FSS). The rate of trait fatigue was different between groups, with MS participants showing the highest rate. Moreover, scores on functional tests and state fatigue were different between groups after the tests. Our results indicate that trait fatigue and state fatigue in individuals with SCI and MS are different with respect to able-bodied population. Both SCI and MS groups experienced more trait fatigue than control group in daily life. In addition, walking tasks produced similar levels of state fatigue between healthy people and patients with MS/SCI. However, these tests induced longer-lasting levels of state fatigue in the patients.
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Affiliation(s)
| | | | | | - Eva Díez-Rodríguez
- FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, 45004, Toledo, Spain
| | - Pablo Arias
- Department of Physiotherapy, Medicine and Biomedical Sciences and INEF Galicia, NEUROcom (Neuroscience and Motor Control Group) and Biomedical Institute of A Coruña (INIBIC), Universidade da Coruña, 15179, A Coruña, Spain
| | - Antonio Oliviero
- FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, 45004, Toledo, Spain.
- Advanced Rehabilitation Unit, Hospital Los Madroños, 28690, Brunete, Spain.
| | - Vanesa Soto-León
- FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, 45004, Toledo, Spain.
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Kartika L, Subadi I, Pawana IPA, Andriana M, Sugianto P. Correlation of fatigue on walking ability in myasthenia gravis patients: a cross-sectional study. Ann Med Surg (Lond) 2024; 86:115-120. [PMID: 38222720 PMCID: PMC10783269 DOI: 10.1097/ms9.0000000000001508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/03/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction Myasthenia gravis (MG) is a neuromuscular junction autoimmune disease characterised of intermittent muscle weakness that increases with activity and recovers with rest. Objective Analysing the correlation of fatigue on walking ability in MG patients. Methods This study used a cross-sectional design with consecutive sampling. Participants MG patients took in this trial. Data collection encompasses fatigue and walking ability, with fatigue being assessed using the fatigue severity scale (FSS) and walking ability being assessed using the 10-metre walking test. The 10-metre walking test assessment contains three components: comfortable walking speed (CWS), maximum walking speed (MWS), and natural cadence. The statistical analysis used in this study includes the Pearson correlation and Spearman rank tests with P<0.05. Results The number of participants was 23 MG patients, and most of the participant was female (69.6%). The participant's fatigue value was 5.46±1.13, including MGFA 1=5.32±1.15, MGFA 2A=5.5±1.11, and MGFA 2B=5.61±1.30. Meanwhile, the participant's walking abilities included CWS of 1.10±0.11 m/s, MWS of 1.31±0.15 m/s, and natural cadence of 110.91±7.74 steps/min. No significant correlation of fatigue on walking ability including FSS vs. CWS (r=-0.141; P=0.520), FSS vs MWS (r=-0.169; P=0.442), and FSS vs. natural cadence (r=-0.050; P=0.822). Conclusion There was no significant correlation between fatigue and walking ability in MG patients who had MGFA 1, MGFA 2A, and MGFA 2B.
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Affiliation(s)
- Lisa Kartika
- Study Program of Physical Medicine and Rehabilitation, Faculty of Medicine, Airlangga University
| | - Imam Subadi
- Departments of Physical Medicine and Rehabilitation
| | | | | | - Paulus Sugianto
- Neurology, Faculty of Medicine, Airlangga University—Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
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Kontaxis S, Laporta E, Garcia E, Martinis M, Leocani L, Roselli L, Buron MD, Guerrero AI, Zabala A, Cummins N, Vairavan S, Hotopf M, Dobson RJB, Narayan VA, La Porta ML, Costa GD, Magyari M, Sørensen PS, Nos C, Bailon R, Comi G. Automatic Assessment of the 2-Minute Walk Distance for Remote Monitoring of People with Multiple Sclerosis. Sensors (Basel) 2023; 23:6017. [PMID: 37447866 DOI: 10.3390/s23136017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/29/2023] [Accepted: 06/10/2023] [Indexed: 07/15/2023]
Abstract
The aim of this study was to investigate the feasibility of automatically assessing the 2-Minute Walk Distance (2MWD) for monitoring people with multiple sclerosis (pwMS). For 154 pwMS, MS-related clinical outcomes as well as the 2MWDs as evaluated by clinicians and derived from accelerometer data were collected from a total of 323 periodic clinical visits. Accelerometer data from a wearable device during 100 home-based 2MWD assessments were also acquired. The error in estimating the 2MWD was validated for walk tests performed at hospital, and then the correlation (r) between clinical outcomes and home-based 2MWD assessments was evaluated. Robust performance in estimating the 2MWD from the wearable device was obtained, yielding an error of less than 10% in about two-thirds of clinical visits. Correlation analysis showed that there is a strong association between the actual and the estimated 2MWD obtained either at hospital (r = 0.71) or at home (r = 0.58). Furthermore, the estimated 2MWD exhibits moderate-to-strong correlation with various MS-related clinical outcomes, including disability and fatigue severity scores. Automatic assessment of the 2MWD in pwMS is feasible with the usage of a consumer-friendly wearable device in clinical and non-clinical settings. Wearable devices can also enhance the assessment of MS-related clinical outcomes.
