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Lajlar N, Vidmar G, Moharić M. Differences in respiratory function, depressive symptoms and quality of life between patients with hereditary motor and sensory neuropathy and myotonic dystrophy undergoing maintenance rehabilitation. Int J Rehabil Res 2024; 47:20-25. [PMID: 38096027 DOI: 10.1097/mrr.0000000000000608] [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: 02/08/2024]
Abstract
Hereditary motor and sensory neuropathy (HMSN) and myotonic dystrophy (MD) are chronic neuromuscular diseases that cause progressive muscular impairment and impact patient's quality of life. Conflicting findings in existing literature underscore the need for focussed research on specific health aspects in these patients. The aim of the study was to explore the differences in respiratory function, depressive symptoms and quality of life between patients with HMSN and MD undergoing maintenance rehabilitation. Our prospective observational study included 62 HMSN patients (median age 53.5, range 19-79 years; 38 women) and 50 MD patients (median age 54.0, range 18-77 years; 34 women) undergoing maintenance rehabilitation. They performed respiratory function tests (vital capacity, forced vital capacity, forced expiratory volume and peak expiratory flow) and respiratory muscle strength tests (maximum inspiratory pressure, maximum expiratory pressure and sniff nasal inspiratory force). The Center for Epidemiological Studies-Depression Scale was used to evaluate depression, and their health-related quality of life was assessed using the Quality of Life in Genetic Neuromuscular Disease Questionnaire. Using logistic regression, we examined group-difference in presence of depressive symptoms while accounting for age, symptoms duration, and marital status. Multiple linear regression was used to assess the difference in quality-of-life scores, adjusting for age, gender, and symptoms' duration. The HMSN group achieved statistically significantly better results than the MD group on all respiratory measures (about 17% absolute difference in the respiratory function measures and 30% relative difference in the respiratory muscle strength measures on average). Both groups exhibited a high level of depression symptoms (HMSN 24%, MD 44%; estimated adjusted odds-ratio MD vs. HMSN 1.9, 95% CI 0.8-4.5, P = 0.127). We did not find a statistically significant difference between the groups regarding quality-of-life domains, though a trend towards better quality-of-life among the HMSN patients could be observed. The implication for future practice is that the MD patients would potentially benefit the most from targeted respiratory-rehabilitation interventions, and both groups could benefit from focussed mental-health interventions.
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Affiliation(s)
- Nika Lajlar
- Celje General Hospital, Celje
- Faculty of Medicine, University of Ljubljana, Ljubljana
| | - Gaj Vidmar
- University Rehabilitation Institute
- Faculty of Medicine, University of Ljubljana, Ljubljana
- Faculty of Mathematics, Natural Sciences and Information Technologies, University of Primorska, Koper, Slovenia
| | - Metka Moharić
- University Rehabilitation Institute
- Faculty of Medicine, University of Ljubljana, Ljubljana
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Harrison AM, Safari R, Mercer T, Picariello F, van der Linden ML, White C, Moss-Morris R, Norton S. Which exercise and behavioural interventions show most promise for treating fatigue in multiple sclerosis? A network meta-analysis. Mult Scler 2021; 27:1657-1678. [PMID: 33876986 PMCID: PMC8474304 DOI: 10.1177/1352458521996002] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/19/2021] [Accepted: 01/29/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Fatigue is a common, debilitating symptom of multiple sclerosis (MS) without a current standardised treatment. OBJECTIVE The aim of this systematic review with network meta-analyses was to estimate the relative effectiveness of both fatigue-targeted and non-targeted exercise, behavioural and combined (behavioural and exercise) interventions. METHODS Nine electronic databases up to August 2018 were searched, and 113 trials (n = 6909) were included: 34 were fatigue-targeted and 79 non-fatigue-targeted trials. Intervention characteristics were extracted using the Template for Intervention Description and Replication guidelines. Certainty of evidence was assessed using GRADE. RESULTS Pairwise meta-analyses showed that exercise interventions demonstrated moderate to large effects across subtypes regardless of treatment target, with the largest effect for balance exercise (SMD = 0.84). Cognitive behavioural therapies (CBTs) showed moderate to large effects (SMD = 0.60), with fatigue-targeted treatments showing larger effects than those targeting distress. Network meta-analysis showed that balance exercise performed significantly better compared to other exercise and behavioural intervention subtypes, except CBT. CBT was estimated to be superior to energy conservation and other behavioural interventions. Combined exercise also had a moderate to large effect. CONCLUSION Treatment recommendations for balance and combined exercise are tentative as the certainty of the evidence was moderate. The certainty of the evidence for CBT was high.
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Affiliation(s)
- Anthony M Harrison
- Department of Clinical and Health Psychology,
Leeds Teaching Hospitals National Health Service Trust, Leeds, UK
| | - Reza Safari
- Health and Social Care Research Centre, College
of Health, Psychology and Social Care, University of Derby, Derby, UK
| | - Tom Mercer
- Centre for Health, Activity and Rehabilitation
Research, Queen Margaret University, Edinburgh, UK
| | - Federica Picariello
- Health Psychology Section, Institute of
Psychiatry, Psychology and Neuroscience, King’s College London, London,
UK
| | | | - Claire White
- School of Population Health & Environmental
Sciences, Faculty of Life Sciences & Medicine, King’s College London,
London, UK
| | - Rona Moss-Morris
- Health Psychology Section, Institute of
Psychiatry, Psychology and Neuroscience, King’s College London, London,
UK
| | - Sam Norton
- Health Psychology Section, Institute of
Psychiatry, Psychology and Neuroscience, King’s College London, London,
UK
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Adnan R, Van Oosterwijck J, Danneels L, Willems T, Meeus M, Crombez G, Goubert D. Differences in psychological factors, disability and fatigue according to the grade of chronification in non-specific low back pain patients: A cross-sectional study. J Back Musculoskelet Rehabil 2021; 33:919-930. [PMID: 33016899 DOI: 10.3233/bmr-191548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Differences in pain processing, muscle structure and function have been reported in patients with low back pain (LBP) with different grades of pain chronicity. OBJECTIVE The present study aims to examine differences in psychological factors, disability and subjective fatigue between subgroups of LBP based on their chronification grade. METHODS Twenty-one healthy controls (HC) and 54 LBP patients (categorized based on the grades of chronicity into recurrent LBP (RLBP), non-continuous chronic LBP (CLBP), or continuous (CLBP)) filled out a set of self-reporting questionnaires. RESULTS The Hospital Anxiety and Depression Scale (HADS) and Multidimensional Pain Inventory (MPI) scores indicated that anxiety, pain severity, pain interference and affective distress were lower in HC and RLBP compared to non-continuous CLBP. Anxiety scores were higher in non-continuous CLBP compared to RLBP, continuous CLBP and HC. The Pain Catastrophizing Scale for Helplessness (PSCH) was higher in non-continuous CLBP compared to HC. The Survey of Pain Attitudes (SOPA) showed no differences in adaptive and maladaptive behaviors across the groups. The Pain Disability Index (PDI) measured a higher disability in both CLBP groups compared to HC. Moreover, the Rolland Morris Disability Questionnaire (RMDQ) showed higher levels of disability in continuous CLBP compared to non-continuous CLBP, RLBP and HC. The Checklist Individual Strength (CIS) revealed that patients with non-continuous CLBP were affected to a higher extent by severe fatigue compared to continuous CLBP, RLBP and HC (subjective fatigue, concentration and physical activity). For all tests, a significance level of 0.05 was used. CONCLUSIONS RLBP patients are more disabled than HC, but have a tendency towards a general positive psychological state of mind. Non-continuous CLBP patients would most likely present a negative psychological mindset, become more disabled and have prolonged fatigue complaints. Finally, the continuous CLBP patients are characterized by more negative attitudes and believes on pain, enhanced disability and interference of pain in their daily lives.
