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Solaro C, Di Giovanni R, Grange E, Brichetto G, Mueller M, Tacchino A, Bertoni R, Patti F, Pappalardo A, Prosperini L, Rosato R, Cattaneo D, Marengo D. Influence of cognition on the correlation between objective and subjective upper limb measures in people with multiple sclerosis. Neurol Sci 2024; 45:2783-2789. [PMID: 38175316 DOI: 10.1007/s10072-023-07286-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND A comprehensive assessment of upper limb (UL) function is mandatory in people with multiple sclerosis (PwMS), and the use of multiple objective and subjective measures is advisable. Findings on the role of cognitive impairment on the assessment of UL function are scant and inconclusive. The present study investigated the influence of cognitive function on the distribution of objective and subjective UL measures and on their association. METHODS In the cross-sectional study, subjects with a diagnosis of MS, age ≥ 18 years, right-hand dominance, no presence of orthopedic UL impairment, or other neurological diseases were recruited. The assessment protocol included the Nine-Hole Peg Test (9-HPT), Box and Block Test (BBT), and hand grip strength (HGS), a validated PROM (MAM-36), and the Symbol Digit Modalities Test (SDMT). RESULTS Two hundred forty-six PwMS were recruited (158 females, mean age = 51.65 ± 13.45 years; mean EDSS = 5.10 ± 1.88) Subject with mild-to-moderate cognitive impairment (SDMT ≤ - 2 SD of normative values) scored lower on the 9-HPT and higher on the BBT and MAM-36 when compared with subject with no cognitive impairment. Cognitive impairment showed a small but significant effect on the association between 9-HPT scores and the MAM-36. DISCUSSION Findings suggest that cognitive impairment is associated with subjects' performance on 9-HPT, BBT, and MAM-36 (but not HGS), resulting in scores indicating a poorer UL function. Interestingly, cognitive impairment slightly affected the congruence between subjective and objective UL measures, although only minor differences in the correlation pattern across groups reporting different cognitive performances emerged.
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Affiliation(s)
- Claudio Solaro
- CRRF "Mons. Luigi Novarese", Moncrivello, VC, Italy
- Neurology Unit, Galliera Hospital, Genoa, Italy
| | | | - Erica Grange
- CRRF "Mons. Luigi Novarese", Moncrivello, VC, Italy
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Margit Mueller
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Rita Bertoni
- IRCSS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Francesco Patti
- MS Center Institute of Neurological Sciences, University of Catania, Catania, Italy
| | - Angelo Pappalardo
- MS Center Institute of Neurological Sciences, University of Catania, Catania, Italy
| | - Luca Prosperini
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - Rosalba Rosato
- Department of Psychology, University of Turin, Turin, Italy
| | - Davide Cattaneo
- IRCSS Fondazione Don Carlo Gnocchi, Milan, Italy
- Department of Physiopathology and Transplants, University of Milan, Milan, Italy
| | - Davide Marengo
- Department of Psychology, University of Turin, Turin, Italy.
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Lotti N, Missiroli F, Galofaro E, Tricomi E, Di Domenico D, Semprini M, Casadio M, Brichetto G, De Michieli L, Tacchino A, Masia L. Soft Robotics to Enhance Upper Limb Endurance in Individuals with Multiple Sclerosis. Soft Robot 2024; 11:338-346. [PMID: 37870773 DOI: 10.1089/soro.2023.0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic autoimmune disorder that affects the central nervous system and can result in various symptoms, including muscle weakness, spasticity, and fatigue, ultimately leading to the deterioration of the musculoskeletal system. However, in recent years, exosuits have emerged as a game-changing solution to assist individuals with MS during their daily activities. These lightweight and affordable wearable robotic devices have gained immense popularity. In our study, we assessed the performance of an elbow exosuit on eight individuals with MS using high-density electromyography to measure biceps muscle activity. The results demonstrated that our prototype significantly reduced muscle effort during both dynamic and isometric tasks while increasing the elbow range of motion. In addition, the exosuit effectively delayed the onset of muscle fatigue, enhancing endurance for people with MS and enabling them to perform heavy duty tasks for a longer period.
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Affiliation(s)
- Nicola Lotti
- Medizintechnik Group, Institut für Technische Informatik (ZITI), Faculty of Engineering Sciences, Heidelberg University, Heidelberg, Deutschland
| | - Francesco Missiroli
- Medizintechnik Group, Institut für Technische Informatik (ZITI), Faculty of Engineering Sciences, Heidelberg University, Heidelberg, Deutschland
| | - Elisa Galofaro
- Medizintechnik Group, Institut für Technische Informatik (ZITI), Faculty of Engineering Sciences, Heidelberg University, Heidelberg, Deutschland
| | - Enrica Tricomi
- Medizintechnik Group, Institut für Technische Informatik (ZITI), Faculty of Engineering Sciences, Heidelberg University, Heidelberg, Deutschland
| | - Dario Di Domenico
- Rehab Technologies Lab, Italian Institute of Technology, Genova, Italy
- Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | - Marianna Semprini
- Rehab Technologies Lab, Italian Institute of Technology, Genova, Italy
| | - Maura Casadio
- Dipartimento di Informatica, Bioingegneria, Robotica e Ingegneria dei Sistemi (DIBRIS), University of Genova, Genoa, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
- AISM Rehabilitation Service of Genoa, Italian Multiple Sclerosis Society (AISM), Genoa, Italy
| | | | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Lorenzo Masia
- Medizintechnik Group, Institut für Technische Informatik (ZITI), Faculty of Engineering Sciences, Heidelberg University, Heidelberg, Deutschland
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Ponzio M, Tacchino A, Verri A, Battaglia MA, Brichetto G, Podda J. Profile and burden of the family caregiver: the caring experience in multiple sclerosis. An observational study. BMC Psychol 2024; 12:173. [PMID: 38528601 DOI: 10.1186/s40359-024-01678-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 03/20/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND The broad implications of caring for a family member with a chronic medical condition, such as MS, can lead caregivers to experience a high burden of care. The aim of the study was to describe profile of MS caregivers and their burden and to explore potential factors influencing this burden. METHODS 200 family caregivers of a person with MS completed survey questionnaires across a cross-sectional study. Many information were collected: caregiver socio-demographic and health-related data, caregiving activities, knowledge of MS, coping strategies, mood, social support received and care recipient information. Caregiving burden was measured by the ZBI (Zarit Burden Interview). The extent to which the variables explained caregiver burden was analyzed using a hierarchical approach. RESULTS 68% of the caregivers reported a perceived burden of care (ZBI score > 20). Our results show that physical and mental related-health variables are important predictive factors of the care burden, explaining much of the observed variance (40.9%). CONCLUSION Family caregivers in MS continue to make up the shortfall produce by national health and welfare systems. We highlighted the importance of good physical and mental health in decreasing perceived burden. Working to alleviate psychological distress through mechanisms focus on reducing worries and perceived burden may be a valid approach.
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Affiliation(s)
- Michela Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Via Operai 40, 16149, Genoa, Italy.
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Via Operai 40, 16149, Genoa, Italy
| | - Anna Verri
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Via Operai 40, 16149, Genoa, Italy
| | - Mario Alberto Battaglia
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Via Operai 40, 16149, Genoa, Italy
- Department of Physiopathology, Experimental Medicine and Public Health, University of Siena, Siena, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Via Operai 40, 16149, Genoa, Italy
- AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Jessica Podda
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Via Operai 40, 16149, Genoa, Italy
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Podda J, Pedullà L, Brichetto G, Tacchino A. Evaluating Cognitive-Motor Interference in Multiple Sclerosis: A Technology-Based Approach. Bioengineering (Basel) 2024; 11:277. [PMID: 38534551 DOI: 10.3390/bioengineering11030277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/06/2024] [Accepted: 03/12/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND People with multiple sclerosis (PwMS) frequently present both cognitive and motor impairments, so it is reasonable to assume they may have difficulties in executing dual-tasks (DT). The aim of the present study is to identify novel technology-based parameters to assess cognitive-motor interference (CMI) in PwMS. In particular, we focused on the definition of dual-task cost (DTC) measures using wearable and portable tools such as insoles and mobile apps. METHODS All participants underwent a verbal fluency task (cognitive single-task, ST), a motor ST of walking, and a combination of these tasks (DT). Number of words uttered in the cognitive ST and steps recorded by insoles were used to calculate the motor and cognitive DTC. RESULTS The number of steps strongly correlated with the walked meters for both single- (r = 0.88, p < 0.05) and dual- (r = 0.91, p < 0.05) tasks. Motor but not cognitive performances significantly worsened during DT. Over the cognitive ST and DT, the number of pronounced words progressively decreased, probably due to the activation of different cognitive processes. Cognitive efforts could be the cause of cognitive task prioritization. CONCLUSIONS Our findings promote the use of low-cost devices to assess CMI easily in the clinical context and to detect ecologically valid DT impairments.