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Affiliation(s)
- Spyridon Kontaxis
- Laboratory of Biomedical Signal Interpretation and Computational Simulation (BSICoS), University of Zaragoza, 50018 Zaragoza, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28006 Barcelona, Spain
| | - Estela Laporta
- Laboratory of Biomedical Signal Interpretation and Computational Simulation (BSICoS), University of Zaragoza, 50018 Zaragoza, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28006 Barcelona, Spain
| | - Esther Garcia
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28006 Barcelona, Spain
- Department of Microelectronics and Electronic Systems, Autonomous University of Barcelona, 08193 Bellaterra, Spain
| | - Matteo Martinis
- Department of Medicine and Surgery, University Vita-Salute and Hospital San Raffaele, 20132 Milan, Italy
| | - Letizia Leocani
- Department of Medicine and Surgery, University Vita-Salute and Hospital San Raffaele, 20132 Milan, Italy
| | - Lucia Roselli
- Department of Medicine and Surgery, University Vita-Salute and Hospital San Raffaele, 20132 Milan, Italy
| | - Mathias Due Buron
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark
| | - Ana Isabel Guerrero
- Multiple Sclerosis Center of Catalonia (CEMCAT), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, 08035 Barcelona, Spain
| | - Ana Zabala
- Multiple Sclerosis Center of Catalonia (CEMCAT), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, 08035 Barcelona, Spain
| | - Nicholas Cummins
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | | | - Matthew Hotopf
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Richard J B Dobson
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | | | - Maria Libera La Porta
- Department of Medicine and Surgery, University Vita-Salute and Hospital San Raffaele, 20132 Milan, Italy
| | - Gloria Dalla Costa
- Department of Medicine and Surgery, University Vita-Salute and Hospital San Raffaele, 20132 Milan, Italy
| | - Melinda Magyari
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark
| | - Per Soelberg Sørensen
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark
| | - Carlos Nos
- Multiple Sclerosis Center of Catalonia (CEMCAT), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, 08035 Barcelona, Spain
| | - Raquel Bailon
- Laboratory of Biomedical Signal Interpretation and Computational Simulation (BSICoS), University of Zaragoza, 50018 Zaragoza, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28006 Barcelona, Spain
| | - Giancarlo Comi
- Department of Medicine and Surgery, University Vita-Salute and Hospital San Raffaele, 20132 Milan, Italy
- Casa di Cura del Policlinico, 20144 Milan, Italy
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Dreyer-Alster S, Menascu S, Aloni R, Givon U, Dolev M, Achiron A, Kalron A. Motoric cognitive risk syndrome in people with multiple sclerosis: prevalence and correlations with disease-related factors. Ther Adv Neurol Disord 2022; 15:17562864221109744. [PMID: 35813608 PMCID: PMC9260572 DOI: 10.1177/17562864221109744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/09/2022] [Indexed: 11/21/2022] Open
Abstract
Background: The motoric cognitive risk (MCR) syndrome, defined as the coexistence of slow
gait and subjective cognitive complaints, has as yet not been researched in
people with multiple sclerosis (pwMS). Objective: To examine the prevalence of the MCR syndrome in pwMS and its association
with disability, disease duration, perceived fatigue, and fear of
falling. Methods: The study comprised 618 pwMS [43.7 (SD = 12.6) years, 61.7% females]. Gait
speed was measured by the GAITRite™ electronic walkway (CIR Systems, Inc.
Haverton, PA, USA). Cognitive status was defined according to the global
cognitive score computed by the NeuroTrax™ cognitive battery (NeuroTrax
Corporation, Medina, NY, USA). The sample was divided into four main groups:
‘normal’, ‘cognitively impaired’, ‘gait impaired’ or ‘MCR’. Perceived
fatigue was assessed by the Modified Fatigue Impact Scale; fear of falling
by the Falls Efficacy Scale International. Results: Sixty-three (10.2%) patients were diagnosed with MCR. The percentage of
subjects categorized as MCR was 26.0% in severely disabled pwMS compared
with 10.9%, 6.0%, and 4.6% in moderately, mildly and very mildly disabled
pwMS, respectively. Subjects in the MCR group presented with elevated
fatigue compared with patients classified as normal [49.7 (SD = 23.3) vs
26.5 (SD = 19.2), p < 0.001]. Fear of falling was
significantly higher in the MCR and gait impairment groups compared with the
cognitively impaired and normal groups. Conclusions: The current study corroborates the presence of MCR in pwMS. Nevertheless,
future longitudinal research is warranted to better understand its
application.
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Affiliation(s)
| | - Shay Menascu
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Roy Aloni
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Uri Givon
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Mark Dolev
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Anat Achiron
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Alon Kalron
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Block VJ, Bove R, Nourbakhsh B. The Role of Remote Monitoring in Evaluating Fatigue in Multiple Sclerosis: A Review. Front Neurol 2022; 13:878313. [PMID: 35832181 PMCID: PMC9272225 DOI: 10.3389/fneur.2022.878313] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/06/2022] [Indexed: 11/21/2022] Open
Abstract
Fatigue is one of the most common multiple sclerosis (MS) symptoms. Despite this, monitoring and measuring fatigue (subjective lack of energy)- and fatigability (objectively measurable and quantifiable performance decline)- in people with MS have remained challenging. Traditionally, administration of self-report questionnaires during in-person visits has been used to measure fatigue. However, remote measurement and monitoring of fatigue and fatigability have become feasible in the past decade. Traditional questionnaires can be administered through the web in any setting. The ubiquitous availability of smartphones allows for momentary and frequent measurement of MS fatigue in the ecological home-setting. This approach reduces the recall bias inherent in many traditional questionnaires and demonstrates the fluctuation of fatigue that cannot be captured by standard measures. Wearable devices can assess patients' fatigability and activity levels, often influenced by the severity of subjective fatigue. Remote monitoring of fatigue, fatigability, and activity in real-world situations can facilitate quantifying symptom-severity in clinical and research settings. Combining remote measures of fatigue as well as objective fatigability in a single construct, composite score, may provide a more comprehensive outcome. The more granular data obtained through remote monitoring techniques may also help with the development of interventions aimed at improving fatigue and lowering the burden of this disabling symptom.