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Affiliation(s)
- Rahmat Adnan
- SPINE Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Belgium.,Faculty of Sports Science and Recreation, Universiti Teknologi MARA, Malaysia
| | - Jessica Van Oosterwijck
- SPINE Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Belgium.,Research Foundation - Flanders (FWO), Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - Lieven Danneels
- SPINE Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Tine Willems
- SPINE Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Mira Meeus
- SPINE Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - Geert Crombez
- Department of Experimental - Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Belgium
| | - Dorien Goubert
- SPINE Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Belgium
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Gasper JM, Lewis M, Kroeger A, Muz B, LaRocca N, Frankel D. Multiple Sclerosis Adult Day Programs and Health-Related Quality of Life of Persons with Multiple Sclerosis and Informal Caregivers. Int J MS Care 2020; 22:187-192. [PMID: 32863787 DOI: 10.7224/1537-2073.2019-020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Multiple sclerosis adult day programs (MSADPs) offer life-enhancing services for individuals and informal caregivers affected by multiple sclerosis (MS), including medical care, rehabilitation therapies, nutrition therapy, cognitive training, tailored education, exercise programs, and social interaction. The purpose of this study was to examine the effects of MSADPs on health-related quality of life (HRQOL) and health care utilization of persons with MS and HRQOL and well-being of informal caregivers. Methods Using a quasi-experimental design, outcomes between baseline and 1-year follow-up in persons with MS and informal caregivers who used MSADP services and a comparison group of similar persons with MS and caregivers who did not use MSADP services were compared. For persons with MS, outcomes included standardized measures of physical and mental HRQOL and health care utilization. For caregivers, outcomes included physical and mental HRQOL and well-being. Changes in outcomes between baseline and follow-up were examined using propensity score-weighted difference-in-differences regression analysis. Results For persons with MS, MSADP use had a significant positive effect on 12-Item Short Form Health Survey physical component scores, although the difference was not clinically meaningful. Use of MSADPs did not have effects on any other outcomes for persons with MS or caregivers. Conclusions Use of MSADPs did not show a clinically meaningful effect on HRQOL for persons with MS or informal caregivers. The MSADPs do not seem to offer sustained benefits to persons with MS or caregivers, but the possibility of initial short-term benefits cannot be ruled out.
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Lane M, Yadav V. Multiple Sclerosis. TEXTBOOK OF NATURAL MEDICINE 2020. [PMCID: PMC7348625 DOI: 10.1016/b978-0-323-43044-9.00199-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Marrow J, Roeser A, Gasper J, LaRocca NG, Frankel D. Benefits of Multiple Sclerosis Adult Day Program Participation for People with Multiple Sclerosis: A Qualitative Study. Int J MS Care 2019; 22:201-207. [PMID: 33177955 DOI: 10.7224/1537-2073.2019-019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Multiple sclerosis adult day programs (MSADPs) are nonmedical service programs that provide care and support to people with multiple sclerosis (MS) experiencing levels of impairment that interfere with employment and activities of daily living. The purpose of this study was to identify how program participants think MSADPs benefit them. Methods We conducted in-depth interviews with 95 people with MS who were MSADP participants. Interviews occurred as part of site visits to ten programs across the country. We supplemented participant interviews with interviews of program staff and ethnographic observation of activities at each site over 1 to 3 days. Results Participants reported several benefits from participating in an MSADP. Almost universally, participants explained that receiving and giving social support were the most important benefits. Other positive outcomes described included increased emotional well-being, better understanding and acceptance of MS, practical know-how for accomplishing ordinary tasks, and increased mobility and improved motor functioning. Conclusions Participants believe that MSADPs have a profound influence on their psychosocial health, much of which they attribute to membership in a socially cohesive community. Clinicians and policy makers should consider recommending these programs for people with MS who have unmet psychosocial needs and experience functional impairments.
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Rooney S, Moffat F, Wood L, Paul L. Effectiveness of Fatigue Management Interventions in Reducing Severity and Impact of Fatigue in People with Progressive Multiple Sclerosis: A Systematic Review. Int J MS Care 2019; 21:35-46. [PMID: 30833871 DOI: 10.7224/1537-2073.2018-019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background Rehabilitation interventions are recommended to manage multiple sclerosis (MS)-related fatigue. However, existing research has largely been generalized to those with relapsing-remitting MS, making it difficult to determine the effectiveness of these interventions in people with progressive MS. Therefore, this study aimed to systematically review the evidence related to the effectiveness of fatigue management interventions in reducing the severity and impact of fatigue in people with progressive MS. Methods Six electronic databases (CINAHL, Cochrane Library, MEDLINE, PEDro, ProQuest, and Web of Science Core Collections) were searched for relevant articles up until November 2017. Randomized controlled trials and quasi-experimental studies that examined the effects of exercise, behavioral interventions, and rehabilitation on fatigue in people with progressive MS using self-reported fatigue outcome measures were included in this review. Results Eight exercise, two rehabilitation, and two behavioral interventions were investigated in the 13 articles included in this review. Heterogeneous effects were reported between studies, with only two exercise, one behavioral, and two rehabilitation interventions recording significant improvements in postintervention fatigue severity or impact. However, most studies were underpowered, only two used fatigue as the primary outcome, and only one specifically recruited participants with predefined levels of fatigue. Conclusions Evidence from this review is inconclusive regarding the effectiveness of nonpharmacologic interventions in reducing the severity and impact of fatigue in progressive MS populations. Adequately powered randomized controlled trials are required to evaluate fatigue management interventions in people with progressive MS experiencing high levels of fatigue and using fatigue as the primary outcome.
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Foroughipour M, Bahrami Taghanaki HR, Saeidi M, Khazaei M, Sasannezhad P, Shoeibi A. Amantadine and the Place of Acupuncture in the Treatment of Fatigue in Patients with Multiple Sclerosis: An Observational Study. Acupunct Med 2018; 31:27-30. [DOI: 10.1136/acupmed-2012-010199] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Fatigue is a common symptom in patients with multiple sclerosis (MS). It has significant negative effects on the quality of life of patients with the condition. There are few therapeutic modalities for fatigue, which are also usually not sufficiently effective. The aim of this study was to evaluate the efficacy of acupuncture on this common symptom of patients with MS. Methods In this before-and-after clinical trial, 40 patients with definite diagnoses of MS, according to the ‘McDonald’ criteria, were studied. Patients who had Expanded Disability Status Scale (EDSS) scores greater than 4, or who had another disease that could be potentially responsible for their fatigue, were excluded from the study. In all, 20 patients with fatigue refractory to amantadine underwent 12 sessions of acupuncture. Fatigue was scored according to the Fatigue Severity Scale (FSS). Results A total of 15 (37.5%) patients with MS with fatigue responded to amantadine. The mean FSS score reduction after 2 months of treatment was 8±4, which was statistically significant (p<0.001). Of the 20 patients who were resistant to amantadine, 5 (25%) responded to acupuncture combined with amantadine treatment. The FSS scores of the 20 patients who were refractory were significantly reduced after this treatment (mean: 13±6, p<0.001). Conclusions Acupuncture appears to be associated with benefits for a proportion of patients with fatigue who are resistant to conventional drugs such as amantadine, and this finding justifies further research.
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Affiliation(s)
- Mohsen Foroughipour
- Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamid Reza Bahrami Taghanaki
- Department of Complementary and Alternative Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Morteza Saeidi
- Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mojtaba Khazaei
- Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Payam Sasannezhad
- Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Shoeibi
- Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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The role of robotic gait training coupled with virtual reality in boosting the rehabilitative outcomes in patients with multiple sclerosis. Int J Rehabil Res 2018; 41:166-172. [DOI: 10.1097/mrr.0000000000000270] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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10
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Helland CB, Holmøy T, Gulbrandsen P. Barriers and Facilitators Related to Rehabilitation Stays in Multiple Sclerosis: A Qualitative Study. Int J MS Care 2015; 17:122-9. [PMID: 26052257 DOI: 10.7224/1537-2073.2014-007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Studies have shown the positive effects of multidisciplinary rehabilitation on disability and health-related quality of life in multiple sclerosis (MS). However, many patients do not seek such treatment, even if it is available free of charge. The aim of this study was to identify facilitators and barriers related to use of such treatment options. METHODS Five focus group interviews with 27 MS patients were conducted. Three groups included patients who had been admitted to a multidisciplinary MS rehabilitation institution, and two groups included outpatients of a university hospital who had not applied for specialized rehabilitation. Interviews were audiotaped and transcribed, and were analyzed qualitatively by means of a modified form of systematic text condensation. RESULTS Important factors influencing the use of an MS rehabilitation service were 1) the availability and suitability of initial information about the disease and the service, 2) assumptions and expectations about such a service, and 3) practical barriers in the patient's life. The prospect of having a retreat from work and family was described as a motivational factor. Lack of reorientation after diagnosis, fears and perceptions of being labeled as an MS patient, or having information overload and being confronted with disabled individuals were identified as barriers. CONCLUSIONS Communication skills, including information-giving skills, of neurologists in relation to newly diagnosed MS patients need improvement. Rehabilitation programs for MS patients should include stays of different durations and purposes to fit patients' needs. Health-care authorities should take measures to secure equal access to information about rehabilitation options across institutions and practicing physicians.