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Affiliation(s)
- Jessica Podda
- Scientific Research Area, Italian Multiple Sclerosis Foundation, 16149 Genoa, Italy
| | - Ludovico Pedullà
- Scientific Research Area, Italian Multiple Sclerosis Foundation, 16149 Genoa, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation, 16149 Genoa, Italy
- AISM Rehabilitation Service of Genoa, Italian Multiple Sclerosis Society, 16149 Genoa, Italy
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation, 16149 Genoa, Italy
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Tacchino A, Di Giovanni R, Grange E, Spirito MM, Ponzio M, Battaglia MA, Brichetto G, Solaro CM. The administration of the paper and electronic versions of the Manual Ability Measure-36 (MAM-36) and Fatigue Severity Scale (FSS) is equivalent in people with multiple sclerosis. Neurol Sci 2024; 45:1155-1162. [PMID: 37828384 DOI: 10.1007/s10072-023-07103-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND The mobile device diffusion has increasingly highlighted the opportunity to collect patient-reported outcomes (PROs) through electronic patient-reported outcomes measurements (ePROMs) during the clinical routine. Despite the ePROMs promises and advantages, the equivalence when a PRO measure is moved from the original paper-and-pencil to the electronic version is still little investigated. This study aims at evaluating equivalence between PROMs and ePROMs self-administration in people with multiple sclerosis (PwMS); in addition, preference of self-administration type was evaluated. METHODS The Manual Ability Measure-36 (MAM-36) and Fatigue Severity Scale (FSS) were selected for the equivalence test. The app ABOUTCOME was developed through a user-centered design approach to administer the questionnaires on tablet. Both paper-and-pencil and electronic versions were randomly self-administered. Intrarater reliability between both versions was evaluated through the intraclass correlation coefficient (ICC, excellent for values ≥ 0.75). RESULTS Fifty PwMS (35 females) participated to the study (mean age: 54.7±11.0 years, disease course: 27 relapsing-remitting and 23 progressive; mean EDSS: 4.7±1.9; mean disease duration: 13.3±9.5 years). No statistically significant differences were found for the means total scores of MAM-36 (p = 0.61) and FSS (p = 0.78). The ICC value for MAM-36 and FSS was excellent (0.98 and 0.94, respectively). Most of participants preferred the tablet version (84%). CONCLUSION The results of the study provide evidence about the equivalence between the paper-and-pencil and electronic versions of PROs administration. In addition, PwMS prefer electronic methods rather than paper because the information can be provided more efficiently and accurately. The results could be easily extended to other MS PROs.
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Affiliation(s)
- Andrea Tacchino
- Italian Multiple Sclerosis Foundation (FISM), Scientific Research Area, Via Operai, 40, 16149, Genoa, Italy.
| | | | - Erica Grange
- Italian Multiple Sclerosis Foundation (FISM), Scientific Research Area, Via Operai, 40, 16149, Genoa, Italy
| | - Maria Marcella Spirito
- Italian Multiple Sclerosis Foundation (FISM), Scientific Research Area, Via Operai, 40, 16149, Genoa, Italy
| | - Michela Ponzio
- Italian Multiple Sclerosis Foundation (FISM), Scientific Research Area, Via Operai, 40, 16149, Genoa, Italy
| | | | - Giampaolo Brichetto
- Italian Multiple Sclerosis Foundation (FISM), Scientific Research Area, Via Operai, 40, 16149, Genoa, Italy
- Italian Multiple Sclerosis Society (AISM) Rehabilitation Service of Liguria, Genoa, Italy
| | - Claudio Marcello Solaro
- CRRF "Mons. L. Novarese", Moncrivello (VC), Italy
- Galliera Hospital, Neurology Unit, Genoa, Italy
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Tacchino A, Skjerbæk AG, Podda J, Prada V, Monti Bragadin M, Bergamaschi V, Susini A, Hvid LG, Pedullà L, Brichetto G. The role of sensory systems in the association between balance and walking in people with multiple sclerosis. Mult Scler Relat Disord 2024; 83:105440. [PMID: 38219298 DOI: 10.1016/j.msard.2024.105440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/09/2023] [Accepted: 01/08/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND In Multiple Sclerosis, it has been demonstrated that balance is related to performances in walking tasks at different levels of complexity. However, it is unknown how the different sensory systems involved in balance control contribute to walking. This observational study investigates the associations between somatosensory, vestibular, and visual systems and measures of self-reported walking and walking capacity at different complexity levels (i.e. low, medium, and high). METHODS People with MS with EDSS<6 were assessed through the Sensory Organization Test (SOT), 12-Item MS Walking Scale (MSWS-12), Timed 25-Foot Walk (T25FW), Timed Up-and-Go Test (TUG), and Six-Spot-Step-Test (SSST). T25FW, TUG and SSST are measures of low, medium and high walking capacity, respectively. RESULTS Forty-five PwMS were enrolled (EDSS: 3.4 ± 1.3). Capacity/ability walking measures were moderate-to-highly significantly associated (p < 0.01). Balance measures from SOT showed significant correlation (p < 0.05) between vestibular system and all the walking measures; between visual system and T25FW, SSST and MSWS-12; between the degree to which the patient relies on the visual system to maintain balance with conflicting visual surroundings information (VIS PREF) and T25FW and TUG. In the multivariate analyses, only VIS PREF significantly correlated (p < 0.05) with T25FW (std. Beta=0.42) and TUG (std. Beta=0.38). CONCLUSIONS Vestibular and visual systems are associated with walking capacity. However, tasks with higher complexity levels require more visual attention towards ground obstacles, as often seen in real-life activities, whereas simpler walking tasks seem to require visual attention towards the surroundings.
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Affiliation(s)
- Andrea Tacchino
- Italian Multiple Sclerosis Foundation (FISM), Scientific Research Area, Via Operai 40, Genoa 16149, Italy.
| | - Anders Guldhammer Skjerbæk
- MS Hospitals in Denmark, Ry, Denmark; Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Jessica Podda
- Italian Multiple Sclerosis Foundation (FISM), Scientific Research Area, Via Operai 40, Genoa 16149, Italy
| | - Valeria Prada
- Italian Multiple Sclerosis Foundation (FISM), Scientific Research Area, Via Operai 40, Genoa 16149, Italy
| | - Margherita Monti Bragadin
- Italian Multiple Sclerosis Foundation (FISM), Scientific Research Area, Via Operai 40, Genoa 16149, Italy; Italian Multiple Sclerosis Society (AISM) Rehabilitation Service of Liguria, Via Operai 30, Genoa 16149, Italy
| | - Valeria Bergamaschi
- Italian Multiple Sclerosis Foundation (FISM), Scientific Research Area, Via Operai 40, Genoa 16149, Italy; Italian Multiple Sclerosis Society (AISM) Rehabilitation Service of Liguria, Via Operai 30, Genoa 16149, Italy
| | - Alessia Susini
- Italian Multiple Sclerosis Foundation (FISM), Scientific Research Area, Via Operai 40, Genoa 16149, Italy
| | - Lars G Hvid
- MS Hospitals in Denmark, Ry, Denmark; Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Ludovico Pedullà
- Italian Multiple Sclerosis Foundation (FISM), Scientific Research Area, Via Operai 40, Genoa 16149, Italy
| | - Giampaolo Brichetto
- Italian Multiple Sclerosis Foundation (FISM), Scientific Research Area, Via Operai 40, Genoa 16149, Italy; Italian Multiple Sclerosis Society (AISM) Rehabilitation Service of Liguria, Via Operai 30, Genoa 16149, Italy
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Albanese GA, Bucchieri A, Podda J, Tacchino A, Buccelli S, De Momi E, Laffranchi M, Mannella K, Holmes MWR, Zenzeri J, De Michieli L, Brichetto G, Barresi G. Robotic systems for upper-limb rehabilitation in multiple sclerosis: a SWOT analysis and the synergies with virtual and augmented environments. Front Robot AI 2024; 11:1335147. [PMID: 38638271 PMCID: PMC11025362 DOI: 10.3389/frobt.2024.1335147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/30/2024] [Indexed: 04/20/2024] Open
Abstract
The robotics discipline is exploring precise and versatile solutions for upper-limb rehabilitation in Multiple Sclerosis (MS). People with MS can greatly benefit from robotic systems to help combat the complexities of this disease, which can impair the ability to perform activities of daily living (ADLs). In order to present the potential and the limitations of smart mechatronic devices in the mentioned clinical domain, this review is structured to propose a concise SWOT (Strengths, Weaknesses, Opportunities, and Threats) Analysis of robotic rehabilitation in MS. Through the SWOT Analysis, a method mostly adopted in business management, this paper addresses both internal and external factors that can promote or hinder the adoption of upper-limb rehabilitation robots in MS. Subsequently, it discusses how the synergy with another category of interaction technologies - the systems underlying virtual and augmented environments - may empower Strengths, overcome Weaknesses, expand Opportunities, and handle Threats in rehabilitation robotics for MS. The impactful adaptability of these digital settings (extensively used in rehabilitation for MS, even to approach ADL-like tasks in safe simulated contexts) is the main reason for presenting this approach to face the critical issues of the aforementioned SWOT Analysis. This methodological proposal aims at paving the way for devising further synergistic strategies based on the integration of medical robotic devices with other promising technologies to help upper-limb functional recovery in MS.