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Affiliation(s)
- Valerie J. Block
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States,*Correspondence: Valerie J. Block
| | - Riley Bove
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Bardia Nourbakhsh
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
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Moore H, Nair KPS, Baster K, Middleton R, Paling D, Sharrack B. Fatigue in multiple sclerosis: A UK MS-register based study. Mult Scler Relat Disord 2022; 64:103954. [PMID: 35716477 DOI: 10.1016/j.msard.2022.103954] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/28/2022] [Accepted: 06/06/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Fatigue is a widely experienced, incapacitating symptom of MS. It hinders daily functioning and has deleterious effects on quality of life. The UK MS Register is an online registry of over 20,000 participants with MS. The aim of this study was to estimate the prevalence, predictors, and impact of fatigue on people with MS using data from the UKMS register. METHODS All participants who completed the Fatigue Severity Scale (FSS), WebEDSS, Hospital Anxiety and Depression Scale (HADS) within 28 days of each other were selected from the UK MS Register. Data on age, gender, duration and type of MS, use of disease modifying drugs and comorbidities were obtained from the UKMS register. We categorised people with FSS score of 5 or more as with fatigue and those with scores of 4 or less as without fatigue. Descriptive statistics and logistical and multiple regressions were used to explore predictors of fatigue and the effect of fatigue on mobility (MS Walking Scale), physical and psychological aspects of life (MS Impact Scale) and quality of life (European Quality of Life 5D-3 L). RESULTS Amongst the 20,946 participants of the UK MS registry, 4620 completed FSS. Out of these, 775 (mean age= 54.71 years, SD= 10.90; mean duration of MS diagnosis =13.21 years, SD=9.75) had completed the FSS, Web EDSS and Hospital Anxiety and Depression Scale within 28 days of each other. 427 (55.1%) of pwMS had a FSS score >5 consistent with clinical fatigue. Logistic regression analysis showed that depression (p=<0.001), duration of MS (p = 0.017), secondary progressive MS (p = 0.001) and EDSS (p=<0.001) predicted fatigue. FSS scores had a significant negative impact on both psychological (p > 0.001) and physical (p > 0.001) domains of the MS Impact scale, MS walking scale (p = 0.003) and EQoL (p = 0.005). CONCLUSIONS Fatigue was a common symptom amongst people with MS. Depression, longer duration of MS, secondary progressive MS, and high EDSS predicted fatigue. Fatigue had an adverse effect on physical activities, mobility, psychological wellbeing, and quality of life of people with MS.
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Ramari C, Hvid LG, Dalgas U, Diniz AR, von Glehn F, de David AC. Implications of lower extremity muscle power and force for walking and fatigability in multiple sclerosis - An exploratory pilot-study. Clin Biomech (Bristol, Avon) 2022; 96:105668. [PMID: 35594782 DOI: 10.1016/j.clinbiomech.2022.105668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 04/15/2022] [Accepted: 05/11/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Limitations in physical function are common in Multiple Sclerosis (MS), yet it is neither clear how muscle power implicates physical function and walking-fatigability. This pilot-study aims to investigate (1) deficits in muscle power/force alongside walking in persons with MS; (2) associations between muscle power/force and physical functions and (3) the impact of prolonged walking in muscle power/force. METHODS 30 relapse-remitting persons with MS and 28 healthy controls performed chair rise and plantar flexion on a force platform before and after 12-minutes of intermittent walking to measure lower extremity muscle power/force. GaitRite measured walking speed. The percentage change in distance walked was also calculated. Persons with MS were classified into subgroups according to walking-fatigability and mobility disability status (Patient Determined Disease Steps). FINDINGS Higher deficits in muscle power compared to force were observed in persons with MS vs. healthy controls particularly in persons with MS having higher disability. Muscle power and force were associated with walking capacity, mobility disability and subjective fatigue, but not with percentage change in distance walked. Persons with MS slowed down over the course of the 12-min intermittent walking, whereas decrements in walking speed and muscle power/force (derived from chair rise) were observed in persons with MS presenting walking-fatigability only. INTERPRETATION Muscle power and force are impaired in persons with MS and appear to be critical for physical function in MS. This exploratory pilot study further suggests that muscle power/force from chair rise could contributes to walking-fatigability which therefore offer future treatment targets.
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Affiliation(s)
- Cintia Ramari
- Faculty of Physical Education, University of Brasília, Brasília, Brazil; Faculty of Rehabilitation Sciences, REVAL Rehabilitation Research Center, Hasselt University, Hasselt, Belgium.
| | - Lars G Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark; The Danish MS Hospitals, Ry and Haslev, Denmark
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Ana R Diniz
- Faculty of Ceilândia, University of Brasília, Brasília, Brazil
| | | | - Ana C de David
- Faculty of Physical Education, University of Brasília, Brasília, Brazil; Faculty of Ceilândia, University of Brasília, Brasília, Brazil
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Özden F, Ozkeskin M, Yüceyar N. The reliability and validity of the Turkish version of the fatigue assessment scale in patients with multiple sclerosis. NEUROL SCI NEUROPHYS 2022. [DOI: 10.4103/nsn.nsn_142_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Zanotto T, Sosnoff JJ, Ofori E, Golan D, Zarif M, Bumstead B, Buhse M, Kaczmarek O, Wilken J, Muratori L, Covey TJ, Gudesblatt M. Variability of Objective Gait Measures across the Expanded Disability Status Scale in People Living with Multiple Sclerosis: a cross-sectional retrospective analysis. Mult Scler Relat Disord 2022. [DOI: 10.1016/j.msard.2022.103645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 01/14/2022] [Accepted: 01/29/2022] [Indexed: 11/23/2022]
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Lavorgna L, Iaffaldano P, Abbadessa G, Lanzillo R, Esposito S, Ippolito D, Sparaco M, Cepparulo S, Lus G, Viterbo R, Clerico M, Trojsi F, Raganose P, Borriello G, Signoriello E, Palladino R, Moccia M, Brigo F, Troiano M, Tedeschi G, Bonavita S. Disability assessment using Google Maps. Neurol Sci 2021; 43:1007-1014. [PMID: 34142263 PMCID: PMC8211455 DOI: 10.1007/s10072-021-05389-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 06/07/2021] [Indexed: 02/04/2023]
Abstract
Objectives To evaluate the concordance between Google Maps® application (GM®) and clinical practice measurements of ambulatory function (e.g., Ambulation Score (AS) and respective Expanded Disability Status Scale (EDSS)) in people with multiple sclerosis (pwMS). Materials and methods This is a cross-sectional multicenter study. AS and EDSS were calculated using GM® and routine clinical methods; the correspondence between the two methods was assessed. A multinomial logistic model is investigated which demographic (age, sex) and clinical features (e.g., disease subtype, fatigue, depression) might have influenced discrepancies between the two methods. Results Two hundred forty-three pwMS were included; discrepancies in AS and in EDDS assessments between GM® and routine clinical methods were found in 81/243 (33.3%) and 74/243 (30.4%) pwMS, respectively. Progressive phenotype (odds ratio [OR] = 2.8; 95% confidence interval [CI] 1.1–7.11, p = 0.03), worse fatigue (OR = 1.03; 95% CI 1.01–1.06, p = 0.01), and more severe depression (OR = 1.1; 95% CI 1.04–1.17, p = 0.002) were associated with discrepancies between GM® and routine clinical scoring. Conclusion GM® could easily be used in a real-life clinical setting to calculate the AS and the related EDSS scores. GM® should be considered for validation in further clinical studies. Supplementary Information The online version contains supplementary material available at 10.1007/s10072-021-05389-7.