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Affiliation(s)
- Caroline Bruun Helland
- Department of Neurology (CBH) and HøKH Research Centre (PG), Akershus University Hospital, Lørenskog, Norway; and Institute of Clinical Medicine, Campus Ahus, University of Oslo, Norway (TH)
| | - Trygve Holmøy
- Department of Neurology (CBH) and HøKH Research Centre (PG), Akershus University Hospital, Lørenskog, Norway; and Institute of Clinical Medicine, Campus Ahus, University of Oslo, Norway (TH)
| | - Pål Gulbrandsen
- Department of Neurology (CBH) and HøKH Research Centre (PG), Akershus University Hospital, Lørenskog, Norway; and Institute of Clinical Medicine, Campus Ahus, University of Oslo, Norway (TH)
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Khan F, Amatya B, Galea M. Management of fatigue in persons with multiple sclerosis. Front Neurol 2014; 5:177. [PMID: 25309504 PMCID: PMC4163985 DOI: 10.3389/fneur.2014.00177] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 09/01/2014] [Indexed: 11/13/2022] Open
Abstract
Fatigue is one of the most common symptoms of multiple sclerosis. Despite advances in pharmacological and non-pharmacological treatment, fatigue continues to be the disabling symptom in persons with MS (pwMS), affecting almost 80% of pwMS. In current practice, both pharmacological and non-pharmacological interventions are used in combination, encompassing a multi-disciplinary approach. The body of research investigating the effect of these interventions is growing. This review systematically evaluated the existing evidence on the effectiveness and safety of different interventions currently applied for the management of fatigue in person with multiple sclerosis in improving patient outcomes, to guide treating clinicians.
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Affiliation(s)
- Fary Khan
- Department of Rehabilitation Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia
- The University of Melbourne, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Bhasker Amatya
- Department of Rehabilitation Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Mary Galea
- Department of Rehabilitation Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia
- The University of Melbourne, Melbourne, VIC, Australia
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Tyler ME, Kaczmarek KA, Rust KL, Subbotin AM, Skinner KL, Danilov YP. Non-invasive neuromodulation to improve gait in chronic multiple sclerosis: a randomized double blind controlled pilot trial. J Neuroeng Rehabil 2014; 11:79. [PMID: 24885412 PMCID: PMC4017705 DOI: 10.1186/1743-0003-11-79] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 04/24/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This study sought to examine the effect of targeted physical therapy with and without cranial nerve non-invasive neuromodulation (CN-NINM), on the walking ability of people with MS who exhibited a dysfunctional gait. We hypothesized that subjects who received electrical stimulation would have greater improvement than those who had a control device after a 14-week intervention. Gait disturbance is a common problem for people with multiple sclerosis (MS). Current management may include exercise, pharmacology, functional electrical stimulation, compensatory strategies, use of assistive devices, and implanted electrical devices. We have developed an effective rehabilitative strategy using neuromodulation of the cranial nerves via electrical stimulation of the tongue to enhance the plasticity of the brain. METHODS The study is a within-subject blinded randomized control design. Twenty chronic MS subjects with an identified gait disturbance were assigned to either an active or control group. Both groups completed a 14-week intervention program using a standardized combination of exercise and a device that provided electrical stimulation to the tongue. Those in the active group received electrical stimulation on the tongue that they could perceive. Those in the control group used a device that did not provide a physiologically significant stimulus and was not perceivable. Subjects were assessed with the Dynamic Gait Index (DGI). RESULTS The DGI scores improved for both groups. There were significant between-group differences, with the active group showing statistically greater improvement than the control group mean. CONCLUSION People with MS demonstrated improved gait with CN-NINM training in a pilot randomized controlled trial. This study suggests that tongue-based neurostimulation may amplify the benefits of exercise for improving gait in people with chronic MS.
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Affiliation(s)
- Mitchell E Tyler
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI 53706, USA
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI 53706, USA
| | - Kurt A Kaczmarek
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI 53706, USA
| | - Kathy L Rust
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI 53706, USA
| | - Alla M Subbotin
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI 53706, USA
| | - Kimberly L Skinner
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI 53706, USA
| | - Yuri P Danilov
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI 53706, USA
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McColl MA, Law M. Interventions affecting self-care, productivity, and leisure among adults: a scoping review. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2014; 33:110-9. [PMID: 24651699 DOI: 10.3928/15394492-20130222-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 01/03/2013] [Indexed: 11/20/2022]
Abstract
This study is a scoping review of 21 years of international occupational therapy literature. Its purpose is to identify and describe interventions used by occupational therapists to enable self-care, productivity, and leisure. The scoping review produced 59 articles published between 1990 and 2010. Nine articles evaluated the effectiveness of occupational therapy interventions focused on leisure outcomes, 21 on productivity outcomes, and 29 on self-care outcomes. The programs were classified according to eight types of interventions: training, education, skill development, task adaptation, occupational development, environmental modification, support provision, and support enhancement. Most studies produced at least one significant positive result (82%), indicating that occupational therapy programs were at least partially successful in improving self-care, productivity, or leisure. There is good evidence for task adaptation, training, and skill development interventions, and for the role of occupational therapy in multi-disciplinary teams.
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Comi G, Leocani L. Assessment, pathophysiology and treatment of fatigue in multiple sclerosis. Expert Rev Neurother 2014; 2:867-76. [DOI: 10.1586/14737175.2.6.867] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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15
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Eliades MN. The rehabilitation of the multiple sclerosis patient. Dis Mon 2013; 59:277-83. [PMID: 23876484 DOI: 10.1016/j.disamonth.2013.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Fatigue in multiple sclerosis - a brief review. J Neurol Sci 2012; 323:9-15. [PMID: 22935407 DOI: 10.1016/j.jns.2012.08.007] [Citation(s) in RCA: 146] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 06/26/2012] [Accepted: 08/08/2012] [Indexed: 11/22/2022]
Abstract
Fatigue is the most common and debilitating symptom in multiple sclerosis (MS) and is believed to be distinctly different from fatigue seen in other chronic conditions. It can affect a patient's mood, sleep and have a detrimental effect on their quality of life. In the recent years much literature has emerged in an attempt to elucidate the potential causes and treatment of this common symptom. This review article aims to examine the most recent theories on the pathophysiology of fatigue in MS as well as its association with sleep and depression. We describe the pharmacological and non-pharmacological approaches to its treatment and propose a multidisciplinary, patient enabled and individualised manner to the management of fatigue in MS.