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Affiliation(s)
| | - Anna Bucchieri
- Rehab Technologies Lab, Istituto Italiano di Tecnologia, Genoa, Italy
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Jessica Podda
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Stefano Buccelli
- Rehab Technologies Lab, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Elena De Momi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Matteo Laffranchi
- Rehab Technologies Lab, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Kailynn Mannella
- Department of Kinesiology, Brock University, St. Catharines, ON, Canada
| | | | | | | | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
- AISM Rehabilitation Center Liguria, Italian Multiple Sclerosis Society (AISM), Genoa, Italy
| | - Giacinto Barresi
- Rehab Technologies Lab, Istituto Italiano di Tecnologia, Genoa, Italy
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Gervasoni E, Anastasi D, Di Giovanni R, Solaro C, Rovaris M, Brichetto G, Confalonieri P, Tacchino A, Carpinella I, Cattaneo D. Uncovering Subtle Gait Deterioration in People with Early-Stage Multiple Sclerosis Using Inertial Sensors: A 2-Year Multicenter Longitudinal Study. Sensors (Basel) 2023; 23:9249. [PMID: 38005634 PMCID: PMC10674176 DOI: 10.3390/s23229249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/09/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023]
Abstract
Limited longitudinal studies have been conducted on gait impairment progression overtime in non-disabled people with multiple sclerosis (PwMS). Therefore, a deeper understanding of gait changes with the progression of the disease is essential. The objective of the present study was to describe changes in gait quality in PwMS with a disease duration ≤ 5 years, and to verify whether a change in gait quality is associated with a change in disability and perception of gait deterioration. We conducted a multicenter prospective cohort study. Fifty-six subjects were assessed at baseline (age: 38.2 ± 10.7 years, Expanded Disability Status Scale (EDSS): 1.5 ± 0.7 points) and after 2 years, participants performed the six-minute walk test (6MWT) wearing inertial sensors. Quality of gait (regularity, symmetry, and instability), disability (EDSS), and walking perception (multiple sclerosis walking scale-12, MSWS-12) were collected. We found no differences on EDSS, 6MWT, and MSWS-12 between baseline and follow-up. A statistically significant correlation between increased EDSS scores and increased gait instability was found in the antero-posterior (AP) direction (r = 0.34, p = 0.01). Seventeen subjects (30%) deteriorated (increase of at least 0.5 point at EDSS) over 2 years. A multivariate analysis on deteriorated PwMS showed that changes in gait instability medio-lateral (ML) and stride regularity, and changes in ML gait symmetry were significantly associated with changes in EDSS (F = 7.80 (3,13), p = 0.003, R2 = 0.56). Moreover, gait changes were associated with a decrease in PwMS perception on stability (p < 0.05). Instrumented assessment can detect subtle changes in gait stability, regularity, and symmetry not revealed during EDSS neurological assessment. Moreover, instrumented changes in gait quality impact on subjects' perception of gait during activities of daily living.
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Affiliation(s)
- Elisa Gervasoni
- IRCCS Fondazione Don Carlo Gnocchi Onlus, 20148 Milan, Italy; (E.G.); (D.A.); (M.R.); (D.C.)
| | - Denise Anastasi
- IRCCS Fondazione Don Carlo Gnocchi Onlus, 20148 Milan, Italy; (E.G.); (D.A.); (M.R.); (D.C.)
| | - Rachele Di Giovanni
- Department of Rehabilitation, Centro di Recupero e Rieducazione Funzionale (CRRF) “Mons. Luigi Novarese”, 13040 Moncrivello, Italy;
| | | | - Marco Rovaris
- IRCCS Fondazione Don Carlo Gnocchi Onlus, 20148 Milan, Italy; (E.G.); (D.A.); (M.R.); (D.C.)
| | - Giampaolo Brichetto
- Italian Multiple Sclerosis Foundation, Scientific Research Area, 16126 Genoa, Italy; (G.B.); (A.T.)
| | - Paolo Confalonieri
- IRCCS Foundation “Carlo Besta” Neurological Institute, 20133 Milan, Italy;
| | - Andrea Tacchino
- Italian Multiple Sclerosis Foundation, Scientific Research Area, 16126 Genoa, Italy; (G.B.); (A.T.)
| | - Ilaria Carpinella
- IRCCS Fondazione Don Carlo Gnocchi Onlus, 20148 Milan, Italy; (E.G.); (D.A.); (M.R.); (D.C.)
| | - Davide Cattaneo
- IRCCS Fondazione Don Carlo Gnocchi Onlus, 20148 Milan, Italy; (E.G.); (D.A.); (M.R.); (D.C.)
- Department of Physiopathology and Transplants, University of Milan, 20122 Milan, Italy
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Tacchino A, Ponzio M, Confalonieri P, Leocani L, Inglese M, Centonze D, Cocco E, Gallo P, Paolicelli D, Rovaris M, Sabattini L, Tedeschi G, Prosperini L, Patti F, Bramanti P, Pedrazzoli E, Battaglia MA, Brichetto G. An Internet- and Kinect-Based Multiple Sclerosis Fitness Intervention Training With Pilates Exercises: Development and Usability Study. JMIR Serious Games 2023; 11:e41371. [PMID: 37938895 PMCID: PMC10666018 DOI: 10.2196/41371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 01/30/2023] [Accepted: 07/30/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Balance impairments are common in people with multiple sclerosis (MS), with reduced ability to maintain position and delayed responses to postural adjustments. Pilates is a popular alternative method for balance training that may reduce the rapid worsening of symptoms and the increased risk of secondary conditions (eg, depression) that are frequently associated with physical inactivity. OBJECTIVE In this paper, we aimed to describe the design, development, and usability testing of MS Fitness Intervention Training (MS-FIT), a Kinect-based tool implementing Pilates exercises customized for MS. METHODS MS-FIT has been developed using a user-centered design approach (design, prototype, user feedback, and analysis) to gain the target user's perspective. A team composed of 1 physical therapist, 2 game programmers, and 1 game designer developed the first version of MS-FIT that integrated the knowledge and experience of the team with MS literature findings related to Pilates exercises and balance interventions based on exergames. MS-FIT, developed by using the Unity 3D (Unity Technologies) game engine software with Kinect Sensor V2 for Windows, implements exercises for breathing, posture, and balance. Feedback from an Italian panel of experts in MS rehabilitation (neurologists, physiatrists, physical therapists, 1 statistician, and 1 bioengineer) and people with MS was collected to customize the tool for use in MS. The context of MS-FIT is traveling around the world to visit some of the most important cities to learn the aspects of their culture through pictures and stories. At each stay of the travel, the avatar of a Pilates teacher shows the user the exercises to be performed. Overall, 9 people with MS (n=4, 44% women; mean age 42.89, SD 11.97 years; mean disease duration 10.19, SD 9.18 years; Expanded Disability Status Scale score 3.17, SD 0.75) were involved in 3 outpatient user test sessions of 30 minutes; MS-FIT's usability was assessed through an ad hoc questionnaire (maximum value=5; higher the score, higher the usability) evaluating easiness to use, playability, enjoyment, satisfaction, and acceptance. RESULTS A user-centered design approach was used to develop an accessible and challenging tool for balance training. All people with MS (9/9, 100%) completed the user test sessions and answered the ad hoc questionnaire. The average score on each item ranged from 3.78 (SD 0.67) to 4.33 (SD 1.00), which indicated a high usability level. The feedback and suggestions provided by 64% (9/14) of people with MS and 36% (5/14) of therapists involved in the user test were implemented to refine the first prototype to release MS-FIT 2.0. CONCLUSIONS The participants reported that MS-FIT was a usable tool. It is a promising system for enhancing the motivation and engagement of people with MS in performing exercise with the aim of improving their physical status.
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Affiliation(s)
- Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Michela Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Paolo Confalonieri
- Multiple Sclerosis Center, IRCCS Foundation "Carlo Besta" Neurological Institute, Milan, Italy
| | - Letizia Leocani
- Vita-Salute University & Hospital San Raffaele, Milan, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS San Martino Hospital, Genoa, Italy
| | | | - Eleonora Cocco
- Department of Medical Science and Public health, University of Cagliari, Cagliari, Italy
| | - Paolo Gallo
- Department of Neuroscience, University of Padua, Padua, Italy
| | - Damiano Paolicelli
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Marco Rovaris
- Multiple Sclerosis Center, IRCCS Don Carlo Gnocchi Foundation, Milan, Italy
| | - Loredana Sabattini
- Uosi Multiple Sclerosis Rehabilitation, IRCCS Istituto delle Scienze Neurologiche of Bologna, Bologna, Italy
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Luca Prosperini
- Department of Neurosciences, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Catania, Italy
| | | | | | | | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
- Rehabilitation Service of Genoa, Italian Multiple Sclerosis Society, Genoa, Italy
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van der Linden ML, Kos D, Moumdjian L, Kalron A, Coote S, Smedal T, Arntzen EC, Tayfur SN, Pedullà L, Tacchino A, Jonsdottir J, Santoyo-Medina C, Novotna K, Yazgan YZ, Nedeljkovic U, Learmonth YC. Changes in physical activity participation during the COVID-19 pandemic in people with multiple sclerosis: An international survey study. Ann Phys Rehabil Med 2023; 66:101798. [PMID: 37967488 DOI: 10.1016/j.rehab.2023.101798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/02/2023] [Accepted: 09/20/2023] [Indexed: 11/17/2023]
Affiliation(s)
- Marietta L van der Linden
- Centre for Health, Activity and Rehabilitation Research, Queen Margaret University Edinburgh, Musselburgh EH21 6UU, United Kingdom; Rehabilitation in Multiple Sclerosis (RIMS, www.eurims.org).