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Affiliation(s)
- Luigi Lavorgna
- Italian Neurological Society (SIN), First Division of Neurology, Department of Advanced Medical and Surgical Sciences, AOU-University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy.
| | - Pietro Iaffaldano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy
| | - Gianmarco Abbadessa
- Second Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Via Sergio Pansini 5, 80131, Naples, Italy
| | - Roberta Lanzillo
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
| | - Sabrina Esposito
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy.,Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Domenico Ippolito
- First Division of Neurology, Department of Advanced Medical and Surgical Sciences, AOU-University of Campania "Luigi Vanvitelli", P.zza Miraglia 2, Naples, Italy
| | - Maddalena Sparaco
- Second Division of Neurology, Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU-University of Campania "Luigi Vanvitelli", via Sergio Pansini 5, 80131, Naples, Italy
| | - Simone Cepparulo
- Second Division of Neurology, Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU-University of Campania "Luigi Vanvitelli", via Sergio Pansini 5, 80131, Naples, Italy
| | - Giacomo Lus
- Second Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Via Sergio Pansini 5, 80131, Naples, Italy
| | - Rosa Viterbo
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy
| | - Marinella Clerico
- Clinical and Biological Sciences Department, University of Torino, Turin, Italy
| | - Francesca Trojsi
- First Division of Neurology, Department of Advanced Medical and Surgical Sciences, AOU-University of Campania "Luigi Vanvitelli", P.zza Miraglia 2, 80138, Naples, Italy
| | - Paolo Raganose
- Department of Experimental, Biomedicine and Clinical Neurosciences, University of Palermo, 90129, Palermo, Italy
| | | | - Elisabetta Signoriello
- Second Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Via Sergio Pansini 5, 80131, Naples, Italy
| | | | - Marcello Moccia
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
| | - Francesco Brigo
- UOC di Neurologia, Ospedale Di Merano (SABES-ASDAA), Via Rossini, 5, 39012, Merano-Meran, BZ, Italy
| | - Maria Troiano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy
| | - Gioacchino Tedeschi
- First Division of Neurology, Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138, Naples, Italy
| | - Simona Bonavita
- Second Division of Neurology, Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU-University of Campania "Luigi Vanvitelli", via Sergio Pansini 5, 80131, Naples, Italy
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Carpinella I, Gervasoni E, Anastasi D, Di Giovanni R, Tacchino A, Brichetto G, Confalonieri P, Rovaris M, Solaro C, Ferrarin M, Cattaneo D. Instrumentally assessed gait quality is more relevant than gait endurance and velocity to explain patient-reported walking ability in early-stage multiple sclerosis. Eur J Neurol 2021; 28:2259-2268. [PMID: 33864413 DOI: 10.1111/ene.14866] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/07/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE People with multiple sclerosis (PwMS) often report walking limitations even when the gold standard Expanded Disability Status Scale (EDSS) indicates normal walking endurance/autonomy. The present multicenter study on early-stage PwMS aims at analyzing which aspects are associated with patient-reported walking limitations measured with the 12-item Multiple Sclerosis Walking Scale (MSWS-12). METHODS Eighty-two PwMS (EDSS ≤ 2.5) were assessed using the Fullerton Advanced Balance Scale-short (FAB-s), the Fatigue Severity Scale (FSS) and the 6-min Walk Test (6MWT), the latter administered also to 21 healthy subjects. Participants performed the 6MWT wearing three inertial sensors on ankles and trunk. Instrumented metrics describing gait velocity (stride length and frequency) and quality (regularity, symmetry, instability) were computed from sensor data. Fatigue (FSS), balance (FAB-s), walking endurance (6MWT) and instrumented metrics were entered in a multiple regression model with MSWS-12 as dependent variable. RESULTS Gait symmetry, gait instability, fatigue and balance were significantly associated with self-rated walking ability, whilst walking endurance and velocity were not. Fatigue, balance, gait symmetry and instability were more impaired in participants reporting mild-to-moderate (MSMM-PWL , 25 ≤ MSWS-12 < 75) compared to those reporting none-to-minimal (MSnm-PWL , 0 ≤ MSWS-12 ≤ 25) perceived walking limitations. Compared to healthy subjects, gait symmetry and stability were reduced in MSnm-PWL and MSMM-PWL , even in those participants with EDSS ≤ 1.5. CONCLUSION Instrumentally assessed gait quality aspects (symmetry and instability) are associated with patient-reported walking ability in early-stage PwMS and seem sensitive biomarkers to detect subtle impairments even in the earliest stages of the disease (EDSS ≤ 1.5). Future studies should assess their ability to follow walking change due to MS progression or pharmacological/rehabilitation interventions.