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Morley MA, Coots LA, Forgues AL, Gage BJ. Inpatient Rehabilitation Utilization for Medicare Beneficiaries With Multiple Sclerosis. Arch Phys Med Rehabil 2012; 93:1377-83. [DOI: 10.1016/j.apmr.2012.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 01/04/2012] [Accepted: 03/02/2012] [Indexed: 10/28/2022]
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Rehabilitation interventions in multiple sclerosis: an overview. J Neurol 2012; 259:1994-2008. [DOI: 10.1007/s00415-012-6577-4] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 05/29/2012] [Accepted: 05/30/2012] [Indexed: 11/30/2022]
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Validation of the comprehensive ICF core set for multiple sclerosis from the perspective of physical therapists. Phys Ther 2012; 92:799-820. [PMID: 22403092 DOI: 10.2522/ptj.20110056] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND The Comprehensive ICF Core Set for Multiple Sclerosis (MS) is an application of the International Classification of Functioning, Disability and Health (ICF) and represents the typical spectrum of problems in the functioning of people with MS. OBJECTIVES The objective of this study was to validate the Comprehensive ICF Core Set for MS from the perspective of physical therapists. DESIGN A 3-round survey based on the Delphi technique was used. METHODS Physical therapists experienced in the management of MS were asked about problems and resources of people with MS as well as environmental aspects treated by physical therapists (eg, use of assistive devices, support). Statements were linked to the ICF and compared with the Comprehensive ICF Core Set for MS. RESULTS Eighty physical therapists from 23 countries mentioned 2,133 issues that covered all of the ICF components. Two hundred thirty-eight ICF categories were linked to the statements. Forty-six categories in the Comprehensive ICF Core Set for MS were confirmed by physical therapists at the same level or a more specific level of classification. Nineteen additional ICF categories were reported by at least 75% of the participants. CONCLUSIONS The results of this study support the content and face validity of the Comprehensive ICF Core Set for MS. Areas of functioning and health that physical therapists believe should be assessed were identified. The findings of this study as well as the results of completed and ongoing validation studies will further elucidate the validity of the Comprehensive ICF Core Set for MS from different perspectives.
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Effects of vestibular rehabilitation on multiple sclerosis-related fatigue and upright postural control: a randomized controlled trial. Phys Ther 2011; 91:1166-83. [PMID: 21680771 DOI: 10.2522/ptj.20100399] [Citation(s) in RCA: 137] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Fatigue and impaired upright postural control (balance) are the 2 most common findings in people with multiple sclerosis (MS), with treatment approaches varying greatly in effectiveness. OBJECTIVES The aim of this study was to investigate the benefits of implementing a vestibular rehabilitation program for the purpose of decreasing fatigue and improving balance in patients with MS. DESIGN The study was a 14-week, single-blinded, stratified blocked randomized controlled trial. SETTING Measurements were conducted in an outpatient clinical setting, and interventions were performed in a human performance laboratory. PATIENTS Thirty-eight patients with MS were randomly assigned to an experimental group, an exercise control group, or a wait-listed control group. INTERVENTION The experimental group underwent vestibular rehabilitation, the exercise control group underwent bicycle endurance and stretching exercises, and the wait-listed control group received usual medical care. MEASUREMENTS Primary measures were a measure of fatigue (Modified Fatigue Impact Scale), a measure of balance (posturography), and a measure of walking (Six-Minute Walk Test). Secondary measures were a measure of disability due to dizziness or disequilibrium (Dizziness Handicap Inventory) and a measure of depression (Beck Depression Inventory-II). RESULTS Following intervention, the experimental group had greater improvements in fatigue, balance, and disability due to dizziness or disequilibrium compared with the exercise control group and the wait-listed control group. These results changed minimally at the 4-week follow-up. Limitations The study was limited by the small sample size. Further investigations are needed to determine the underlying mechanisms associated with the changes in the outcome measures due to the vestibular rehabilitation program. CONCLUSION A 6-week vestibular rehabilitation program demonstrated both statistically significant and clinically relevant change in fatigue, impaired balance, and disability due to dizziness or disequilibrium in patients with MS.
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Burks JS, Bigley GK, Hill HH. Rehabilitation challenges in multiple sclerosis. Ann Indian Acad Neurol 2011; 12:296-306. [PMID: 20182578 PMCID: PMC2824958 DOI: 10.4103/0972-2327.58273] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Revised: 10/18/2009] [Accepted: 10/18/2009] [Indexed: 11/04/2022] Open
Abstract
While current immunomodulating drugs aim to reduce multiple sclerosis (MS) exacerbations and slow disease progression, rehabilitation aims to improve and maintain the functional abilities of patients in the face of disease progression. An increasing number of journal articles are describing the value of the many rehabilitation interventions that can be used throughout the course of the disease, from the initial symptoms to the advanced stages. An integrated team of healthcare professionals is necessary to address a myriad of problems to reduce impairments, disabilities, and handicaps. The problems may be related to fatigue, weakness, spasticity, mobility, balance, pain, cognition, mood, relationships, bowel, bladder, sexual function, swallowing, speech, transportation, employment, recreation, and activities of daily living (ADL) such as dressing, eating, bathing, and household chores. The team can help prevent complications and secondary disabilities, while increasing patient safety. Improving neurologically related function, maintaining good relationships, and feeling productive and creative adds enormously to the quality of life of people with MS and their families. Rehabilitation is more than an 'extra' service that is given after medical therapies; it is an integral part of the management of the diverse set of problems encountered throughout the course of the disease. An interdisciplinary team may have many members, including physicians, nurses, physical therapists, occupational therapists, speech and language pathologists, psychotherapists, social workers, recreational therapists, vocational rehabilitation therapists, patients, families, and other caregivers.
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Affiliation(s)
- Jack S Burks
- Medicine (Neurology), University School of Medicine, Reno, Nevada; and Chief Medical Officer, Multiple Sclerosis Association of America (MSAA), Cherry Hill, New Jersey, USA
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Miller L, Paul L, Mattison P, McFadyen A. Evaluation of a home-based physiotherapy programme for those with moderate to severe multiple sclerosis: a randomized controlled pilot study. Clin Rehabil 2011; 25:720-30. [PMID: 21504954 DOI: 10.1177/0269215511398376] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the effect of an eight-week home-based physiotherapy programme in reducing physical impairment, disability and psychological distress for people with moderate to severe multiple sclerosis (MS). DESIGN Pilot randomized controlled trial. SETTING Community; subjects' homes. SUBJECTS Thirty people moderately to severely affected by MS (Extended Disability Status Score, EDSS, 6.5-8) were randomized to an intervention or control group. INTERVENTION The intervention group received twice weekly, home-based physiotherapy for eight weeks and the control group received usual care. MAIN MEASURES The following outcome measures were recorded at baseline, post-intervention (Week 8) and at follow-up (Week 16). Primary outcome measure; Multiple Sclerosis Impact Scale (MSIS29) and secondary outcome measures assessed physical impairment, MS symptoms, quality of life, mood, and disability. RESULTS Although the Group * Time interaction failed to reach statistical significance with MSIS29 (p = 0.925), MS - related symptom checklist (MS-RS) (p = 0.627) and for lower limb strength, right knee extension (p = 0.375) and right knee flexion (p = 0.794), there is more evidence of altered levels in the treatment group than in the control group. CONCLUSION A minimum of 58 subjects per group are required to achieve a power of 80% at the 5% level of significance based on the MSIS29. A larger scale study is required.
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Affiliation(s)
- L Miller
- MS Service, NHS Ayrshire and Arran, School of Health, Glasgow Caledonian University, Irvine, UK.
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Braley TJ, Chervin RD. Fatigue in multiple sclerosis: mechanisms, evaluation, and treatment. Sleep 2010; 33:1061-7. [PMID: 20815187 DOI: 10.1093/sleep/33.8.1061] [Citation(s) in RCA: 234] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Among patients with multiple sclerosis (MS), fatigue is the most commonly reported symptom, and one of the most debilitating. Despite its high prevalence and significant impact, fatigue is still poorly understood and often under-emphasized because of its complexity and subjective nature. In recent years, an abundance of literature from specialists in sleep medicine, neurology, psychiatry, psychology, physical medicine and rehabilitation, and radiology have shed light on the potential causes, impact, and treatment of MS-related fatigue. Though such a diversity of contributions clearly has advantages, few recent articles have attempted to synthesize this literature, and existing overviews have focused primarily on potential causes of fatigue rather than clinical evaluation or treatment. The aims of this review are to examine, in particular for sleep specialists, the most commonly proposed primary and secondary mechanisms of fatigue in MS, tools for assessment of fatigue in this setting, and available treatment approaches to a most common and challenging problem.
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Affiliation(s)
- Tiffany J Braley
- Multiple Sclerosis Center, Department of Neurology, University ofMichigan, Ann Arbor MI, USA.