| | - Daphne Kos
- Rehabilitation in Multiple Sclerosis (RIMS, www.eurims.org); Research Group for Neurorehabilitation, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101 box 1501, 3001 Leuven, Belgium; National Multiple Sclerosis Center Melsbroek, Vanheylenstraat 16, 1820 Melsbroek, Belgium
| | - Lousin Moumdjian
- Rehabilitation in Multiple Sclerosis (RIMS, www.eurims.org); UMSC Hasselt, Pelt, Belgium; REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan, 3590 Diepenbeek Belgium; IPEM Institute of Psychoacoustics and Electronic Music, Faculty of Arts and Philosophy, Ghent University, Miriam Makebaplein 1, 9000 Gent, Belgium
| | - Alon Kalron
- Rehabilitation in Multiple Sclerosis (RIMS, www.eurims.org); Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. 55 Haim Levanon st, Tel-Aviv, Israel; Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Israel. 2 Derech Sheba st, Ramat-Gan, Israel
| | - Susan Coote
- Rehabilitation in Multiple Sclerosis (RIMS, www.eurims.org); Multiple Sclerosis Society of Ireland and Physical Activity for Health Research Centre, Ireland; University of Limerick, Limerick, V94 T9PX Ireland
| | - Tori Smedal
- Rehabilitation in Multiple Sclerosis (RIMS, www.eurims.org); The Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital, Post-box 1400, 5021 Bergen, Norway; The Norwegian Multiple sclerosis Registry and Biobank, Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Physiotherapy, Haukeland University Hospital, Bergen, Norway
| | - Ellen Christin Arntzen
- Faculty of Nursing and Health Science, Nord University, Universitetsalleen 11, 8026 Bodø, Norway; Department of Health and Work, Nordland Hospital Trust, Gidsken Jakobsens vei 32, 8008 Bodø, Norway
| | - Sümeyra N Tayfur
- Centre for Applied Social Sciences, Queen Margaret University Edinburgh, Musselburgh EH21 6UU, United Kingdom
| | - Ludovico Pedullà
- Rehabilitation in Multiple Sclerosis (RIMS, www.eurims.org); Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Via Operai 40, 16149 Genoa, Italy
| | - Andrea Tacchino
- Rehabilitation in Multiple Sclerosis (RIMS, www.eurims.org); Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Via Operai 40, 16149 Genoa, Italy
| | - Johanna Jonsdottir
- Rehabilitation in Multiple Sclerosis (RIMS, www.eurims.org); IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via Capecelatro 66, 20148 Milan, Italy
| | - Carme Santoyo-Medina
- Rehabilitation in Multiple Sclerosis (RIMS, www.eurims.org); Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Neurology-Neuroimmunology Department & Neurorehabilitation Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Department of Physiotherapy, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, C/ Josep Trueta sn, 08195 Sant Cugat del Vallès, Barcelona, Spain
| | - Klara Novotna
- Rehabilitation in Multiple Sclerosis (RIMS, www.eurims.org); Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Kateřinská 30, Prague Czech Republic; Department of Rehabilitation Medicine, First Faculty of Medicine and General University Hospital in Prague, Albertov 7, Prague, Czech Republic
| | - Yonca Zenginler Yazgan
- Rehabilitation in Multiple Sclerosis (RIMS, www.eurims.org); Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Büyükçekmece Yerleşkesi, Alkent 2000 Mahallesi, Yiğittürk Caddesi, No:5/9/1, 34500 Büyükçekmece, Istanbul, Turkey
| | - Una Nedeljkovic
- Rehabilitation in Multiple Sclerosis (RIMS, www.eurims.org); Centre for Physical medicine and Rehabilitation, University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotica starijeg 8, Belgrade, Serbia
| | - Yvonne C Learmonth
- Rehabilitation in Multiple Sclerosis (RIMS, www.eurims.org); Discipline of Exercise Science, Murdoch University, Perth, WA 6150, Australia; Centre for Molecular Medicine and Innovative Therapeutics, and Centre for Healthy Ageing, Murdoch University, WA 6150, Australia; Perron Institute for Neurological and Translational Science, Perth, WA 6009 Australia
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11
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Tacchino A, Pedullà L, Podda J, Monti Bragadin M, Battaglia MA, Bisio A, Bove M, Brichetto G. Motor imagery has a priming effect on motor execution in people with multiple sclerosis. Front Hum Neurosci 2023; 17:1179789. [PMID: 37746058 PMCID: PMC10512728 DOI: 10.3389/fnhum.2023.1179789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023] Open
Abstract
Priming is a learning process that refers to behavioral changes caused by previous exposure to a similar stimulus. Motor imagery (MI), which involves the mental rehearsal of action representations in working memory without engaging in actual execution, could be a strategy for priming the motor system. This study investigates whether MI primes action execution in Multiple Sclerosis (MS). Here, 17 people with MS (PwMS) and 19 healthy subjects (HS), all right-handed and good imaginers, performed as accurately and quickly as possible, with a pencil, actual or mental pointing movements between targets of small (1.0 × 1.0 cm) or large (1.5 × 1.5 cm) size. In actual trials, they completed five pointing cycles between the left and right targets, whereas in mental trials, the first 4 cycles were imagined while the fifth was actually executed. The fifth cycle was introduced to assess the MI priming effect on actual execution. All conditions, presented randomly, were performed with both dominant (i.e., right) and non-dominant arms. Analysis of the duration of the first 4 cycles in both actual and mental trials confirmed previous findings, showing isochrony in HS with both arms and significantly faster mental than actual movements (anisochrony) in PwMS (p < 0.01) [time (s); HS right: actual: 4.23 ± 0.15, mental: 4.36 ± 0.16; left: actual: 4.32 ± 0.15, mental: 4.43 ± 0.18; PwMS right: actual: 5.85 ± 0.16, mental: 5.99 ± 0.21; left: actual: 6.68 ± 0.20, mental: 5.94 ± 0.23]; anisochrony in PwMS was present when the task was performed with the non-dominant arm. Of note, temporal analysis of the fifth actual cycle showed no differences between actual and mental trials for HS with both arms, whereas in PwMS the fifth actual cycle was significantly faster after the four actual cycles for the non-dominant arm (p < 0.05) [time (s); HS right: actual: 1.03 ± 0.04, mental: 1.03 ± 0.03; left: actual: 1.08 ± 0.04, mental: 1.05 ± 0.03; PwMS right: actual: 1.48 ± 0.04, mental: 1.48 ± 0.06; left: actual: 1.66 ± 0.05, mental: 1.48 ± 0.06]. These results seem to suggest that a few mental repetitions of an action might be sufficient to exert a priming effect on the actual execution of the same action in PwMS. This would indicate further investigation of the potential use of MI as a new motor-cognitive tool for MS neurorehabilitation.
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Affiliation(s)
- Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Ludovico Pedullà
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Jessica Podda
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | | | - Mario Alberto Battaglia
- Department of Physiopathology, Experimental Medicine, and Public Health, University of Siena, Siena, Italy
| | - Ambra Bisio
- Section of Human Physiology, Department of Experimental Medicine, University of Genoa, Genoa, Italy
- Centro Polifunzionale di Scienze Motorie, University of Genoa, Genoa, Italy
| | - Marco Bove
- Section of Human Physiology, Department of Experimental Medicine, University of Genoa, Genoa, Italy
- IRCCS Policlinico San Martino, Genoa, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
- AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
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12
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Podda J, Marchesi G, Squeri V, De Luca A, Bellosta A, Pedullà L, Konrad G, Battaglia MA, Brichetto G, Tacchino A. Standard versus innovative robotic balance assessment for people with multiple sclerosis: a correlational study. Eur J Med Res 2023; 28:254. [PMID: 37491303 PMCID: PMC10369743 DOI: 10.1186/s40001-023-01223-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 07/12/2023] [Indexed: 07/27/2023] Open
Abstract
INTRODUCTION Balance disorders are common in people with Multiple Sclerosis (PwMS) and, together with other impairments and disabilities, often prevent PwMS from performing their daily living activities. Besides clinical scales and performance tests, robotic platforms can provide more sensitive, specific, and objective monitoring. Validated technologies have been adopted as gold standard, but innovative robotic solutions would represent an opportunity to detect balance impairment in PwMS. AIM Study's aim was to compare postural assessment of 46 PwMS with a relapsing-remitting form during static tasks performed with the novel robotic platform hunova® and the gold standard EquiTest®, METHODS: Pearson's r was run on Center of Pressure (COP)-related parameters and global static balance measures computed from hunova® and EquiTest® in eyes-open (EO) and eyes-closed (EC) conditions. In addition, agreeableness level toward the use of both devices was tested through numeric rating scale. RESULTS Considering COP-related parameters, correlations were significant for all measures (p < .001). Interestingly, in EO, a strong correlation was shown for sway area (r = .770), while Medio-Lateral (ML) and Anterior-Posterior (AP) oscillation range, path length, ML and AP speed, ML and AP root mean square distance had a relatively strong association (.454 ≤ r ≤ .576). In EC, except for ML oscillation range showing a relatively strong correlation (r = .532), other parameters were strongly associated (.603 ≤ r ≤ .782). Correlations between global balance indexes of hunova® and EquiTest® revealed a relatively strong association between the Somatosensory Score in EquiTest® and the Somatosensory Index in hunova® (r = - .488). While in EO Static Balance Index from hunova® was highly correlated with Equilibrium score of EquiTest® (r = .416), Static Balance Index had a relatively strong association with both the Equilibrium (r = .482) and Strategy Score (r = .583) of EquiTest® in EC. Results from agreeableness rating scale revealed that hunova® was highly appreciated compared to EquiTest® (p = .044). CONCLUSIONS hunova® represents an innovative adjunct to standard robotic balance evaluation for PwMS. This confirms that combining traditional and robotic assessments can more accurately detect balance impairments in MS.