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Affiliation(s)
| | | | | | | | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | | | | | | | | | - Davide Cattaneo
- IRCSS Fondazione Don Carlo Gnocchi, Milan, Italy.,Department of Physiopathology and Transplants, University of Milan, Milan, Italy
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12
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Hadouiri N, Monnet E, Gouelle A, Decavel P, Sagawa Y. Evaluation of Prolonged Walking in Persons with Multiple Sclerosis: Reliability of the Spatio-Temporal Walking Variables during the 6-Minute Walk Test. Sensors (Basel) 2021; 21:s21093075. [PMID: 33925075 PMCID: PMC8125198 DOI: 10.3390/s21093075] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/10/2021] [Accepted: 04/26/2021] [Indexed: 12/11/2022]
Abstract
Background: Walking disorders represent the most disabling condition in persons with Multiple Sclerosis (PwMS). Several studies showed good reliability of the 6-min walk test (6MWT) (i.e., especially distance traveled), but little is known about the reliability of the Spatio-temporal (ST) variables in the 6MWT. Objective: To evaluate the test-retest reliability of ST variables and perceived exertion during the 6MWT in PwMS and comparable healthy persons. Methods: We explored three 1-min intervals (initial: 0′–1′, middle: 2′30″–3′30″, end: 5′–6′) of the 6MWT. Six ST variables and perceived exertion were measured (respectively, using the GAITRite system and the Borg Scale). These measurements were performed twice, 1 week apart. The test-retest effects were assessed using the intraclass correlation coefficient (ICC) or the weighted kappa. Results: Forty-five PwMS and 24 healthy persons were included. The test-retest reliability of ST variables values was good-to-excellent for PwMS (ICC range: 0.858–0.919) and moderate-to-excellent for healthy persons (ICC range: 0.569–0.946). The test-retest reliability values of perceived exertion were fair for PwMS (weighted kappa range: 0.279–0.376) and substantial for healthy persons (weighted kappa range: 0.734–0.788). Conclusion: The measurement of ST variables during these 6MWT intervals is reliable and applicable in clinical practice and research to adapt rehabilitation care in PwMS.
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Affiliation(s)
- Nawale Hadouiri
- Laboratory of Clinical Functional Exploration of Movement, University Hospital of Besançon, F-25000 Besançon, France; (P.D.); (Y.S.)
- Clinical Investigation Center, University Hospital of Besançon, INSERM 1431, F-25000 Besançon, France;
- Department of Physical Medicine and Rehabilitation, Dijon-Bourgogne University Hospital, F-21000 Dijon, France
- Correspondence:
| | - Elisabeth Monnet
- Clinical Investigation Center, University Hospital of Besançon, INSERM 1431, F-25000 Besançon, France;
| | - Arnaud Gouelle
- Gait and Balance Academy, ProtoKinetics, Havertown, PA 19083, USA;
- Laboratory Performance, Santé, Métrologie, Société (EA7507), UFR STAPS, F-51100 Reims, France
| | - Pierre Decavel
- Laboratory of Clinical Functional Exploration of Movement, University Hospital of Besançon, F-25000 Besançon, France; (P.D.); (Y.S.)
- Integrative and Clinical Neurosciences EA481, Bourgogne Franche-Comte University, F-25000 Besançon, France
- Rehabilitation Department, HFR, CH-1700 Fribourg, Switzerland
| | - Yoshimasa Sagawa
- Laboratory of Clinical Functional Exploration of Movement, University Hospital of Besançon, F-25000 Besançon, France; (P.D.); (Y.S.)
- Clinical Investigation Center, University Hospital of Besançon, INSERM 1431, F-25000 Besançon, France;
- Integrative and Clinical Neurosciences EA481, Bourgogne Franche-Comte University, F-25000 Besançon, France
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13
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Theunissen K, Plasqui G, Boonen A, Brauwers B, Timmermans A, Meyns P, Meijer K, Feys P. The Relationship Between Walking Speed and the Energetic Cost of Walking in Persons With Multiple Sclerosis and Healthy Controls: A Systematic Review. Neurorehabil Neural Repair 2021; 35:486-500. [PMID: 33847188 PMCID: PMC8135251 DOI: 10.1177/15459683211005028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Persons with multiple sclerosis (pwMS) experience walking impairments, characterized by decreased walking speeds. In healthy subjects, the self-selected walking speed is the energetically most optimal. In pwMS, the energetically most optimal walking speed remains underexposed. Therefore, this review aimed to determine the relationship between walking speed and energetic cost of walking (Cw) in pwMS, compared with healthy subjects, thereby assessing the walking speed with the lowest energetic cost. As it is unclear whether the Cw in pwMS differs between overground and treadmill walking, as reported in healthy subjects, a second review aim was to compare both conditions. METHOD PubMed and Web of Science were systematically searched. Studies assessing pwMS, reporting walking speed (converted to meters per second), and reporting oxygen consumption were included. Study quality was assessed with a modified National Heart, Lung and Blood Institute checklist. The relationship between Cw and walking speed was calculated with a second-order polynomial function and compared between groups and conditions. RESULTS Twenty-nine studies were included (n = 1535 pwMS) of which 8 included healthy subjects (n = 179 healthy subjects). PwMS showed a similar energetically most optimal walking speed of 1.44 m/s with a Cw of 0.16, compared with 0.14 mL O2/kg/m in healthy subjects. The most optimal walking speed in treadmill was 1.48 m/s, compared with 1.28 m/s in overground walking with a similar Cw. CONCLUSION Overall, the Cw is elevated in pwMS but with a similar energetically most optimal walking speed, compared with healthy subjects. Treadmill walking showed a similar most optimal Cw but a higher speed, compared with overground walking.