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Cantor F. Central and peripheral fatigue: exemplified by multiple sclerosis and myasthenia gravis. PM R 2010; 2:399-405. [PMID: 20656621 DOI: 10.1016/j.pmrj.2010.04.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Accepted: 04/15/2010] [Indexed: 12/12/2022]
Abstract
Fatigue is a feature of several chronic diseases of the central and peripheral nervous system. The pathophysiology of central fatigue is complex and often not well-defined. In contrast, peripheral fatigue is more objectively defined and measured. Fatigue can be part of the primary disease process, but there are often contributions from comorbid factors such as depression, sleep disturbance, medication, or deconditioning. Multiple sclerosis (MS) offers an example of central fatigue. More than 40% of MS patients complain of fatigue. Validated questionnaires are used to assess fatigue severity and comorbid factors. Although fatigue is believed to be a primary process in MS, depression and sleep disturbance are often comorbid problems. Magnetic resonance imaging (MRI), positron emission tomography, and functional MRI studies suggest that fatigue is related to gray matter disease, particularly of the cerebral cortex, but also of the thalamus and caudate. Disruption of impulse propagation from demyelination is also a likely factor. It is uncertain if pro-inflammatory cytokines have a specific effect on the genesis of MS fatigue. Several medications have been reported to alleviate fatigue in MS, but controlled studies show contradictory results. Treatment of depression and sleep disturbance, use of exercise programs and rehabilitation therapies as well as treatment of other comorbid conditions is necessary for optimal alleviation of fatigue. Myasthenia gravis (MG) patients exhibit peripheral fatigue. In contrast to MS, the mechanism of weakness and fatigue in MG is well-defined. Antibodies to the postsynaptic acetylcholine receptor at the myoneural junction cause diminution of the force of muscle contractions. This leads to a feeling of fatigue. MG treatments increase the availability of acetylcholine and reduce antibody formation. Evaluation for comorbid conditions, especially thymoma and hyperthyroidism, are mandatory in patients with MG.
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Affiliation(s)
- Fredric Cantor
- Neuroimmunology Branch, National Institute of Neurological Disorders and Stroke/NIH, 10 Center Drive, Bethesda, MD 20892-1400, USA.
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Comparison of Prevalence, Related Medical History, Symptoms, and Interventions Regarding Bowel Dysfunction in Persons With Multiple Sclerosis. J Neurosci Nurs 2010. [DOI: 10.1097/jnn.0b013e3181e26bfb] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rasova K, Feys P, Henze T, van Tongeren H, Cattaneo D, Jonsdottir J, Herbenova A. Emerging evidence-based physical rehabilitation for multiple sclerosis - towards an inventory of current content across Europe. Health Qual Life Outcomes 2010; 8:76. [PMID: 20667079 PMCID: PMC2915974 DOI: 10.1186/1477-7525-8-76] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Accepted: 07/28/2010] [Indexed: 11/10/2022] Open
Abstract
In Europe, theoretical approaches to physical therapy and rehabilitation in multiple sclerosis often appear significantly different. While there is general agreement that rehabilitation plays an important role in maintaining and improving function in persons with multiple sclerosis, no consensus exists on what may be the most effective approach to achieve the best possible functionality within an individual's limitations.The objective of this paper is to initiate an analysis of currently applied physical interventions for people with multiple sclerosis throughout Europe during inpatient or outpatient rehabilitation programs. A study of the content of rehabilitation may show presently performed treatment methods revealing the basic considerations that nowadays guide clinicians implicitly or explicitly in the treatment of persons with multiple sclerosis. Following this first step, comparative studies can be set up.
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Affiliation(s)
- Kamila Rasova
- Department of Rehabilitation, Third Medical Faculty, Charles University, Ruská 87, 100 00 Prague 10, Czech Republic.
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Vaney C, Roth R. Rehabilitation bei Multipler Sklerose (MS). NeuroRehabilitation 2010. [DOI: 10.1007/978-3-642-12915-5_38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nutini M, Karczewski M, Capoor J. Fatigue in children with neurologic impairments. Phys Med Rehabil Clin N Am 2009; 20:339-46. [PMID: 19389615 DOI: 10.1016/j.pmr.2008.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Children with neuromuscular illness are at high risk for fatigue. This symptom, although difficult to decipher, can contribute significantly to the child's disability. It is, therefore, imperative to consider fatigue in the management of children with special health care needs. Currently, the literature on chronic fatigue in children is sparse and so more investigative work must be done to understand and manage this condition.
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Affiliation(s)
- Marykatharine Nutini
- The Mount Sinai Hospital, 1425 Madison Avenue, Box 1240, Department of Rehabilitation Medicine, 4th Floor, New York, NY 10029, USA.
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29
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Abstracts. Br J Occup Ther 2009. [DOI: 10.1177/03080226090728s101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Exercise and quality of life among people with multiple sclerosis: looking beyond physical functioning to mental health and participation in life. Arch Phys Med Rehabil 2009; 90:420-8. [PMID: 19254606 DOI: 10.1016/j.apmr.2008.09.558] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Revised: 06/24/2008] [Accepted: 09/04/2008] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To describe the prevalence of exercise in a national sample of veterans with multiple sclerosis (MS) and the association of exercise with quality of life, including physical health, mental health, and participation restriction. DESIGN Cross-sectional cohort study linking computerized medical records to mailed survey data from 1999. SETTING Veterans Health Administration. PARTICIPANTS Veterans with MS (N=2995; 86.5% men) who received services in the Veterans Health Administration and returned survey questionnaires. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Demographic information, Veteran RAND 36-Item Health Survey (VR-36), self-reported exercise frequency. RESULTS Among all survey respondents with MS, only 28.6% (95% confidence interval, 26.9-30.2) endorsed any exercise. In adjusted logistic regression, exercise was associated with younger age, more education, living alone, lower levels of bodily pain, and higher body mass index. After adjusting for demographic variables and medical comorbidities, exercise was associated with better physical and mental health. People who exercised reported they had better social functioning and better role functioning (participation in life despite physical and emotional difficulties). CONCLUSIONS Exercise in veterans with MS is uncommon. In the context of chronic illness care, the identification of exercise patterns and promotion of physical activity may represent an important opportunity to improve mental health and quality of life among people with MS. Intervention should address factors associated with lower rates of exercise including age, education, and pain.
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Bol Y, Duits AA, Hupperts RMM, Vlaeyen JWS, Verhey FRJ. The psychology of fatigue in patients with multiple sclerosis: a review. J Psychosom Res 2009; 66:3-11. [PMID: 19073287 DOI: 10.1016/j.jpsychores.2008.05.003] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Revised: 04/10/2008] [Accepted: 05/06/2008] [Indexed: 11/19/2022]
Abstract
Fatigue is a frequent and disabling symptom in patients with multiple sclerosis (MS), but it is difficult to define and measure. Today, MS-related fatigue is not fully understood, and evidence related to explanatory pathophysiological factors are conflicting. Here, we evaluate the contribution of psychological factors to MS-related fatigue. Insight into the possible underlying psychological mechanisms might help us to develop adequate psychological interventions and to improve the overall management of fatigue. Conceptual issues and the relationships between MS-related fatigue and mood, anxiety, cognition, personality, and cognitive-behavioral factors are discussed, and the implications for clinical practice and research are presented.
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Affiliation(s)
- Yvonne Bol
- Department of Psychology, Maastricht University Medical Center, Maastricht, The Netherlands.