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Affiliation(s)
- Jessica Podda
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Via Operai 40, 16149, Genoa, Italy.
| | | | | | | | - Alice Bellosta
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Via Operai 40, 16149, Genoa, Italy
| | - Ludovico Pedullà
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Via Operai 40, 16149, Genoa, Italy
| | - Giovanna Konrad
- AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Mario Alberto Battaglia
- Department of Physiopathology, Experimental Medicine and Public Health, University of Siena, Siena, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Via Operai 40, 16149, Genoa, Italy
- AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Via Operai 40, 16149, Genoa, Italy
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Podda J, Tacchino A, Verri A, Battaglia MA, Brichetto G, Ponzio M. Development and psychometric properties of a self-assessed knowledge questionnaire for caregivers of people with multiple sclerosis (CareKoMS): a cross-sectional study. BMJ Open 2023; 13:e071657. [PMID: 37399437 DOI: 10.1136/bmjopen-2023-071657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023] Open
Abstract
OBJECTIVES Knowledge about multiple sclerosis (MS) is crucial for those who provide care and support as caregivers. However, despite the key benefits of acquiring relevant information to properly assume the caregiving role, caregivers' knowledge of MS is poorly investigated. The aim of this study was to develop and validate the Caregivers' Knowledge of Multiple Sclerosis (CareKoMS), a self-assessed questionnaire, to test MS knowledge in caregivers of people with MS. DESIGN Cross-sectional study. SETTING Italy. PARTICIPANTS Two-hundred caregivers (female: 49%) were asked to self-administer the 32-item CareKoMS questionnaire; they had a median age of 60 years (IQR: 51-68 years) and a medium-high educational level (36.5% primary school and 63.5% high school/university). Item analysis using item difficulty index, item discrimination index, Kuder-Richardson-20 coefficient and item-total correlation were assessed. Once excluding less useful items, reliability, floor and ceiling effects and construct validity were calculated on the 21-item CareKoMS final version. RESULTS Psychometric evaluation indicates that the 21-item CareKoMS was a good questionnaire with no ceiling or floor effects registered. Internal consistency was satisfactory and acceptable as indicated by the mean value of 0.74 of Kuder-Richardson-20. No ceiling or floor effects have been observed. Interestingly, educational level and disease duration correlated with MS knowledge. CONCLUSION CareKoMS is a valid self-assessed questionnaire on MS knowledge for caregivers that may be used in clinical practice and research. Assessing knowledge of MS among caregivers is essential to facilitate their caregiving role and thus decrease the burden of disease management.
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Affiliation(s)
- Jessica Podda
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genova, Italy
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genova, Italy
| | - Anna Verri
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genova, Italy
| | - Mario Alberto Battaglia
- Department of Physiopathology, Experimental Medicine and Public Health, University of Siena, Siena, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genova, Italy
- AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Michela Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genova, Italy
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Pedullà L, Santoyo-Medina C, Novotna K, Moumdjian L, Smedal T, Arntzen EC, van der Linden ML, Learmonth Y, Kalron A, Güngör F, Nedeljkovic U, Kos D, Jonsdottir J, Coote S, Tacchino A. Physical Activity in Multiple Sclerosis: Meeting the Guidelines at the Time of the COVID-19 Pandemic. J Neurol Phys Ther 2023; 47:112-121. [PMID: 36753458 DOI: 10.1097/npt.0000000000000430] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND PURPOSE Regular physical activity (PA) helps to reduce the severity of physical and mental symptoms and improves quality of life in people with multiple sclerosis (PwMS). Based on current evidence and expert opinion, the recent multiple sclerosis guidelines recommend at least 150 minutes/week of PA. This study presents the results of a survey analyzing whether and how PwMS met the guidelines before and during the pandemic. METHODS We developed and disseminated an international online survey between December 2020 and July 2021, investigating changes in self-reported PA type, duration, frequency, and intensity due to the COVID-19 outbreak in PwMS with differing disability levels. RESULTS Among respondents (n = 3810), 3725 were eligible. The proportion of those who conducted at least one activity decreased with increasing disability level at both time points (pre and during). Overall 60% of respondents met the guidelines before the pandemic (mild: 64.43%; moderate: 51.53%; severe: 39.34%; χ 2(2) = 109.13, P < 0.01); a reduction of approximately 10% occurred during the pandemic in all disability groups (mild: 54.76%; moderate: 42.47%; severe: 29.48%; χ 2(2) = 109.67, P < 0.01). Respondents with higher disability participated more in physical therapy and less in walking, cycling, and running at both time points. Most respondents reported practicing PA at a moderate intensity at both time points; frequency and duration of sessions decreased as disability level increased. DISCUSSION AND CONCLUSIONS The percentage of those meeting the guidelines reduced with increasing disability level and during the pandemic. PA type and intensity varied widely across the disability categories. Interventions accounting for disability level are required to enable more PwMS to reap the benefits of PA.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A415 ).
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Affiliation(s)
- Ludovico Pedullà
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy (L.P., A.T.); Rehabilitation in Multiple Sclerosis (RIMS), Leuven, Belgium (L.P., C.S.-M., K.N., L.M., T.S., E.C.A., M.L.L., Y.L., A.K., F.G., U.N., D.K., J.J., S.C., A.T.); Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Neurology-Neuroimmunology Department & Neurorehabilitation Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (C.S.-M.); Department of Physiotherapy, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain (C.S.-M.); Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic (K.N.); Department of Rehabilitation Medicine, First Faculty of Medicine and General University Hospital in Prague, Prague, Czech Republic (K.N.); UMSC Hasselt, Pelt, Belgium (L.M.); REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium (L.M.); IPEM Institute of Psychoacoustics and Electronic Music, Faculty of Arts and Philosophy, Ghent University, Gent, Belgium (L.M.); The Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital, Bergen, Norway (T.S.); The Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology, Haukeland University Hospital, Bergen, Norway (T.S.); Department of Physiotherapy, Haukeland University Hospital, Bergen, Norway (T.S.); Faculty of Nursing and Health Science, Nord University, Bodø, Norway (E.C.A.); Department of Health and Work, Nordland Hospital Trust, Bodø, Norway (E.C.A.); Centre for Health, Activity and Rehabilitation Research, Queen Margaret University, Edinburgh, Musselburgh, United Kingdom (M.L.L.); Discipline of Exercise Science, Murdoch University, Perth, Australia (Y.L.); Centre for Molecular Medicine and Innovative Therapeutics, and Centre for Healthy Ageing, Murdoch University, Perth, Australia (Y.L.); Perron Institute for Neurological and Translational Science, Perth, Australia (Y.L.); Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel (A.K.); Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Israel (A.K.); Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey (F.G.); Centre for Physical Medicine and Rehabilitation, University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia (U.N.); Research Group for Neurorehabilitation, Department of Rehabilitation Sciences, KU Leuven, Belgium (D.K.); National Multiple Sclerosis Center Melsbroek, Melsbroek, Belgium (D.K.); IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy (J.J.); Multiple Sclerosis Society of Ireland and Physical Activity for Health Research Centre, Dublin, Ireland (S.C.); and University of Limerick, Limerick, Ireland (S.C.)
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Ponzio M, Monti MC, Mallucci G, Borrelli P, Fusco S, Tacchino A, Brichetto G, Tronconi L, Montomoli C, Bergamaschi R. The economic impact of comorbidity in multiple sclerosis. Neurol Sci 2023; 44:999-1008. [PMID: 36441342 PMCID: PMC9925507 DOI: 10.1007/s10072-022-06517-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 11/17/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Comorbid conditions are common in people with multiple sclerosis (pwMS). They can delay diagnosis and negatively impact the disease course, progression of disability, therapeutic management, and adherence to treatment. OBJECTIVE To quantify the economic impact of comorbidity in multiple sclerosis (MS), based on cost-of-illness estimates made using a bottom-up approach. METHODS A retrospective study was carried out in two northern Italian areas. The socio-demographic and clinical information, including comorbidities data, were collected through ad hoc anonymous self-assessment questionnaire while disease costs (direct and indirect costs of disease and loss of productivity) were estimated using a bottom-up approach. Costs were compared between pwMS with and without comorbidity. Adjusted incremental costs associated with comorbidity were reported using generalized linear models with log-link and gamma distributions or two-part models. RESULTS 51.0% of pwMS had at least one comorbid condition. Hypertension (21.0%), depression (15.7%), and anxiety (11.7%) were the most prevalent. PwMS with comorbidity were more likely to use healthcare resources, such as hospitalizations (OR = 1.21, p < 0.001), tests (OR = 1.59, p < 0.001), and symptomatic drugs and supplements (OR = 1.89, p = 0.012), and to incur non-healthcare costs related to investment (OR = 1.32, p < 0.001), transportation (OR = 1.33, p < 0.001), services (OR = 1.33, p < 0.001), and informal care (OR = 1.43, p = 0.16). Finally, they experienced greater productivity losses (OR = 1.34, p < 0.001) than pwMS without comorbidity. The adjusted incremental annual cost per patient due to comorbidity was €3,106.9 (13% of the overall costs) with MS disability found to exponentially affect annual costs. CONCLUSION Comorbidity has health, social, and economic consequences for pwMS.