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Affiliation(s)
- Kyra Theunissen
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, The Netherlands.,Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, and Care and Public Health Research Institute, The Netherlands.,Rehabilitation Research Center, REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Belgium
| | - Guy Plasqui
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, The Netherlands
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, and Care and Public Health Research Institute, The Netherlands
| | - Bente Brauwers
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, The Netherlands
| | - Annick Timmermans
- Rehabilitation Research Center, REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Belgium
| | - Pieter Meyns
- Rehabilitation Research Center, REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Belgium
| | - Kenneth Meijer
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, The Netherlands
| | - Peter Feys
- Rehabilitation Research Center, REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Belgium.,Universitair MS Centrum, Belgium
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14
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Van Geel F, Hvid LG, Van Noten P, Eijnde BO, Dalgas U, Feys P. Is maximal muscle strength and fatigability of three lower limb muscle groups associated with walking capacity and fatigability in multiple sclerosis? An exploratory study. Mult Scler Relat Disord 2021; 50:102841. [PMID: 33621946 DOI: 10.1016/j.msard.2021.102841] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/04/2021] [Accepted: 02/07/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Both muscle fatigability and walking fatigability are prevalent in persons with MS (pwMS), but their associations remains unclear. The aim of this study was to examine the association of muscle strength and fatigability from both isometric and concentric protocols of three different muscle groups, and their association to walking capacity and walking fatigability. METHODS Twenty-seven pwMS and 13 Healthy Controls (HC) were included in this exploratory study. All participants performed a six-minute walking test (6MWT), where the distance walked index (DWI) was calculated to measure walking fatigability with a cut-off score of -10%. In three different muscle groups (knee extensors (KE), knee flexors (KF), ankle dorsiflexors (DF)), isometric and concentric muscle fatigability protocols (FIisometric or FIconcentric) were used to quantify maximal voluntary contraction (MVC) and muscle fatigability. Pearson or Spearman correlation coefficients and linear regression models were calculated to establish the association between muscle strength/fatigability and walking capacity/fatigability. RESULTS Higher MVCs values for all muscle groups were found in HC compared to pwMS (mainly those having walking fatigability) (p < 0.05). FIisometric of DF was lower in pwMS having walking fatigability compared to no walking fatigability. MVC of KE, KF and DF had a low to moderate association with walking capacity (range r = 0.52-0.56; p < 0.05) and walking fatigability in pwMS (range r-rs: 0.39-0.50; p<0.05). FIconcentric of KF and DF, but not of KE, were associated with walking fatigability (r = 0.39 and rs = 0.47, respectively; p < 0.05). In contrast, FIisometric for all muscle groups were not related to walking capacity or walking fatigability. CONCLUSION MVC of KE, KF and DF are associated with walking capacity and walking fatigability, while concentric (but not isometric) muscle fatigability of KF and DF are associated with walking fatigability.
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Affiliation(s)
- Fanny Van Geel
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Belgium; UMSC, Hasselt-Pelt, Belgium.
| | - Lars G Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Denmark.
| | - Pieter Van Noten
- SMRC Sports Medical Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, 3590 Diepenbeek, Belgium; Anatomy and Embryology department, Faculty of Health, Medicine and Life Sciences, University of Maastricht, the Netherlands.
| | - Bert O Eijnde
- UMSC, Hasselt-Pelt, Belgium; SMRC Sports Medical Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, 3590 Diepenbeek, Belgium.
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Denmark.
| | - Peter Feys
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Belgium; UMSC, Hasselt-Pelt, Belgium.
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15
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Johansson S, Skjerbæk AG, Nørgaard M, Boesen F, Hvid LG, Dalgas U. Associations between fatigue impact and lifestyle factors in people with multiple sclerosis - The Danish MS hospitals rehabilitation study. Mult Scler Relat Disord 2021; 50:102799. [PMID: 33582566 DOI: 10.1016/j.msard.2021.102799] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The lack of medical treatment options to reduce fatigue in patients with multiple sclerosis (MS) emphasize the importance of identifying potential non-pharmacological modifiable factors, as this may help advance current treatment strategies. The aim of this study was to identify potential modifiable lifestyle factors as well as patient- and disease-related characteristics, that are associated with fatigue in a large sample of clinically well-characterized patients with MS. METHODS This study was a secondary analysis of a pragmatic randomized controlled trial of inpatient multidisciplinary rehabilitation in Denmark. MS patients aged 18 to 65 years and with a disease severity score ≤ 7.5 according to the Expanded Disability Status Scale participated. Data on patient- and disease-related characteristics, fatigue impact (Modified Fatigue Impact Scale (MFIS)), and on lifestyle factors (tobacco smoking, alcohol intake, and physical activity), were collected at baseline. A linear mixed model was used to compare MFIS total, physical, cognitive, and psychosocial scores across subgroups of selected characteristics. Regression analyses were used to examine associations between lifestyle factors and MFIS total, physical, cognitive, and psychosocial scores. RESULTS In the sample of 417 MS patients, median age was 51 years, 69% were female, median time since diagnosis was 8 years, with 41% having relapsing remitting MS. Higher MFIS total scores were observed in MS patients with shorter time since diagnosis, being a tobacco smoker, and not undertaking regular physical activity. Somewhat similar findings were observed for MFIS subscores (physical, cognitive, psychosocial), especially MFIS physical scores. In the multivariate analyses, physical activity was significantly associated with fatigue impact on total, physical and psychosocial functioning. Tobacco smoking was significantly associated with fatigue impact on psychosocial functioning. Alcohol intake was not associated with fatigue impact. None of the lifestyle factors were associated with fatigue impact on cognitive functioning. In the adjusted models time since diagnosis was significantly associated with fatigue impact on total, physical and cognitive functioning, as was disease severity with fatigue impact on physical and cognitive functioning. CONCLUSION Physical activity showed the most pronounced associations with fatigue impact on physical and psychosocial functioning, while the impact on cognitive functioning showed a trend. Tobacco smoking contributed significantly to impact on psychosocial functioning, while alcohol intake did not contribute to fatigue impact. Introducing or supporting maintenance of physical activity/exercise and cessation of tobacco smoking seems to be a useful approach for rehabilitation services to help patients with MS manage fatigue.