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Vanner EA, Block P, Christodoulou CC, Horowitz BP, Krupp LB. Pilot study exploring quality of life and barriers to leisure-time physical activity in persons with moderate to severe multiple sclerosis. Disabil Health J 2008; 1:58-65. [DOI: 10.1016/j.dhjo.2007.11.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2007] [Revised: 11/02/2007] [Accepted: 11/08/2007] [Indexed: 10/22/2022]
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Prvu Bettger JA, Stineman MG. Effectiveness of multidisciplinary rehabilitation services in postacute care: state-of-the-science. A review. Arch Phys Med Rehabil 2007; 88:1526-34. [PMID: 17964900 PMCID: PMC4309994 DOI: 10.1016/j.apmr.2007.06.768] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Revised: 06/14/2007] [Accepted: 06/19/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To summarize the efficacy of postacute rehabilitation and to outline future research strategies for increasing knowledge of its effectiveness. DATA SOURCES English-language systematic reviews that examined multidisciplinary therapy-based rehabilitation services for adults, published in the last 25 years and available through Cochrane, Medline, or CINAHL databases. We excluded multidisciplinary biopsychosocial rehabilitation programs and mental health services. STUDY SELECTION Using the search term rehabilitation, 167 records were identified in the Cochrane database, 1163 meta-analyses and reviews were identified in Medline, and 226 in CINAHL. The Medline and CINAHL search was further refined with 3 additional search terms: therapy, multidisciplinary, and interdisciplinary. In summary, we used 12 reviews to summarize the efficacy of multidisciplinary, therapy-based postacute rehabilitation; the 12 covered only 5 populations. DATA EXTRACTION Two reviewers extracted information about study populations, sample sizes, study designs, the settings and timing of rehabilitation, interventions, and findings. DATA SYNTHESIS Based on systematic reviews, the evidence for efficacy of postacute rehabilitation services across the continuum was strongest for stroke. There was also strong evidence supporting multidisciplinary inpatient rehabilitation for patients with rheumatoid arthritis, moderate to severe acquired brain injury, including traumatic etiologies, and for older adults. Heterogeneity limited our ability to conclude a benefit or a lack of a benefit for rehabilitation in other postacute settings for the other conditions in which systematic reviews had been completed. The efficacy of multidisciplinary rehabilitation services has not been systematically reviewed for many of the diagnostic conditions treated in rehabilitation. We did not complete a summary of findings from individual studies. CONCLUSIONS Given the limitations and paucity of systematic reviews, information from carefully designed nonrandomized studies could be used to complement randomized controlled trials in the study of the effectiveness of postacute rehabilitation. Consequently, a stronger evidence base would become available with which to inform policy decisions, guide the use of services, and improve patient access and outcomes.
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Affiliation(s)
- Janet A Prvu Bettger
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, PA, USA
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Schwid SR. SYMPTOMATIC MANAGEMENT OF MULTIPLE SCLEROSIS. Continuum (Minneap Minn) 2007. [DOI: 10.1212/01.con.0000293645.20988.3c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
Multiple sclerosis (MS) is a chronic progressive disease which is the leading cause, after road traffic accidents, of handicap in young subjects. The large range of symptoms associated with MS lead to continuing decline in mood and quality of life. Despite therapeutic advances, functional impairments have significant consequences. Neurorehabilitation can be highly contributive in this disease with the goals of increasing independence and quality-of-life and improving functional capacities. Individualized programs elaborated by a multidisciplinary team of experts are the key to success of rehabilitation. Assessment is difficult because of the underlying conflict between the philosophies of rehabilitation and evidence-based medicine. The aim of this paper is to provide an overview of MS rehabilitation. Physical exercise is safe and should be encouraged for people with MS. Some studies have shown that supervised exercises have a beneficial effect on MS disability and quality of life. Inpatient rehabilitation for MS yields short-term benefits in function, mobility and quality of life; periodic hospitalization may be needed. In the future, rehabilitation professionals will have to learn how to anticipate patient needs and lay the groundwork for services and equipment in advance. Rehabilitation is one of the treatments of MS patients and should be viewed as an ongoing process to maintain and restore maximum function and quality of life.
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Affiliation(s)
- C Donzé
- Service de médecine physique et réadaptation fonctionnelle, groupe hospitalier de l'Institut catholique de Lille, Lille, France.
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Khan F, Turner-Stokes L, Ng L, Kilpatrick T. Multidisciplinary rehabilitation for adults with multiple sclerosis. Cochrane Database Syst Rev 2007; 2007:CD006036. [PMID: 17443610 PMCID: PMC8992048 DOI: 10.1002/14651858.cd006036.pub2] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Multidisciplinary rehabilitation (MD) is an important component of symptomatic and supportive treatment for Multiple sclerosis (MS), but evidence base for its effectiveness is yet to be established. OBJECTIVES To assess the effectiveness of organized MD rehabilitation in adults with MS. To explore rehabilitation approaches that are effective in different settings and the outcomes that are affected. SEARCH STRATEGY The sources used included: Cochrane Central Register of Controlled Trials "CENTRAL", MEDLINE (1966- 2005), CINAHL (1982- 2005), PEDro (1990- 2005), EMBASE (1988- 2005), the Cochrane Rehabilitation and Related Therapies Field trials Register and the National Health Service National Research Register (NRR). SELECTION CRITERIA Randomized and controlled clinical trials that compared MD rehabilitation with routinely available local services or lower levels of intervention; or trials comparing interventions in different settings or at different levels of intensity. DATA COLLECTION AND ANALYSIS Three reviewers selected trials and rated their methodological quality independently. A 'best evidence' synthesis based on methodological quality was performed. Trials were grouped in terms of setting and type of rehabilitation and duration of patient follow up. MAIN RESULTS Eight trials (7 RCTs; 1 CCT) (747 participants and 73 caregivers) were identified. Seven RCTs scored well and one CCT scored poorly on the methodological quality assessment. There was 'strong evidence' that despite no change in the level of impairment, inpatient MD rehabilitation can produce short-term gains at the levels of activity (disability) and participation for patients with MS. For outpatient and home-based rehabilitation programmes there was 'limited evidence' for short-term improvements in symptoms and disability with high intensity programmes, which translated into improvement in participation and quality of life. For low intensity programmes conducted over a longer period there was strong evidence for longer-term gains in quality of life; and also limited evidence for benefits to carers. Although some studies reported potential for cost-savings, there is no convincing evidence regarding the long-term cost-effectiveness of these programmes. It was not possible to suggest best 'dose' of therapy or supremacy of one therapy over another. This review highlights the limitations of RCTs in rehabilitation settings and need for better designed randomized and multiple centre trials. AUTHORS' CONCLUSIONS MD rehabilitation programmes do not change the level of impairment, but can improve the experience of people with MS in terms of activity and participation. Regular evaluation and assessment of these persons for rehabilitation is recommended. Further research into appropriate outcome measures, optimal intensity, frequency, cost and effectiveness of rehabilitation therapy over a longer time period is needed. Future research in rehabilitation should focus on improving methodological and scientific rigour of clinical trials.
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Affiliation(s)
- F Khan
- University of Melbourne, Department of Rehabilitation Medicine, Poplar Road, Parkville, Melbourne, Victoria, Australia, 3052.
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Bjarnadottir OH, Konradsdottir AD, Reynisdottir K, Olafsson E. Multiple sclerosis and brief moderate exercise. A randomised study. Mult Scler 2007; 13:776-82. [PMID: 17613606 DOI: 10.1177/1352458506073780] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This is a randomised control study, to determine the effect of aerobic and strength exercise on physical fitness and quality of life in patients with mild multiple sclerosis (MS). Sixteen outpatients with definitive MS, aged 18-50, with an Expanded Disability Status Scale (EDSS) <4, completed the study. Every patient was evaluated according to physical fitness with peak oxygen consumption (V'O2peak), workload and anaerobic threshold; quality of life (SF-36); and degree of disability (EDSS). The patients were then randomised to an exercise group (EG) (n =6) or a control group (CG) (n = 10). The EG exercised three times a week for five weeks, and the CG did not change their habits regarding exercise. In the EG, the mean change in workload was 0.34 W/kg (95% confidence interval (CI): 0.09-0.58), the mean change in V'O2peak was 4.54 mL/kg per minute (95% CI: 1.65-7.44), and the mean change in anaerobic threshold was 0.32 L/min (95% CI: 0.08-0.57). There was a tendency towards improved quality of life, and no change was detected in the degree of disability. This study confirms that brief, moderate, aerobic exercise improves physical fitness in individuals with mild MS. No evidence was found for worsening of MS symptoms in association with exercises.
