What is the distribution of trunk impairments and its relationship with disability level in individuals with multiple sclerosis?

The relationship between trunk function and spasticity in people with multiple sclerosis

BACKGROUND

As People with multiple sclerosis (PWMS) experience greater disability, their ability to control their trunk diminishes, indicating that trunk control should be a focus as the disease advances. Spasticity is another complication that leads to disability in people with multiple sclerosis is spasticity. Patients who do not have proper trunk control and an inappropriate length-tension relationship have less capacity for lower extremity movements and high tonicity in the lower limb muscles.

METHODS

Sixty-six women and men with multiple sclerosis between the ages of 20-50 who have moderate disability participated in this study. An evaluation of the relationship between trunk control and spasticity has been carried out. Trunk motor control was assessed using the Trunk Impairment Scale (TIS) and spasticity was assessed using the Multiple Sclerosis Spasticity Scale-88 (MSSS-88). Trunk motor control was assessed with the Trunk Impairment Scale (TIS) and spasticity with the Multiple Sclerosis Spasticity Scale 88 (MSSS-88).

RESULTS

The MSSS-88 total score was negatively correlated with the TIS score (b = -0.011, 95% CI: 0.018 to -0.003, P = 0.006). A 1-point increase in the MSSS-88 total score was associated with a 0.011-point decrease in the TIS score.

CONCLUSION

It was revealed that the Trunk function was associated with spasticity in PWMS. The core function has an inverse relationship with spasticity. The better the core functions of PWMS, the less spasticity they will have.

The effect of proprioceptive neuromuscular facilitation techniques on pain, motor functions, fatigue and health related quality of life in individuals with multiple sclerosis: a randomized, single-blind study

PURPOSE

This study aimed to evaluate the effects of PNF on pain, motor function, fatigue, and quality of life in MS patients.

METHOD

A randomized, controlled, single-blind study was conducted. Forty-four patients were randomly assigned to either the PNF Group (PNFG, n = 22, 16 female) or the Control Group (CG, n = 22, 16 female). PNFG underwent supervised combined aerobic and PNF training thrice weekly for 8 weeks, while CG followed a home exercise regimen. Various measures were employed, including the Visual Analogue Scale (VAS) for pain, Timed Up and Go (TUG) test, Functional Reach Test (FRT), Six-Minute Walk Test (6-MWT), Fatigue Severity Scale (FSS), Fatigue Impact Scale (FIS), Dexterity Questionnaire-24 (DextQ-24) and Multiple Sclerosis Quality of Life-54 (MSQoL-54).

RESULTS

PNFG exhibited significant improvements in VAS (p = 0.000), FRT (p = 0.001), TUG (p = 0.000), 6-MWT (p = 0.000), FIS (p = 0.007), DextQ-24 (p = 0.033), MSQoL-54 scores (Physical Health Composite, Mental Health Composite, p = 0.005, p = 0.002, respectively) (p < 0.05). CG also showed improvements in VAS (p = 0.018), TUG (p = 0.000), 6-MWT (p = 0.000), FSS (p = 0.006), psychosocial function (p = 0.007), MSQoL-54 (Physical Health Composite, Mental Health Composite, p = 0.017, p = 0.001, respectively), DextQ-24 ADL scores (p = 0.045) (p < 0.05). PNFG outperformed CG in DextQ-24 (Dressing, p = 0.038) and MSQoL-54 subscales (emotional well-being, energy, health perception, p = 0.007, p = 0.037, p = 0.044, respectively) (p < 0.05).

CONCLUSIONS

This is the first randomized controlled trial to show that PNF improves upper limb motor function (skill) and quality of life in MS patients. PNF and home physiotherapy effectively improved pain, motor function, fatigue and quality of life, with the PNF group achieving better outcomes. Both modalities offered accessible rehabilitation options.

Measurement properties of the Trunk Impairment Scale-modified Norwegian version among people with mild to moderate multiple sclerosis

PURPOSE

The Trunk Impairment Scale-modified Norwegian version (TIS-modNV) measures trunk control for clinical and research purposes. This study examined the validity and reliability of the TIS-modNV in people with multiple sclerosis (pwMS).