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Affiliation(s)
- Sverker Johansson
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Allied Health Professionals Function, Medical Unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.
| | | | | | - Finn Boesen
- MS Hospitals in Denmark, Ry and Haslev, Denmark
| | - Lars G Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
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16
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Veldhuijzen van Zanten J, Douglas MR, Ntoumanis N. Fatigue and fluctuations in physical and psychological wellbeing in people with multiple sclerosis: A longitudinal study. Mult Scler Relat Disord 2020; 47:102602. [PMID: 33176231 DOI: 10.1016/j.msard.2020.102602] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/22/2020] [Accepted: 10/23/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Fatigue is a highly prevalent and disabling symptom of multiple sclerosis (MS). The aetiology remains unclear, potentially resulting from neuroinflammatory or neurodegenerative processes, mood disturbance, MS symptoms including pain, poor sleep, physical decompensation or medication side effects. Cross-sectional associations have been reported between fatigue and markers of physical and psychological health in people with MS. The current study examined if fluctuations in markers of physical and psychological wellbeing were associated with between-person differences in fatigue in MS. METHODS Longitudinal data of up to 7 years was available of 3369 people with MS who were enrolled in the UK MS Register. Participants completed MS impact scale ratings and MS walking scales up to 4 times per year for up to 7 years. Fatigue was assessed at one time point using the Fatigue Severity Scale. Multilevel analyses were conducted to examine the degree of variance in the outcome measures accounted for by fatigue. RESULTS Fatigue was associated with fluctuations in depression, MS impact, and walking ability, and to a lesser extent with fluctuations in anxiety and perceived health status. Interference of fatigue in participation in social activities and work-related responsibilities and the physical effects of fatigue were most strongly related to MS-related outcomes. CONCLUSION Given the strong associations between fatigue and many MS outcomes, fatigue management interventions are likely to impact on different aspects of physical and psychological wellbeing in MS.
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Affiliation(s)
- Jet Veldhuijzen van Zanten
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK; Department of Neurology, Dudley Group NHS Foundation Trust, Russells Hall Hospital, Birmingham, UK.
| | - Michael R Douglas
- Department of Neurology, Dudley Group NHS Foundation Trust, Russells Hall Hospital, Birmingham, UK; College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Nikos Ntoumanis
- Physical Activity and Well-Being Research Group, School of Psychology, Curtin University, Western Australia, Australia
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17
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Abstract
Very limited progress has been made to date in the treatment of
debilitating Multiple Sclerosis (MS) daily onset symptoms. These daily
symptoms include motor, sensory, and cognitive impairments as well as
an overwhelming feeling of tiredness, often referred to as “MS
fatigue.” Although widely cited as a main cause of inability to work
and poor quality of life in patients with MS, daily onset MS-related
tiredness continues to defy definition, and, consequently, measurement
and treatment. Beginning with a historical overview of observations of
daily onset MS-related tiredness, this Topical Review demonstrates how
the misnomer “MS fatigue” has introduced ongoing misunderstanding for
patients, investigators, clinicians, and therapists. Finally,
combining current findings in clinical neuroscience with the striking
set of long-standing commonalities present throughout the past
200 years of clinical observations, we underscore the immediate
necessity for conceptual and applied change, to be initiated by the
renaming of this distinct syndrome.
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Affiliation(s)
- Amy Lynn Hubbard
- Department of Neurology, Psychosomatic Medicine, and Psychiatry, Institute of Health Promotion and Clinical Movement Science, German Sport University Cologne, Cologne, Germany
| | - Heidrun Golla
- Department of Palliative Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Hedda Lausberg
- Department of Neurology, Psychosomatic Medicine, and Psychiatry, Institute of Health Promotion and Clinical Movement Science, German Sport University Cologne, Cologne, Germany
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18
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Monjezi S, Molhemi F, Shaterzadeh Yazdi MJ, Salehi R, Mehravar M, Kashipazha D. Responsiveness and clinically meaningful changes for the Persian versions of the multiple sclerosis walking scale-12 and the modified fatigue impact scale following balance and gait rehabilitation in people with multiple sclerosis. Physiother Theory Pract 2020; 38:464-470. [PMID: 32431220 DOI: 10.1080/09593985.2020.1762267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background and Purpose: The Multiple sclerosis walking scale-12 (MSWS-12) and the Modified Fatigue Impact Scale (MFIS) are two popular outcome measures applied widely for assessing self-perceived walking ability and fatigue in people with multiple sclerosis (PwMS). The present study aimed to examine responsiveness and clinically meaningful changes for the Persian versions of the MSWS-12 and the MFIS following balance and gait rehabilitation in PwMS.Methods: Fifty-eight PwMS completed the Persian versions of the MSWS-12 and the MFIS before and after 4 weeks of balance and gait rehabilitation. Also, a 7-point global rating scale as an external criterion of change was completed at the post-intervention evaluation. The area under the receiver operating characteristics curve (AUC) and the correlation analysis were used to assess the responsiveness. In addition, the minimally clinically important change (MCIC) was measured to determine clinically meaningful changes following rehabilitation.Results: The AUC values for the Persian MSWS-12 and MFIS were 0.74 and 0.73, respectively. There were good to excellent correlations between the global rating scale of change and the Persian MSWS-12 (Gamma = 0.77) also MFIS (Gamma = 0.80) change scores (p = .001). Moreover, the MCICs of 7.5 and 4 points were obtained for the Persian MSWS-12 and MFIS, respectively.Conclusion: The Persian versions of the MSWS-12 and the MFIS were responsive outcome measures for monitoring changes in walking and fatigue after balance and gait rehabilitation in PwMS. The calculation of MCIC values would enhance the interpretation of changes in clinical and research settings.