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Affiliation(s)
- Michela Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy.
| | - Maria Cristina Monti
- Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy
| | - Giulia Mallucci
- Multiple Sclerosis Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Paola Borrelli
- Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy
- Department of Medical, Oral and Biotechnological Sciences, Laboratory of Biostatistics, University ''G. d'Annunzio'' Chieti-Pescara, Chieti, Italy
| | - Sara Fusco
- Multiple Sclerosis Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
- AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Livio Tronconi
- Legal Medicine Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Public Health, Experimental and Forensic Medicine, Forensic Science Unit, University of Pavia, Pavia, Italy
| | - Cristina Montomoli
- Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy
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16
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Jonsdottir J, Santoyo-Medina C, Kahraman T, Kalron A, Rasova K, Moumdjian L, Coote S, Tacchino A, Grange E, Smedal T, Arntzen EC, Learmonth Y, Pedulla L, Quinn G, Kos D. Changes in physiotherapy services and use of technology for people with multiple sclerosis during the COVID-19 pandemic. Mult Scler Relat Disord 2023; 71:104520. [PMID: 36724646 DOI: 10.1016/j.msard.2023.104520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/04/2023] [Accepted: 01/13/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND The COVID-19 pandemic has led to reorganization or reduction of neurorehabilitation services for people with multiple sclerosis (PwMS). The aim of this study was to explore the changes in the organizational framework and technology usage in physiotherapy services for PwMS during the COVID-19 pandemic. METHODS This international cross-sectional survey study was designed, developed, and disseminated by RIMS European Network for Best Practice and Research in Multiple Sclerosis Rehabilitation. Physiotherapists from nine countries (Australia, Belgium, Czech Republic, Ireland, Israel, Italy, Norway, Spain, Turkey) who provided physiotherapy services to PwMS, were invited to complete an online survey to compare physiotherapy delivery to PwMS prior to and during the pandemic period. RESULTS The survey was completed by 215 physiotherapists. Accessibility, the average number, length and perceived effectiveness of physiotherapy sessions provided to PwMS were significantly reduced during the COVID-19 pandemic (p=0.001). Physiotherapists increased the advice of mobile apps, recorded videos for rehabilitation and exercise websites during the pandemic (p<0.001) while the use of telerehabilitation and virtual reality technology did not change. CONCLUSION There was of a reduction in the number, duration and perceived effectiveness of rehabilitation sessions for people with multiple sclerosis during the COVID-19 pandemic while use of remote technologies for physiotherapy did not change. To ensure the continuity of physiotherapy for PwMS with complex healthcare needs also during pandemics, the provision of guidelines and training in telehealth technologies in professional education becomes crucial.
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Affiliation(s)
| | - Carme Santoyo-Medina
- Neurology-Neuroimmunology Department & Neurorehabilitation Unit, Multiple Sclerosis Centre of Catalonia (Cemcat), Barcelona, Spain; Department of Physiotherapy, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, C/ Josep Trueta sn, 08195 Sant Cugat del Vallès, Barcelona, Spain.
| | - Turhan Kahraman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey.
| | - Alon Kalron
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, and Sagol School of Neuroscience, Tel-Aviv University, Israel; Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Kamila Rasova
- Department of Rehabilitation, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lousin Moumdjian
- UMSC Hasselt, Pelt, Belgium; REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium; IPEM Institute of Psychoacoustics and Electronic Music, Faculty of Arts and Philosophy, Ghent University, Ghent, Belgium.
| | - Susan Coote
- Centre of Physical Activity for Health, Health Research Institute, University of Limerick, Limerick, Ireland; Multiple Sclerosis Society of Ireland and Physical Activity for Health Research Centre, Ireland.
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genova, Italy.
| | - Erica Grange
- CRRF "Mons. L. Novarese", Moncrivello (VC), Italy
| | - Tori Smedal
- Department of Physiotherapy, Haukeland University Hospital, Helse Bergen, Bergen, Norway,; Department of Neurology, Multiple Sclerosis Competence Centre, Haukeland University Hospital, Helse Bergen, Bergen, Norway.
| | | | - Yvonne Learmonth
- Discipline of Exercise Science, Murdoch University, Murdoch, Australia; Centre for Molecular Medicine and Innovative Therapeutics, Centre for Healthy Ageing, Health Futures Institute, Murdoch University, Murdoch, Australia; Perron Institute for Neurological and Translational Science, Nedlands, Australia.
| | - Ludovico Pedulla
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy.
| | - Gillian Quinn
- Physiotherapy Department, St. James's Hospital, Dublin, Ireland
| | - Daphne Kos
- Department of Rehabilitation Sciences, KU Leuven, Leuven 1501-3001, Belgium; National MS Center, Melsbroek, Belgium.
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17
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Solaro C, Di Giovanni R, Grange E, Brichetto G, Mueller M, Tacchino A, Bertoni R, Patti F, Pappalardo A, Prosperini L, Castelli L, Rosato R, Cattaneo D, Marengo D. Correlation between patient-reported manual ability and three objective measures of upper limb function in people with multiple sclerosis. Eur J Neurol 2023; 30:172-178. [PMID: 36086993 PMCID: PMC10087787 DOI: 10.1111/ene.15560] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/14/2022] [Accepted: 09/04/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Upper limb (UL) function is often affected in people with multiple sclerosis (PwMS) and is typically assessed through objective measures, including the Nine Hole Peg Test (9-HPT), Box and Block Test (BBT), and Hand Grip Strength (HGS). It is important to include the subjective perspective of PwMS in the assessment. This study aims to evaluate associations between Manual Ability Measure-36 (MAM-36) and 9-HPT, BBT, and HGS in MS. METHODS The cross-sectional study included five Italian centers. Inclusion criteria were age ≥ 18 years, MS diagnosis, and stable disease course. Exclusion criteria were bilateral UL paralysis, and concomitant orthopedic or neurological diseases. RESULTS A total of 199 PwMS were included: 128 female, mean age = 50.7 ± 13.0 years, 119 relapsing-remitting MS (RRMS), 31 primary and 49 secondary progressive MS, mean disease duration = 14.0 ± 10.4, years, mean Expanded Disability Status Scale (EDSS) = 4.6 ± 2.0. The MAM-36 showed small correlations with 9-HPT, BBT, and HGS. Correlations between MAM-36 and 9-HPT and BBT were highest among subjects with EDSS ≥ 6 and progressive MS. MAM-36 and HGS showed the highest correlations in subjects with EDSS ≤ 5 and RRMS. Combining 9-HPT and HGS provided the strongest predictive power over the MAM-36. CONCLUSIONS Correlations between objective measures and MAM-36 were small to moderate, meaning that objective measures do not match subjects' perception of UL function. The combination of 9-HPT and HGS measures can help improve the assessment of UL function in activities of daily living.
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Affiliation(s)
- Claudio Solaro
- Department of Rehabilitation, CRRF "Mons. Luigi Novarese", Moncrivello, Italy
| | - Rachele Di Giovanni
- Department of Rehabilitation, CRRF "Mons. Luigi Novarese", Moncrivello, Italy
| | - Erica Grange
- Department of Rehabilitation, CRRF "Mons. Luigi Novarese", Moncrivello, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Margit Mueller
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Rita Bertoni
- LaRice Lab, Don Carlo Gnocchi Foundation, Institute of Hospitalization and Scientific Care, Milan, Italy
| | - Francesco Patti
- Multiple Sclerosis Center, Institute of Neurological Sciences, University of Catania, Catania, Italy
| | - Angelo Pappalardo
- Multiple Sclerosis Center, Institute of Neurological Sciences, University of Catania, Catania, Italy
| | - Luca Prosperini
- Department of Neurosciences, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Letizia Castelli
- Department of Neurosciences, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Rosalba Rosato
- Department of Psychology, University of Turin, Turin, Italy
| | - Davide Cattaneo
- LaRice Lab, Don Carlo Gnocchi Foundation, Institute of Hospitalization and Scientific Care, Milan, Italy.,Department of Physiopathology and Transplants, University of Milan, Milan, Italy
| | - Davide Marengo
- Department of Psychology, University of Turin, Turin, Italy
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18
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Tacchino A, Podda J, Bergamaschi V, Pedullà L, Brichetto G. Cognitive rehabilitation in multiple sclerosis: Three digital ingredients to address current and future priorities. Front Hum Neurosci 2023; 17:1130231. [PMID: 36908712 PMCID: PMC9995764 DOI: 10.3389/fnhum.2023.1130231] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/09/2023] [Indexed: 02/25/2023] Open
Abstract
Multiple sclerosis (MS) is a neurological chronic disease with autoimmune demyelinating lesions and one of the most common disability causes in young adults. People with MS (PwMS) experience cognitive impairments (CIs) and clinical evidence shows their presence during all MS stages even in the absence of other symptoms. Cognitive rehabilitation (CR) aims at reducing CI and improving PwMS' awareness of cognitive difficulties faced in their daily living. More defined cognitive profiles, easier treatment access and the need to transfer intervention effects into everyday life activities are aims of utmost relevance for CR in MS. Currently, advanced technologies may pave the way to rethink CR in MS to address the priority of more personalized and effective, accessible and ecological interventions. For this purpose, digital twins, tele-cognitive-rehabilitation and metaverse are the main candidate digital ingredients. Based on scientific evidences, we propose digital twin technology to enhance MS cognitive phenotyping; tele-cognitive-rehabilitation to make feasible the cognitive intervention access to a larger number of PwMS; and metaverse to represent the best choice to train real-world dual- and multi-tasking deficits in virtual daily life environments. Moreover, multi-domain high-frequency big-data collected through tele-cognitive-assessment, tele-cognitive-rehabilitation, and metaverse may be merged to refine artificial intelligence algorithms and obtain increasingly detailed patient's cognitive profile in order to enhance intervention personalization. Here, we present how these digital ingredients and their integration could be crucial to address the current and future needs of CR facilitating the early detection of subtle CI and the delivery of increasingly effective treatments.