MATERIALS AND METHODS

Sixty-eight pwMS (mild to moderate) participated. The TIS-modNV and the Mini-Balance Evaluation Systems Test (Mini-BESTest) scores were compared for construct validity using Spearman's rho (rs). TIS-modNV performance was videotaped and rated by four physiotherapists on two occasions. The inter- and intrarater reliability was analyzed via intraclass correlation coefficients (ICC), standard errors of measurement (SEM), Bland-Altman plots, and kappa statistics (k).

RESULTS

Validity was demonstrated (rs = 0.55-0.61). Interrater reliability for the total score was moderate to good (ICC(A,1) =0.67; ICC(C,1) = 0.78), and the SEM was 2 points (12.8%). Interrater reliability varied across the rater pairs (ICC(A,1) = 0.54-0.81) as displayed in the Bland-Altman plots. Item-level interrater agreement varied from poor to good (k = 0.10-0.79). Intrarater reliability of the total scores was moderate to good (ICC(A,1) = 0.67-0.82).

CONCLUSION

This study supports the construct validity and overall reliability of the TIS-modNV in pwMS with mild to moderate disability. However, variations in rater reliability need to be addressed.

Trunk control in people with multiple sclerosis with different disability level: a cross-sectional study

BACKGROUND

Trunk control is significant for a quality movement. Trunk control is reduced in people with Multiple Sclerosis compared to healthy individuals.

OBJECTIVE

The study aims to compare trunk control in people with Multiple Sclerosis according to disability level and to examine the relationship between disability level and trunk control.

METHODS

A total of one hundred-two people with Multiple Sclerosis were included in the study. The disability level was recorded with the Expanded Disability Status Scale score. Trunk control was evaluated with the Trunk Impairment Scale and core stability tests. Additionally, people with Multiple Sclerosis were divided into subgroups according to their disability levels (Expanded Disability Status Scale ≤ 3 and ≥ 3.5).

RESULTS

Trunk Impairment Scale scores and core stability test results were statistically significantly lower in the group of people with Multiple Sclerosis with a higher Expanded Disability Status Scale score (3.5-6.5) than in the group with a lower Expanded Disability Status Scale score (1-3) (p = 0.001). A correlation was found between the level of disability and all parameters of trunk control in the total sample (p = 0.001). A significant relationship was detected between the disability level and most trunk control parameters in the Expanded Disability Status Scale ≤ 3 and ≥ 3.5 subgroups (p < 0.05).

CONCLUSIONS

As the level of disability increases in people with Multiple Sclerosis, trunk control decreases, suggesting that care should be taken regarding trunk control during the progression of the disease. Evaluation of trunk control will be guiding when creating treatment programs.

Exploring key factors associated with falls in people with multiple sclerosis: The role of trunk impairment and other contributing factors

Background

Falls are a common and consequential concern for persons with multiple sclerosis (PwMS), with trunk impairment frequently observed even in the early stages of the disease. However, the relationship between falls and trunk impairment using the trunk impairment scale in this population remains unclear. This study aims to explore this association and identify potential factors contributing to falls in PwMS.

Method

Sixty-four patients were assessed for falls or near falls in the past 6 months, trunk impairment using the Trunk Impairment Scale (TIS), balance and gait using the Performance-Oriented Mobility Assessment (POMA), depression and anxiety using the Hospital Anxiety and Depression Scale (HADS), fatigue using the Modified Fatigue Impact Scale (MFIS), and fear of falling using the Modified Falls Efficacy Scale (MFES).

Results

Simple binary logistic regression revealed significant associations for TIS (OR = 0.75, p = 0.001, 95 % CI: 0.63 to 0.88), POMA (OR = 0.75, p ≤ 0.001, 95 % CI: 0.65 to 0.87), MFES (OR = 0.96, p ≤ 0.001, 95 % CI: 0.93 to 0.98), MFIS (OR = 1.05, p = 0.002, 95 % CI: 1.02 to 1.08), and HADS (OR = 1.09, p = 0.01, 95 % CI: 1.02 to 1.17). The multiple logistic regression model identified TIS (OR = 0.78, p = 0.007, 95 % CI: 0.66 to 0.94) and MFES (OR = 0.96, p = 0.005, 95 % CI: 0.93 to 0.98) as significant factors of falls.