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Neill J, Belan I, Ried K. Effectiveness of non-pharmacological interventions for fatigue in adults with multiple sclerosis, rheumatoid arthritis, or systemic lupus erythematosus: a systematic review. J Adv Nurs 2006; 56:617-35. [PMID: 17118041 DOI: 10.1111/j.1365-2648.2006.04054.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This paper reports a systematic review of non-pharmacological interventions for fatigue in adults with three common autoimmune conditions. BACKGROUND A considerable proportion of people with multiple sclerosis, rheumatoid arthritis, and systemic lupus erythematosus experience compromised quality of life due to fatigue. Recent reviews of pharmacotherapies for fatigue in these conditions remain inconclusive, and systematic evidence for effectiveness of non-pharmacological interventions was unavailable. Our paper addresses this gap. METHODS The literature search used the key words fatigue, energy, multiple sclerosis, rheumatoid arthritis and systemic lupus. It included 19 electronic databases and libraries, three evidence-based journals, two internet search engines, was dated 1987-2006, and limited to English. Non-pharmacological experimental studies about fatigue comprising more than five adults were included. Meta-analysis was not possible due to diverse interventions and outcome measures, therefore studies were analysed by types of interventions used to reduce fatigue. RESULTS Of 653 hits, 162 papers were reviewed, and 36 met the inclusion criteria. Thirty-three primary studies reported 14 randomized controlled trials and 19 quasi-experimental designs. Most interventions were tested with people with multiple sclerosis. Exercise, behavioural, nutritional and physiological interventions were associated with statistically significant reductions in fatigue. Aerobic exercise was effective, appropriate and feasible for reducing fatigue among adults with chronic autoimmune conditions. Electromagnetic field devices showed promise. The diversity of interventions, designs, and using 24 different instruments to measure fatigue, limited comparisons. CONCLUSION Low impact aerobic exercise gradually increasing in intensity, duration and frequency may be an effective strategy in reducing fatigue in some adults with chronic auto-immune conditions. However, fatigue is a variable and personal experience and a range of behavioural interventions may be required. Well-designed studies testing these promising strategies and consensus on outcome fatigue measures are needed.
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Affiliation(s)
- Jane Neill
- School of Nursing and Midwifery, Flinders University, Adelaide, Australia.
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Abstract
Over the past decade, community neurorehabilitation has emerged as a promising extension of neurological rehabilitation. The goal of community neurorehabilitation is to maximize functional ability and quality of life through multidimensional rehabilitation that occurs while the individual is living in a home versus acute or transitory care setting. Because of its multidisciplinary focus, many variations of community neurorehabilitation teams have been implemented. Critical gaps exist, however, in understanding of the influence of structural and procedural differences among programs, as well as patient level variables such as social support, on recovery. This paper examines the current evidence of the effectiveness of community neurorehabilitation through a review of the findings of systematic reviews and meta-analyses of four neurological conditions: stroke, multiple sclerosis, traumatic brain injury, and Parkinson's disease. It focuses in particular on the data regarding physical therapy and occupational therapy, which are two of the primary components of community neurorehabilitation programs.
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Affiliation(s)
- Sarah E Chard
- Department of Sociology and Anthropology, University of Maryland, Baltimore County, Baltimore, Maryland 21250, USA.
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Henze T, Rieckmann P, Toyka KV. Symptomatic treatment of multiple sclerosis. Multiple Sclerosis Therapy Consensus Group (MSTCG) of the German Multiple Sclerosis Society. Eur Neurol 2006; 56:78-105. [PMID: 16966832 DOI: 10.1159/000095699] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2006] [Accepted: 07/12/2006] [Indexed: 01/13/2023]
Abstract
Besides immunomodulation and immunosuppression, the specific treatment of symptoms is an essential component of the overall management of multiple sclerosis (MS). Symptomatic treatment is aimed at the elimination or reduction of symptoms impairing the functional abilities and quality of life of the affected patients. Moreover, with symptomatic treatment the development of a secondary physical impairment due to an existing one may be avoided. Many therapeutic techniques as well as different drugs are used for the treatment of MS symptoms, but only a few of them have been investigated, especially in MS patients, and are approved by the national health authorities. Despite an overwhelming number of publications, only a few evidence-based studies exist and consensus reports are very rare, too. Therefore, it seemed necessary to develop a consensus statement on symptomatic treatment of MS comprising existing evidence-based literature as well as therapeutic experience of neurologists who have dealt with these problems over a long time. This consensus paper contains proposals for the treatment of the most common MS symptoms: disorders of motor function and coordination, of cranial nerve function, of autonomic, cognitive, and psychological functions as well as MS-related pain syndromes and epileptic seizures.
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Affiliation(s)
- T Henze
- Reha-Zentrum Nittenau, Rehabilitationszentrum fur Neurologie, Nittenau, Germany.
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Rasova K, Havrdova E, Brandejsky P, Zálisová M, Foubikova B, Martinkova P. Comparison of the influence of different rehabilitation programmes on clinical, spirometric and spiroergometric parameters in patients with multiple sclerosis. Mult Scler 2006; 12:227-34. [PMID: 16629428 DOI: 10.1191/135248506ms1248oa] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
PURPOSE The aim of this study was to compare the effect of four different programmes on spiroergometric, spirometric and clinical parameters in multiple sclerosis (MS) patients. METHODS One hundred and twelve MS patients were divided into four groups. The first group underwent neurophysiologically based physiotherapy, the second aerobic training, the third combined therapy (neurophysiologically based physiotherapy and aerobic training) and the fourth did not change any habits. Seventeen patients did not finish the study. Patients were examined on impairment (Expanded Disability Status Scale), disability (Barthel Index), handicap (Environment Status Scale), quality of life (Multiple Sclerosis Quality of Life), fatigue (Modified Fatigue Impact Scale), depression (Beck Depression Inventory Score), respiratory function (spirometric parameters on spirometry) and physical fitness (spiroergometric parameters on a bicycle ergometer). RESULTS The patients who participated in one of our training programmes showed a significant improvement of the examined parameters in comparison to those who did not change their present habits. Each of the four training programmes had a different impact on the parameters, which means that each of them had a different effect. The neurophysiologically based physiotherapy had the greatest impact on impairment, and the aerobic training on spirometric and spiroergometric parameters. All methods (the neurophysiologically based physiotherapy, the aerobic training and the combined programme) had an impact on fatigue.
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Affiliation(s)
- K Rasova
- Department of Neurology, 1st Medical Faculty, Charles University in Prague and General Faculty Hospital, Czech Republic.
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Storr LK, Sørensen PS, Ravnborg M. The efficacy of multidisciplinary rehabilitation in stable multiple sclerosis patients. Mult Scler 2006; 12:235-42. [PMID: 16629429 DOI: 10.1191/135248506ms1250oa] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To evaluate the short-term efficacy of multidisciplinary, inpatient rehabilitation of multiple sclerosis (MS) patients. METHODS A double-blind, randomized, parallel group design was used. The intervention group were offered comprehensive, multidisciplinary inpatient rehabilitation at the Haslev MS Hospital for an average of 35.5 days, while the control group received no treatment related to the study. All patients were examined in their homes twice with a 10-week interval. The rehabilitation of the intervention group started 2-3 weeks after the first examination and ended 2-3 weeks before the second examination. Impairment was assessed by the Multiple Sclerosis Impairment Scale and the Expanded Disability Status Scale. Disability was assessed by means of Guy's Neurological Disability Scale. Two specific scales were used to assess upper limb function and ambulation: The Nine-Hole Peg Test and timed 10-metre walking. Patients' own perception of bodily pain, bladder symptoms, spasticity, fatigue, impaired walking and transfers were recorded using visual analogue scales. Finally, quality of life was assessed using the Life Appreciation and Satisfaction Questionnaire and the Functional Assessment in Multiple Sclerosis. PATIENTS Two hundred and thirty-three patients were screened and of those 38 were included for treatment and 52 as controls. RESULTS We found no statistically significant differences between the two groups in any of the outcome measures. CONCLUSION Although the study was underpowered, the negative outcome exposes the difficulties in quantitative analyses of the efficacy of multidisciplinary rehabilitation, which is liable to confounding factors such as variation in the indication for treatment, in the placebo effect, and in the reliability and responsiveness of the outcome measures.
