MAM-36 and ABILHAND as outcome measures of multiple sclerosis hand disability: an observational study

Sustained-release oral dalfampridine appears to have no impact on upper extremity function in people with multiple sclerosis: a randomized controlled trial

Background

Upper limb dysfunction is common in people with multiple sclerosis (pwMS), significantly affecting daily activities and quality of life. While dalfampridine has shown efficacy in improving gait in pwMS, its impact on upper extremity function remains unclear.

Objectives

To evaluate the effect of sustained-release oral dalfampridine on upper extremity function in pwMS.

Design

A randomized, placebo-controlled trial.

Methods

In all, 30 pwMS were randomized to receive either dalfampridine (10 mg twice daily) or a placebo for 2 weeks. Upper extremity function was assessed at baseline, after 1 week, after 2 weeks of treatment, and 2 weeks post-treatment using clinical tests (9-Hole Peg Test, Box, and Block Test, peak isometric grip force, 2-point discrimination) and self-reported questionnaires (disabilities of the arm, shoulder and hand, ability measure of the hand, Manual Ability Measurement 36). Data were analyzed using repeated-measures analysis of variance to evaluate group × time interactions.

Results

No significant group × time interactions were observed across clinical or self-reported outcomes. Both groups exhibited similar trends over time, with no measurable improvements in upper extremity dexterity, strength, or perceived function attributable to dalfampridine.

Conclusion

Sustained-release dalfampridine does not appear to improve upper extremity function in pwMS, highlighting its limitations beyond gait-related benefits. These findings underscore the need for further research to explore alternative treatments targeting upper limb dysfunction in this population.

Trial registration

ClinicalTrials.gov NCT02259361.

Effects of the powerball® system on muscle strength, coordination, fatigue, functionality and quality of life in people with multiple sclerosis. A randomized clinical trial

INTRODUCTION

Although clinical and functional impairments in the lower limbs have been extensively studied in patients with MS, the upper limb (UL) are also frequently affected. Clinical impairment of the UL in patients with MS is very common with muscle strength and hand dexterity as critical factors in maintaining functional activities that are the basis for independence and quality of life in people with MS.

OBJECTIVE

To investigate the effects of a training protocol using the Powerball® system in combination with conventional physiotherapy on muscle strength, coordination, fatigue, functionality, and quality of life in persons with MS over an 8-week period.

MATERIALS AND METHODS

A double-blind randomized controlled trial was conducted. The control group received conventional treatment, while the experimental group received additional UL training using the Powerball® system. Both groups received the same number of sessions and weeks of intervention. The following outcome measures were used: isometric grip and pinch strength, Box and Block Test (BBT), Nine Hole Peg Test (NHPT), Abilhand scale, Fatigue Severity Scale (FSS), Multiple Sclerosis Impact Scale (MSIS-29), and Likert satisfaction questionnaire for the experimental group. All measures were administered at baseline, after the treatment, and during a 3-week follow-up period.

RESULTS

25 patients completed the study (12 in the experimental and 13 in the control group). The experimental group showed significant improvements in coordination and manual dexterity of the more affected UL as measured by the BBT comparing pre- to post-treatment (p = 0.048) and pre-treatment to follow-up (p = 0.001), and on the less affected UP comparing pre-treatment to follow-up (p < 0.001) and post-treatment to follow-up (p = 0.034). The Likert-type satisfaction questionnaire obtained a mean score of 89.10 (± 8.54) out of 100 points.

CONCLUSIONS

Upper limb treatment protocol using the Powerball® system, in combination with conventional physiotherapy for 8 weeks resulted in significant improvements in the intra-group analysis for UL coordination and manual dexterity in favor of the experimental group. The experimental group showed excellent satisfaction to the treatment.

[Questionnaires for arm function assessment in patients with multiple sclerosis]

Arm dysfunction is one of the disabling manifestations of multiple sclerosis (MS), especially in later stages of the disease. Assessment of the functioning of the upper limbs is necessary to objectify the course of MS, determine the effectiveness of therapy, and individualize rehabilitation measures. The tools that assess the upper extremity dysfunction include tests and questionnaires. Questionnaires (patient-reported outcome measures) represent the special importance, since the opinions and preferences of patients themselves help to implement a patient-centered approach to treatment. The article presents a brief description of three multidimensional MS-specific and four unidimensional MS-nonspecific questionnaires that used in assessment of upper limb function in MS patients. The disease-specific unidimensional Arm Function in Multiple Sclerosis Questionnaire (AMSQ), specifically designed to assess the arm use in patients with MS, is discussed in more detail. The use of AMSQ in the Russian population is possible only after the procedure of cultural adaptation and validation of the Russian version.