Conclusion

This study confirms the significant impact of trunk impairment, tested by the trunk impairment scale and fear of falling as factors of falls among PwMS. Additionally, it highlights the roles of balance, gait, fatigue, and depression as factors that contribute to fall risk. These findings suggest that a comprehensive assessment incorporating these elements may be crucial for developing effective fall prevention strategies in this population. This research underscores the need for targeted interventions that address both physical and psychological aspects to mitigate the risk of falls in PwMS.

Psychometric properties of the modified reaching performance scale in persons with multiple sclerosis

BACKGROUND

A valid and reliable assessment tool to describe the quality of the movement pattern of reaching can provide valuable insights into motor performance deficits in persons with MS (pwMS). The Reaching Performance Scale, developed for stroke, is a promising scale to assess movement patterns in pwMS. However, psychometric properties of the scale are lacking in pwMS.

OBJECTIVES

Firstly, to investigate the content validity of the modified Reaching Performance Scale for application in patients with MS (mRPS). Secondly, to investigate the psychometric properties (within- and between-session reliability and concurrent validity) of the mRPS for pwMS.

METHODS

Forty-five pwMS (mean EDSS 6.6 pt, IQR 6-7.5) executed the mRPS that rates the quality of movement patterns and compensations during reach to grasp tasks. The content validity was determined by an expert panel based on observations of subjects performing the RPS. The reliability was based on five repetitions within one day, and between two days. For the concurrent validity, outcome measures at two levels of the International Classification of Functioning were correlated with the mRPS: Body Structure and Function level: Fugl-Meyer Assessment of the Upper Limb (FMA-UL), maximal isometric hand grip strength (HGS; Activity level: Action Research Arm Test (ARAT), Box and Blocks Test (BBT), Nine Hole Peg Test (NHPT) and Trunk Impairment Scale 2.0 (TIS 2.0) as well as perceived performance by the Manual Ability Measure-36 (MAM-36).

RESULTS

Scale modifications were made only on the ratings of the trunk displacement subscale. The mRPS had excellent agreement scores for within-session reliability (range of Kappa between 0.85 and 0.98) and moderate-to-excellent agreement scores for between-session reliability (K: 0.66-1.00). Regarding validity, the mRPS was highly correlated with the ARAT (rho=0.74, p < 0.001), followed by moderate correlations with trunk performance (TIS 2.0, rho= 0.61, p < 0.001), hand function (BBT: rho=0.64, p < 0.001; NHPT: rho=-0.61, p < 0.001) and perceived performance (MAM36 rho= 0.53, p < 0.001).

CONCLUSION

The mRPS is a reliable measurement tool to describe the movement pattern quality and motor compensations used during reaching in pwMS. Concerning concurrent validity, the mRPS is partially related to other measures of upper limb and trunk performance.

The meaningfulness of exploring one's own limits through interactions and enjoyment in outdoor high-intensity physiotherapy for people with multiple sclerosis: a qualitative study

Background and purpose

Physical activity (PA) is often reduced in people with MS (pwMS), even when disability is low. Understanding the perspectives of pwMS on interventions aiming to improve PA is important to inform the development of such services. The aim of this study was to explore the experiences of pwMS participating in an outdoor, high-intensity and balance exercise group intervention.

Methods

This qualitative study was nested within an RCT exploring a novel intervention integrating sensorimotor exercises with high-intensity intervals of running/walking. Individual, in-depth interviews with the intervention group (n = 15; 12 women, 3 men; age 38-66; EDSS score 0-3.5) were conducted postintervention (mean days = 14), analyzed using a phenomenological-inspired approach with systematic text condensation, and interpreted based on enactive theory.

Results

Four categories were generated: (1) Exploration of one's own physical abilities: Challenging one's own limits was perceived by all participants to improve movement performance and/or intensity level. Such bodily changes engendered strong positive feelings. Some negative consequences of high-intensity training were described, increasing a feeling of loss. (2) New insights and beliefs: Participants experienced enhanced beliefs in their own capabilities, which they integrated in activities outside the intervention. (3) An engaging environment: The group setting was perceived as supportive, and the outdoor environment was perceived as stimulating activity. (4) Professional leadership, tailoring and co-creation of enjoyment: Physiotherapist-led, individualized interactions were regarded as necessary to safely revisit prior activities, such as running. Co-creating enjoyment facilitated high-intensity training and intervention adherence.