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Affiliation(s)
- Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Jessica Podda
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Valeria Bergamaschi
- AISM Rehabilitation Center Liguria, Italian Multiple Sclerosis Society (AISM), Genoa, Italy
| | - Ludovico Pedullà
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy.,AISM Rehabilitation Center Liguria, Italian Multiple Sclerosis Society (AISM), Genoa, Italy
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19
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Carpinella I, Anastasi D, Gervasoni E, Di Giovanni R, Tacchino A, Brichetto G, Confalonieri P, Rovaris M, Solaro C, Ferrarin M, Cattaneo D. Balance Impairments in People with Early-Stage Multiple Sclerosis: Boosting the Integration of Instrumented Assessment in Clinical Practice. Sensors (Basel) 2022; 22:9558. [PMID: 36502265 PMCID: PMC9736931 DOI: 10.3390/s22239558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/15/2022] [Accepted: 12/03/2022] [Indexed: 06/17/2023]
Abstract
The balance of people with multiple sclerosis (PwMS) is commonly assessed during neurological examinations through clinical Romberg and tandem gait tests that are often not sensitive enough to unravel subtle deficits in early-stage PwMS. Inertial sensors (IMUs) could overcome this drawback. Nevertheless, IMUs are not yet fully integrated into clinical practice due to issues including the difficulty to understand/interpret the big number of parameters provided and the lack of cut-off values to identify possible abnormalities. In an attempt to overcome these limitations, an instrumented modified Romberg test (ImRomberg: standing on foam with eyes closed while wearing an IMU on the trunk) was administered to 81 early-stage PwMS and 38 healthy subjects (HS). To facilitate clinical interpretation, 21 IMU-based parameters were computed and reduced through principal component analysis into two components, sway complexity and sway intensity, descriptive of independent aspects of balance, presenting a clear clinical meaning and significant correlations with at least one clinical scale. Compared to HS, early-stage PwMS showed a 228% reduction in sway complexity and a 63% increase in sway intensity, indicating, respectively, a less automatic (more conscious) balance control and larger and faster trunk movements during upright posture. Cut-off values were derived to identify the presence of balance abnormalities and if these abnormalities are clinically meaningful. By applying these thresholds and integrating the ImRomberg test with the clinical tandem gait test, balance impairments were identified in 58% of PwMS versus the 17% detected by traditional Romberg and tandem gait tests. The higher sensitivity of the proposed approach would allow for the direct identification of early-stage PwMS who could benefit from preventive rehabilitation interventions aimed at slowing MS-related functional decline during neurological examinations and with minimal modifications to the tests commonly performed.
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Affiliation(s)
| | - Denise Anastasi
- IRCCS Fondazione Don Carlo Gnocchi Onlus, 20148 Milan, Italy
| | - Elisa Gervasoni
- IRCCS Fondazione Don Carlo Gnocchi Onlus, 20148 Milan, Italy
| | - Rachele Di Giovanni
- Department of Rehabilitation, Centro di Recupero e Rieducazione Funzionale (CRRF) “Mons. Luigi Novarese”, 13040 Moncrivello, Italy
| | - Andrea Tacchino
- Italian Multiple Sclerosis Foundation, Scientific Research Area, 16126 Genoa, Italy
| | - Giampaolo Brichetto
- Italian Multiple Sclerosis Foundation, Scientific Research Area, 16126 Genoa, Italy
| | - Paolo Confalonieri
- IRCCS Foundation “Carlo Besta” Neurological Institute, 20133 Milan, Italy
| | - Marco Rovaris
- IRCCS Fondazione Don Carlo Gnocchi Onlus, 20148 Milan, Italy
| | - Claudio Solaro
- Department of Rehabilitation, Centro di Recupero e Rieducazione Funzionale (CRRF) “Mons. Luigi Novarese”, 13040 Moncrivello, Italy
| | | | - Davide Cattaneo
- IRCCS Fondazione Don Carlo Gnocchi Onlus, 20148 Milan, Italy
- Department of Physiopathology and Transplants, University of Milan, 20122 Milan, Italy
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20
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Brichetto G, Tacchino A, Leocani L, Kos D. Impact of Covid-19 emergency on rehabilitation services for Multiple Sclerosis: An international RIMS survey. Mult Scler Relat Disord 2022; 67:104179. [PMID: 36130457 PMCID: PMC9474392 DOI: 10.1016/j.msard.2022.104179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/08/2022] [Accepted: 09/11/2022] [Indexed: 11/29/2022]
Abstract
Background Covid-19 pandemic greatly impacted on the healthcare systems worldwide with negative consequences on several aspects of clinical populations. For neurological chronic conditions such as Multiple Sclerosis (MS), rehabilitation activities have been suspended or postponed during the pandemic. Rehabilitation is crucial for people with MS (PwMS) because it promotes recovery from relapses and maximizes opportunities for social participation. To better understand the impact of Covid-19 emergency on rehabilitation services for MS, the European network for rehabilitation in MS (RIMS) disseminated a survey to healthcare professionals (HPs) and representatives of the MS rehabilitation services (RSs), to explore the two different perspectives on the delivery of rehabilitation in usual circumstances and during the Covid-19 emergency. Methods The online survey was distributed from July 9th to September 20th, 2020. Besides general information on the responders (e.g. location of center, and memebership to RIMS), information was collected on usual service delivery (e.g. settings, specialities, and types of treatment), the impact of Covid-19 circumstances (e.g. restrictions, use of personal protective equipment, and impact on work), and the use of technologiesin rehabilitation. Results Twenty-two representatives of MS rehabilitation services (RSs)and 143 health care professionals (HPs) responded. Most of RSs and HPs worked in services specialized for MS including a mixture of all usual rehabilitation settings (i.e. inpatient, outpatient and community setting). The majority of services adopted a multidisciplinary framework, including physical therapy, occupational therapy, social service, speech and language therapy, psychological support, dietary interventions, medical management, vocational rehabilitation and cognitive rehabilitaton. Overall, most of responders indicated they did not use technologies in their practice (e.g. for treatment or assessment). However, depending on the type of technology a low-to-medium percentage of responders declared to use some technologies before Covid-19 crisis (5-55% for RSs and 12-53% for HPs) and a low percentage planned the use after pandemic (0-14% for RSs and 1-10% for HPs). Moreover, for the responders the most feasible interventions deliverable through tele-rehabilitation were psychological support and dietary interventions, with psychological support considered the most necessary intervention to be remotely implemented. Moderate feasibility (30-60%) was reported for hands-off interventions (e.g. aerobic exercise and cognitive rehabilitation) whereas low feasibility (<30%) was reported for hands-on interventions. Feasibility was especially low when tools were used that are not adaptable at-home (e.g. hyperbaric oxygen therapy). Conclusion The Covid-19 pandemic has stimulated the MS healthcare professionals to find new solutions to deliver alternative interventions to PwMS. In this context, the role of telemedicine is crucial to continue rehabilitation services at home, and limit exposure to infection. However, most of healthcare professionals have not incorporated the use of technologies. Therefore, the implementation of digital health solutions in the clinical practice needs more attention towards education on the potentials of technologies for rehabilitation and simplification of the national healthcare system reimbursement procedures for the rehabilitation technologies use.
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Affiliation(s)
- Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy; AISM Rehabilitation Service of Liguria, Genoa, Italy; Rehabilitation in Multiple Sclerosis (RIMS).
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy; Rehabilitation in Multiple Sclerosis (RIMS)
| | - Letizia Leocani
- Rehabilitation in Multiple Sclerosis (RIMS); Vita-Salute San Raffaele University and Experimental Neurophysiology Unit, Institute of Experimental Neurology (INSPE), IRCCS-Scientific Institute San Raffaele, Milan, Italy
| | - Daphne Kos
- Rehabilitation in Multiple Sclerosis (RIMS); Research Group for Neurorehabilitation, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.; National Multiple Sclerosis Center Melsbroek, Melsbroek, Belgium
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21
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Moumdjian L, Smedal T, Arntzen EC, van der Linden ML, Learmonth Y, Pedullà L, Tacchino A, Novotna K, Kalron A, Yazgan YZ, Nedeljkovic U, Kos D, Jonsdottir J, Santoyo-Medina C, Coote S. The impact of the COVID-19 pandemic on physical activity and associated technology use in persons with multiple sclerosis: an international RIMS-SIG Mobility survey study. Arch Phys Med Rehabil 2022; 103:2009-2015. [PMID: 35760106 PMCID: PMC9233892 DOI: 10.1016/j.apmr.2022.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/12/2022] [Accepted: 06/05/2022] [Indexed: 11/23/2022]
Abstract
Objective To investigate the impact of the COVID-19 pandemic on physical activity in persons with multiple sclerosis (PwMS). Design Multicenter international online survey study. Setting The survey was conducted within 11 participating countries. Each country launched the survey using online platforms from May to July 2021. Participants This was an electronic survey study targeting PwMS (N=3725). Intervention Not applicable. Main Outcome Measures The survey ascertained physical activity performance and its intensity, the nature of the activities conducted, and the use of technology to support home-based physical activity before and during the pandemic. Results A total of 3725 respondents completed the survey. Prepandemic, the majority (83%) of respondents reported being physically active, and this decreased to 75% during the pandemic. This change was significant for moderate- and high-intensity activity (P<.0001). Activities carried out in physiotherapy centers, gyms, or pools decreased the most. Walking was the most frequently performed activity prepandemic (27%) and increased during the pandemic (33%). A total of 24% of those inactive during the pandemic had no intention of changing their physical activity behavior post pandemic. A total of 58% of the respondents did not use technology to support physical activity during the pandemic. Of those who did use technology, wearables were most used (24%). Of those currently nonactive (25%) expressed a preference for an in-person format to conduct physical activity post pandemic. Conclusions Physical activity performance, especially activities at moderate and high intensities, decreased during the pandemic in PwMS compared with prepandemic. Walking and using wearables gained popularity as ways to stay active. As we move toward an endemic COVID-19, a call for action to develop interventions focused on walking programs with specific emphasis on increasing physical activity of PwMS is proposed.