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Affiliation(s)
- Saeideh Monjezi
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Farshad Molhemi
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Reza Salehi
- Rehabilitation Research Center, Department of Rehabilitation Management, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mehravar
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Davood Kashipazha
- Department of Neurology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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19
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Zuber P, Tsagkas C, Papadopoulou A, Gaetano L, Huerbin M, Geiter E, Altermatt A, Parmar K, Ettlin T, Schuster-amft C, Suica Z, Alrasheed H, Wuerfel J, Kesselring J, Kappos L, Sprenger T, Magon S. Efficacy of inpatient personalized multidisciplinary rehabilitation in multiple sclerosis: behavioural and functional imaging results. J Neurol 2020; 267:1744-53. [DOI: 10.1007/s00415-020-09768-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 01/23/2020] [Accepted: 02/19/2020] [Indexed: 01/31/2023]
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20
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Kalron A, Menascu S, Frid L, Aloni R, Achiron A. Physical activity in mild multiple sclerosis: contribution of perceived fatigue, energy cost, and speed of walking. Disabil Rehabil 2019; 42:1240-1246. [PMID: 30620227 DOI: 10.1080/09638288.2018.1519603] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Purpose: To clarify the relationship between leisure-time physical activity, perceived fatigue, and energy expenditure while walking in people with multiple sclerosis.Methods: Sixty-six people afflicted with multiple sclerosis (MS) (32 women) with a mild neurological disability, participated in this study. Energy expenditure was separately measured at rest, during comfortable walking and during fast walking via a portable metabolic device using breath-by-breath technology (COSMED K5, COSMED Srl, Rome, Italy). The Godin leisure-time exercise questionnaire assessed leisure-time physical activity. The Modified Fatigue Impact Scale determined the level of perceived fatigue.Results: Seventeen people with MS were classified as physically active; 49 were insufficiently active. Scores recorded on the Godin Leisure-Time Exercise Questionnaire were 47.8 (SD = 18.4), 7.0 (SD = 8.2), respectively. Insufficiently physically active people with MS walked slower at both normal and fast walking conditions. However, no differences between groups were observed in energy expenditure measures in both walking speeds. O2 cost was 0.20 (SD = 0.13) and 0.21 (SD = 0.06) in the active and insufficiently active group, respectively. The insufficiently active group reported more perceived fatigue compared with the active patients; 33.3 (SD = 18.6) vs. 15.0 (SD = 19.0), p value = 0.002. Perceived fatigue was a significant variable maintaining a 10.4% variance related to leisure-time physical activity.Conclusions: Leisure-time physical activity was inversely associated with perceived fatigue and walking speed in persons with mild MS. Rehabilitation professionals should be aware of these relationships when planning rehabilitation strategies.Implication for rehabilitationThis study found that perceived fatigue is a barrier to physical activity participation even in people with mild multiple sclerosis and minimal disability.Insufficiently active people with multiple sclerosis expend the same amount of energy while walking as active multiple sclerosis individuals, though walking slower.The relationship between perceived fatigue and physical activity participation requires further exploration in the multiple sclerosis population.
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Affiliation(s)
- Alon Kalron
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, and Sagol School of Neurosciences, Tel-Aviv University, Tel Aviv, Israel
| | - Shay Menascu
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Lior Frid
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Roy Aloni
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Anat Achiron
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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21
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Valet M, Lejeune T, Devis M, van Pesch V, El Sankari S, Stoquart G. Timed Up-and-Go and 2-Minute Walk Test in patients with multiple sclerosis with mild disability: reliability, responsiveness and link with perceived fatigue. Eur J Phys Rehabil Med 2018; 55:450-455. [PMID: 30311490 DOI: 10.23736/s1973-9087.18.05366-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Mobility limitations are frequent in patients with multiple sclerosis (MS), and could already be present in patients with so-called mild neurological disability (Expanded Disability Status Scale≤4). Assessing mobility in these patients is therefore of paramount importance. Timed Up-and-Go Test (TUG) and 2-Minute Walk Test (2MWT) are two clinically feasible tests which reliability and responsiveness are unknown among these patients. Whether fatigue, which is the number one symptom among these patients, is linked to these limitations remains unknown. AIM The aim of this study was to explore the intrarater reliability and minimal detectable change (MDC95), as an index of responsiveness, of TUG and 2MWT. To explore their link with perceived fatigue among patients with MS. DESIGN Cross-sectional observational study, including two measures. SETTING Two university hospital outpatient centers. POPULATION Patients (N.=63, 49 seen twice) with MS with mild disability (Expanded Disability Status Scale≤4). METHODS 2MWT and TUG were performed twice in one occasion, and repeated 2 weeks later. Modified fatigue impact scale (MFIS) was used to assess fatigue. Intraclass coefficient correlations were calculated for immediate and 2-week reliability. MDC95 were computed. Correlations between mobility indices and fatigue were explored using Spearman's ρ. RESULTS Mobility was impaired in comparison to normative values (2MWT: -4.9% from normative distance; TUG: +32% from normative time). The immediate reliability was excellent for both the 2MWT (ICC=0.98) and TUG (ICC=0.98). Reliability at 2 weeks was excellent for 2MWT (ICC=0.95) and very good for TUG (ICC=0.90). MDC95 were respectively 20m (2MWT) and 1.3s (TUG). Both measures were significantly weakly correlated to total MFIS (ρ=-0.37 and 0.39, respectively; P<0.01). CONCLUSIONS The 2MWT and TUG are highly reliable and responsive in the assessment of respectively the walking capacity and general mobility of patients with MS with mild disability. Mobility impairments are linked to perceived fatigue among these patients. CLINICAL REHABILITATION IMPACT TUG and 2MWT are easy to administer and could be reliably used in so called mildly disabled patients with MS to assess mobility limitation.
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Affiliation(s)
- Maxime Valet
- Department of Health Sciences, Institute of Experimental and Clinical Research, Neuromusculoskeletal Lab (NMSK), Catholic University of Louvain, Brussels, Belgium - .,Department of Physical Medicine and Rehabilitation, Saint-Luc University Clinic, Brussels, Belgium -
| | - Thierry Lejeune
- Department of Health Sciences, Institute of Experimental and Clinical Research, Neuromusculoskeletal Lab (NMSK), Catholic University of Louvain, Brussels, Belgium.,Department of Physical Medicine and Rehabilitation, Saint-Luc University Clinic, Brussels, Belgium
| | - Marine Devis
- Department of Physical Medicine and Rehabilitation, Saint-Luc University Clinic, Brussels, Belgium
| | - Vincent van Pesch
- Department of Neurology, Saint-Luc University Clinic, Brussels, Belgium
| | | | - Gaëtan Stoquart
- Department of Health Sciences, Institute of Experimental and Clinical Research, Neuromusculoskeletal Lab (NMSK), Catholic University of Louvain, Brussels, Belgium.,Department of Physical Medicine and Rehabilitation, Saint-Luc University Clinic, Brussels, Belgium
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