Discussion

High-intensity training combined with detailed exercises in a physiotherapy outdoor group was perceived to create meaningful bodily changes and enhance PA and prospects for both PA and life. Importantly, however, some negative experiences were also reported from the high-intensity training. Enactive theory allowed for the illumination of new perspectives: the importance of embodiment for self-efficacy and of tailored physiotherapy and an outdoor-group environment for exploring one's own limits to physical capabilities. These aspects should inform future exercise interventions in pwMS with low disability.

Feasibility of a new intervention addressing group-based balance and high-intensity training, physical activity, and employment in individuals with multiple sclerosis: a pilot randomized controlled trial

Background and purpose

Impaired sensorimotor function, reduced physical activity and unemployment are common challenges in persons with multiple sclerosis (pwMS), even when disability is low. CoreDISTparticipation is a new, multidisciplinary intervention delivered across healthcare levels systematically addressing these elements. This study primarily aimed to evaluate the feasibility of CoreDISTparticipation in terms of process, resources, management, and scientific outcomes. The secondary aim was to evaluate initial efficacy in terms of possible short-term effects compared with the usual care on barriers to employment, balance, walking, health-related quality of life (HRQoL), and physical activity.

Methods

This assessor-blinded prospective pilot randomized controlled trial included 29 pwMS [Expanded Disability Status Scale (EDSS): 0-3.5] randomly allocated to the intervention group (CoreDISTparticipation) (n = 15) or usual care (n = 14). CoreDISTparticipation consists of three phases: (1) hospital outpatient clinic: MS nurse work-focused session and physiotherapist exploring balance; (2) municipality: a digital meeting with pwMS, employer, MS nurse, and physiotherapist addressing employment and physical activity, 4 weeks indoor CoreDIST balance training (60 min × 2/week); and (3) 4 weeks outdoor CoreDIST balance training and high-intensity running/walking (60 min × 2/week). Assessments were undertaken at baseline and at weeks 6 and 11. Primary feasibility metric outcomes were the reporting of process, resources, management, and scientific outcomes. Efficacy measures included evaluation of the Multiple Sclerosis Work Difficulties Questionnaire-23 Norwegian Version (MSWDQ-23NV) and 6 Minute Walk-test as well as the Trunk Impairment Scale-modified Norwegian Version, Mini-Balance Evaluation Systems Test (Mini-BESTest), Multiple Sclerosis Walking Scale-12, Multiple Sclerosis Impact Scale-29 Norwegian Version (MSIS-29NV), ActiGraph wGT3x-BT monitors, and AccuGait Optimized force platform. The statistical analyses included repeated-measures mixed models performed in IBM SPSS Version 29.

Results

The primary feasibility metric outcomes demonstrated the need for minor adjustments in regard to the content of the intervention and increasing the number of staff. In regard to the efficacy measures, one person attended no postintervention assessments and was excluded, leaving 28 participants (mean EDSS: 1.8, SD: 1). The mean percentage employment was 46.3 (SD: 35.6) and 65.4 (SD: 39.3) in the CoreDISTparticipation and usual care group, respectively. No between-group differences were found. MSWDQ-23NV demonstrated a within-group difference of 5.7 points from baseline to Week 11 (P = 0.004; confidence interval: 2.2-9.3). Mini-BESTest and MSIS-29NV demonstrated within-group differences. The study is registered in ClinicalTrials.gov (Identifier: NCT05057338).

Discussion

The CoreDISTparticipation intervention is feasible to support pwMS when the identified feasibility metric outcomes in regard to process, resource, management, and scientific outcome metrics are adjusted to improve feasibility. Regarding efficacy measures, no between-group differences were detected; however, within-group differences in barriers to employment, balance, and HRQoL were detected for the CoreDISTparticipation group. A larger comparative trial is needed to explore between-group differences and should accurately and precisely define usual care and address the identified limitations of this study.

Is there a relationship between respiratory function and trunk control and functional mobility in patients with relapsing-remitting multiple sclerosis?

OBJECTIVE

Multiple sclerosis (MS) causes impairment of respiratory function, trunk control, and functional mobility. The purpose of this study was to investigate the relationship between functional mobility and respiratory function and trunk control in MS patients and to compare the findings with those in healthy individuals.

METHODS

Thirty MS patients and 30 healthy subjects were included in this case-control study. All participants were evaluated with a pulmonary function test, maximal inspiratory and expiratory pressure (MIP, MEP), core stability tests, a lumbopelvic stability test (LST), a 2-minute walk test (2MWT), and the Timed Up and Go test (TUG). The disability level of the MS patients was assessed with the Expanded Disability Status Scale (EDSS).