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Affiliation(s)
- L K Storr
- Copenhagen Multiple Sclerosis Centre, the Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Denmark
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Colle F, Bonan I, Gellez Leman MC, Bradai N, Yelnik A. Fatigue après accident vasculaire cérébral. ACTA ACUST UNITED AC 2006; 49:272-6, 361-4. [PMID: 16716436 DOI: 10.1016/j.annrmp.2006.04.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Accepted: 04/09/2006] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To examine the phenomenon of fatigue after stroke and to review the knowledge about frequency, consequences, associated factors, physiopathology and treatment. MATERIALS AND METHOD Medline was systematically searched with the following keywords: stroke, fatigue, sleep disorders, exercise, and rehabilitation. All relevant articles found in the references were screened as well. RESULTS AND DISCUSSION Fatigue is a common complaint after stroke and occurs in 39-72% of stroke survivors. Some studies show a severe functional impact of this symptom as well as a high mortality rate. Available evidence concerning associated factors is limited, but fatigue is clearly multifactorial. Some studies show that limited exercise capacity, increased gait energy cost, sleep-disordered breathing and sleep disorders can be related to physical fatigue. Other studies show a link between fatigue and depression. The existence of primary fatigue is still controversial. Treatment must follow a diagnostic approach. Treadmill training, among other treatments, improves fitness reserve and lowering of the energy cost of hemiparetic gait, which could be useful in relieving fatigue.
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Affiliation(s)
- F Colle
- Unité de Médecine Physique et Réadaptation, Centre Hospitalier Sainte-Anne, 1, rue Cabanis, 75674 Paris cedex 14, France.
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Boërio D, Lefaucheur JP, Hogrel JY, Créange A. [Pathophysiology and treatment of fatigue in multiple sclerosis]. Rev Neurol (Paris) 2006; 162:311-20. [PMID: 16585886 DOI: 10.1016/s0035-3787(06)75017-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patients suffering from multiple sclerosis (MS) frequently complain of fatigue (53 to 92 percent depending on studies). Fatigue can be one of the most disabling symptoms of MS and presents as physical or mental fatigue in daily living activities. Besides this permanent feeling of exhaustion, MS patients can suffer from an abnormal tiredness and lack of energy after a given motor or mental task, which defines fatigability. A number of studies explored the origins of fatigue and fatigability by means of subjective and objective tools. The implication of central nervous system dysfunctions has been established in several studies; however the contribution of peripheral nervous system factors and systemic abnormalities associated with inflammatory and immunological parameters was also suggested. The aim of this review is to present the different types of fatigue and fatigability occurring in MS patients, their origins, the investigation tools which allow the quantification of fatigue and fatigability and characterization of their mechanisms. The currently available therapeutic strategies that have been proposed to relieve this disabling symptom are presented.
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Affiliation(s)
- D Boërio
- Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, AP-HP, Créteil
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Béthoux F. Fatigue and multiple sclerosis. ACTA ACUST UNITED AC 2006; 49:265-71, 355-60. [PMID: 16757056 DOI: 10.1016/j.annrmp.2006.04.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Accepted: 04/03/2006] [Indexed: 11/28/2022]
Abstract
Even if the definition and pathophysiology of fatigue in multiple sclerosis (MS) are still debated, and despite the scarcity of objective markers correlated with the subjective sensation of fatigue, a review of the literature shows the importance of its detection and management, and allows one to propose therapeutic strategies. Fatigue is not only the most frequently reported symptom in MS, but also a frequent source of activity and participation limitations, psychological distress, and impairment of quality of life. Its management, which must be initiated early, is based on a comprehensive evaluation of its characteristics and consequences (sometimes with the use of scales such as the Fatigue Severity Scale and the Modified Fatigue Impact Scale), and on the identification of many potential contributing factors (psychological disorders, sleep disturbances, pain, infections and other comorbidities, medications, and deconditioning). Rehabilitative interventions are essential to the treatment of fatigue. Beyond the traditional energy conservation strategies and cooling techniques, several randomized controlled studies have demonstrated the positive impact of aerobic exercise. Medications are partially beneficial, and with the exception of amantadine, their efficacy has not been confirmed by randomized double-blind trials.
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Affiliation(s)
- F Béthoux
- The Mellen Center for Multiple Sclerosis Treatment and Research, the Cleveland clinic, 9500 Euclid avenue, Cleveland, OH 44195, USA.
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Cantalloube S, Monteil I, Lamotte D, Mailhan L, Thoumie P. Évaluation préliminaire des effets de la rééducation sur les paramètres de force, d'équilibre et de marche dans la sclérose en plaques. ACTA ACUST UNITED AC 2006; 49:143-9. [PMID: 16545886 DOI: 10.1016/j.annrmp.2006.01.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2005] [Accepted: 01/05/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the impact of rehabilitation on balance, gait and strength in inpatients with multiple sclerosis (MS). METHODS Twenty-one in patients with MS benefited from a program of rehabilitation with evaluation before and after rehabilitation. Balance was assessed by stabilometry, walking speed with use of a locometer device and maximal peak torque of knee extensor and flexor with use of an isokinetic dynamometer at 60 degrees /s speed. The functional independence measure (FIM) was also applied before and after rehabilitation. RESULTS After rehabilitation, patients showed significant improvement in balance with opened and closed eyes, velocity gait, strength of the lower quadriceps and the higher hamstrings and FIM values. Absolute values of gait speed and strength parameters were related as were improvement in velocity speed and the higher hamstrings. CONCLUSION The results are encouraging and confirm the interest and tolerance of a program of rehabilitation among patients with MS.
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Affiliation(s)
- S Cantalloube
- Service de Rééducation Neurologique, Hôpital Léopold-Bellan, 21, rue Vercingétorix, 75014 Paris, France
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Abstract
Multiple sclerosis (MS) is associated with a variety of symptoms and functional deficits that result in a range of progressive impairments and handicap. Symptoms that contribute to loss of independence and restrictions in social activities lead to continuing decline in quality of life. Our aim is to give an updated overview on the management of symptoms and rehabilitation measures in MS. Appropriate use of these treatment options might help to reduce long-term consequences of MS in daily life. First, we review treatment of the main symptoms of MS: fatigue, bladder and bowel disturbances, sexual dysfunction, cognitive and affective disorders, and spasticity. Even though these symptomatic therapies have benefits, their use is limited by possible side-effects. Moreover, many common disabling symptoms, such as weakness, are not amenable to drug treatment. However, neurorehabilitation has been shown to ease the burden of these symptoms by improving self-performance and independence. Second, we discuss comprehensive multidisciplinary rehabilitation and specific treatment options. Even though rehabilitation has no direct influence on disease progression, studies to date have shown that this type of intervention improves personal activities and ability to participate in social activities, thereby improving quality of life. Treatment should be adapted depending on: the individual patient's needs, demands of their surrounding environment, type and degree of disability, and treatment goals. Improvement commonly persists for several months beyond the treatment period, mostly as a result of reconditioning and adaptation and appropriate use of medical and social support at home. These findings suggest that quality of life is determined by disability and handicap more than by functional deficits and disease progression.
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Affiliation(s)
- Jürg Kesselring
- Department of Neurology and Neurorehabilitation, Rehabilitation Centre, CH-7317, Valens, Switzerland.
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Brown TR, Kraft GH. Exercise and Rehabilitation for Individuals with Multiple Sclerosis. Phys Med Rehabil Clin N Am 2005; 16:513-55. [PMID: 15893685 DOI: 10.1016/j.pmr.2005.01.005] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
It is the coexistence of physical and cognitive impairments, together with emotional and social issues in a disease with an uncertain course, that makes MS rehabilitation unique and challenging. Inpatient rehabilitation improves functional independence but has only limited success improving the level of neurologic impairment. Benefits are usually not long lasting. Severely disabled people derive equal or more benefit than those who are less disabled, but cognitive problems and ataxia tend to be refractory. There is now good evidence that exercise can improve fitness and function for those with mild MS and helps to maintain function for those with moderate to severe disability. Therapy can be performed over 6 to 15 weeks in outpatient or home-based settings or as a weekly day program lasting several months. Several different forms of exercise have been investigated. For most individuals, aerobic exercise that incorporates a degree of balance training and socialization is recommended. Time constraints, access, impairment level, personal preferences, motivations, and funding sources influence the prescription for exercise and other components of rehabilitation. Just as immunomodulatory drugs must be taken on a continual basis and be adjusted as the disease progresses, so should rehabilitation be viewed as an ongoing process to maintain and restore maximum function and QOL.
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Affiliation(s)
- Theodore R Brown
- MS Hub Medical Group, 1100 Olive Way, Suite 150, Seattle, WA 98101, USA.
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