RESULTS

Respiratory function, respiratory muscle strength, trunk control, and functional mobility were lower in the MS patients than in the controls (p < 0.05). TUG values had a significant negative correlation and the 2MWT values had a significant positive correlation with MEP, core stability tests, and the LST (p < 0.05). Of the variance in the 2MWT distance, 69% was explained by the LST, EDSS, and MEP; of the variance in TUG time, 40% was explained by the EDSS and MEP (p < 0.05).

CONCLUSIONS

To preserve and develop functional mobility in MS patients, approaches to increase respiratory function and trunk control should be included in rehabilitation programs.

CLINICALTRIALS.GOV REGISTRATION NUMBER

NCT03826095.

Impaired trunk control and its relationship with balance, functional mobility, and disease severity in patients with cervical dystonia

BACKGROUND

Impaired trunk control is common in neurological disorders; however, trunk control has not been examined in patients with cervical dystonia (CD). Therefore, the primary aim was to compare trunk control between patients with CD and healthy people. The secondary aim was to investigate the relationship between trunk control and balance, functional mobility, and disease severity in patients with CD.

METHODS

]This cross-sectional study included 32 patients with CD and 32 healthy people. Trunk control was compared using the trunk impairment scale (TIS) that consists of three subscales: static sitting balance, dynamic sitting balance, and trunk coordination between two groups. Balance was assessed using Berg Balance Scale, four square step test, and one-leg stance test. The Timed Up and Go Test was measured to determine functional mobility. Toronto Western Spasmodic Torticollis Rating Scale was used to evaluate disease severity.]></AbstractText> <AbstractText Label="RESULTS"><![CDATA[ Patients with CD demonstrated worse performance on the TIS-total with TIS-dynamic sitting subscale and TIS-trunk coordination subscale (p < 0.001, p < 0.001, and p < 0.001), except for TIS-static sitting subscale (p = 0.078) compared to healthy people. TIS-total scores had moderate to strong correlations with balance, functional mobility, and disease severity (range r between 0.786 and 0.536, p < 0.05 for all). There was no correlation between TIS-total scores and disease severity (p = 0.102).

DISCUSSION

Patients with CD had impaired trunk control, especially in dynamic sitting balance and trunk coordination. Impaired trunk control was also associated with balance and functional mobility but not disease severity. These findings suggest that trunk control deficits should receive attention in the assessment and treatment of patients with CD.

Effect of Dynamic Neuromuscular Stabilization on Balance, Trunk Function, Falling, and Spasticity in People With Multiple Sclerosis: A Randomized Controlled Trial

OBJECTIVE

To compare the effects of core stabilization (CS) and dynamic neuromuscular stabilization (DNS) on balance, trunk function, mobility, falling, and spasticity, in people with multiple sclerosis (PWMS).

DESIGN

Two-group randomized controlled trial.

SETTING

General community and referral center.

PARTICIPANTS

A total of 64 PWMS, between 30 and 50 years old, and an expanded disability status scale between 2 and 5, participated in this study (N=64).

INTERVENTIONS

Participants were randomly assigned to CS (n=32) and DNS (n=32) groups. Both groups received a total of 15 sessions of CS or DNS exercises, 60 minutes per session, 3 times a week during the 5 weeks.

OUTCOME MEASURES

Balance function was measured as the primary outcome measure. Trunk function, postural stability, falling rate, fear of falling, falling index, mobility, and spasticity were measured as secondary outcomes.

RESULTS

DNS group had significant improvement in Berg balance scale, trunk impairment scale, postural stability, activities-specific balance confidence, reduced falling rate, the timed Up and Go (TUG), multiple sclerosis walking scale-12, and multiple sclerosis spasticity scale in PWMS compared with the CS group, (P<.0001) after 5 weeks of intervention and 17 weeks of follow-up. Except for the modified Ashworth scale (MAS), significant improvements were seen in all outcome measures in both groups after 5 weeks of intervention.

CONCLUSION

This is the first clinical evidence to support the importance of DNS exercise in improving balance, trunk function, and fall prevention in PWMS. This study provides clinical evidence that DNS may be more effective for PWMS than CS.