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Affiliation(s)
- Lousin Moumdjian
- UMSC Hasselt, Pelt, Belgium; REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan, 3590, Diepenbeek Belgium; IPEM Institute of Psychoacoustics and Electronic Music, Faculty of Arts and Philosophy, Ghent University, Miriam Makebaplein 1, 9000, Gent; Rehabilitation in Multiple Sclerosis (RIMS), www.eurims.org.
| | - Tori Smedal
- The Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital, Post-box 1400, 5021 Bergen, Norway; The Norwegian Multiple sclerosis Registry and Biobank, Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Physiotherapy, Haukeland University Hospital, Bergen, Norway; Rehabilitation in Multiple Sclerosis (RIMS), www.eurims.org
| | - Ellen Christin Arntzen
- Faculty of Nursing and Health Science, Nord University, Universitetsalleen 11, 8026 Bodø, Norway; Department of Health and Work, Nordland Hospital Trust, Gidsken Jakobsens vei 32, 8008 Bodø, Norway; Rehabilitation in Multiple Sclerosis (RIMS), www.eurims.org
| | - Marietta L van der Linden
- Centre for Health, Activity and Rehabilitation Research, Queen Margaret University Edinburgh, Musselburgh EH21 6UU, United Kingdom; Rehabilitation in Multiple Sclerosis (RIMS), www.eurims.org
| | - Yvonne Learmonth
- Discipline of Exercise Science, Murdoch University, Perth, WA, 6150, Australia; Centre for Molecular Medicine and Innovative Therapeutics, and Centre for Healthy Ageing, Murdoch University, WA, 6150, Australia; Perron Institute for Neurological and Translational Science, Perth, WA, 6009 Australia; Rehabilitation in Multiple Sclerosis (RIMS), www.eurims.org
| | - Ludovico Pedullà
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Via Operai 40, 16149, Genoa, Italy; Rehabilitation in Multiple Sclerosis (RIMS), www.eurims.org
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Via Operai 40, 16149, Genoa, Italy; Rehabilitation in Multiple Sclerosis (RIMS), www.eurims.org
| | - Klara Novotna
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Kateřinská 30, Prague Czech Republic; Department of Rehabilitation Medicine, First Faculty of Medicine and General University Hospital in Prague, Albertov 7, Prague, Czech Republic; Rehabilitation in Multiple Sclerosis (RIMS), www.eurims.org
| | - Alon Kalron
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. 55 Haim Levanon st, Tel-Aviv, Israel.; Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Israel. 2 Derech Sheba st, Ramat-Gan, Israel.; Rehabilitation in Multiple Sclerosis (RIMS), www.eurims.org
| | - Yonca Zenginler Yazgan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Büyükçekmece Yerleşkesi, Alkent 2000 Mahallesi, Yiğittürk Caddesi, No:5/9/1, 34500, Büyükçekmece, Istanbul, Turkey.; Rehabilitation in Multiple Sclerosis (RIMS), www.eurims.org
| | - Una Nedeljkovic
- Centre for Physical medicine and Rehabilitation,University Clinical Centre of Serbia, Faculty of Medicine,University of Belgrade, Dr Subotica starijeg 8, Belgrade,Serbia,; Rehabilitation in Multiple Sclerosis (RIMS), www.eurims.org.
| | - Daphne Kos
- Research Group for Neurorehabilitation, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101 box 1501, 3001 Leuven, Belgium; National Multiple Sclerosis Center Melsbroek, Vanheylenstraat 16, 1820 Melsbroek, Belgium; Rehabilitation in Multiple Sclerosis (RIMS), www.eurims.org
| | - Johanna Jonsdottir
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via Capecelatro 66, 20148 Milan, Italy; Rehabilitation in Multiple Sclerosis (RIMS), www.eurims.org
| | - Carme Santoyo-Medina
- Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Neurology-Neuroimmunology Department & Neurorehabilitation Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.; Department of Physiotherapy, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, C/ Josep Trueta sn, 08195 Sant Cugat del Vallès, Barcelona, Spain.; Rehabilitation in Multiple Sclerosis (RIMS), www.eurims.org
| | - Susan Coote
- Multiple Sclerosis Society of Ireland and Physical Activity for Health Research Centre, Ireland; University of Limerick, Limerick, V94 T9PX Ireland; Rehabilitation in Multiple Sclerosis (RIMS), www.eurims.org
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22
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Podda J, Uccelli MM, Tacchino A, Pedullà L, Monti Bragadin M, Alberto Battaglia M, Brichetto G, Ponzio M. Predictors of Mood Disorders in Parents With Multiple Sclerosis: The Role of Disability Level, Coping Techniques, and Perceived Social Support. Int J MS Care 2022; 24:224-229. [DOI: 10.7224/1537-2073.2021-101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Abstract
Background:
Being a parent can be demanding and stressful, especially for people with chronic diseases such as multiple sclerosis (MS). Parenting can be disrupted by flare-ups, disease worsening, and other MS symptoms, including mobility problems, pain, fatigue, and cognitive impairment. Mood disorders, such as depression and anxiety, have been found to occur at much higher rates in people with MS than in the general population. Surprisingly, less is known about which factors may predict mood disorders in parents with MS. This study aims to identify potential demographic, clinical, and self-reported predictors that contribute to mood disorders measured by the Hospital Anxiety and Depression Scale.
Methods:
A total of 285 parents with MS completed an anonymous online questionnaire combining sociodemographic, clinical, and family characteristics and scales, validated in Italian, related to coping strategies and social support. Associations between each variable and mood disorders were assessed using univariate and multivariate logistic regression analyses.
Results:
Disability level, emotional and dysfunctional coping strategies, and perceived social support were significant predictors of mood disorders in parents with MS.
Conclusions:
These findings confirm the importance of identifying risk factors for mood disorders in parents with MS so that early intervention can minimize mood disruptions caused by the disease.
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Affiliation(s)
- Jessica Podda
- From Scientific Research (JP, MMU, AT, LP, MMB, GB, MP), Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Michele Messmer Uccelli
- From Scientific Research (JP, MMU, AT, LP, MMB, GB, MP), Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Andrea Tacchino
- From Scientific Research (JP, MMU, AT, LP, MMB, GB, MP), Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Ludovico Pedullà
- From Scientific Research (JP, MMU, AT, LP, MMB, GB, MP), Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Margherita Monti Bragadin
- From Scientific Research (JP, MMU, AT, LP, MMB, GB, MP) and AISM Rehabilitation Service (MMB, GB), Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Mario Alberto Battaglia
- The Department of Physiopathology, Experimental Medicine, and Public Health, University of Siena, Siena, Italy (MAB)
| | - Giampaolo Brichetto
- From Scientific Research (JP, MMU, AT, LP, MMB, GB, MP) and AISM Rehabilitation Service (MMB, GB), Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Michela Ponzio
- From Scientific Research (JP, MMU, AT, LP, MMB, GB, MP), Italian Multiple Sclerosis Foundation, Genoa, Italy
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Gervasoni E, Anastasi D, Giovanni RD, Solaro C, Rovaris M, Brichetto G, Carpinella I, Confalonieri P, Tacchino A, Rabuffetti M, Cattaneo D. Physical activity in non-disabled People with early Multiple Sclerosis: a multicenter cross-sectional study. Mult Scler Relat Disord 2022; 64:103941. [DOI: 10.1016/j.msard.2022.103941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/16/2022] [Accepted: 06/03/2022] [Indexed: 10/18/2022]
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Kahraman T, Rasova K, Jonsdottir J, Medina CS, Kos D, Coote S, Tacchino A, Smedal T, Arntzen EC, Quinn G, Learmonth Y, Pedulla L, Moumdjian L, Kalron A. The impact of the COVID-19 pandemic on physical therapy practice for people with multiple sclerosis: A multicenter survey study of the RIMS network. Mult Scler Relat Disord 2022; 62:103799. [PMID: 35428030 PMCID: PMC8994702 DOI: 10.1016/j.msard.2022.103799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/24/2022] [Accepted: 04/08/2022] [Indexed: 10/24/2022]
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25
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Podda J, Tacchino A, Pedullà L, Monti Bragadin M, Battaglia MA, Brichetto G, Ponzio M. Mind wandering in people with Multiple Sclerosis: A psychometric study. Mult Scler Relat Disord 2022; 58:103521. [DOI: 10.1016/j.msard.2022.103521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/29/2021] [Accepted: 01/09/2022] [Indexed: 11/28/2022]
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26
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Carpinella I, Gervasoni E, Anastasi D, Di Giovanni R, Tacchino A, Brichetto G, Confalonieri P, Solaro C, Rovaris M, Ferrarin M, Cattaneo D. Walking With Horizontal Head Turns Is Impaired in Persons With Early-Stage Multiple Sclerosis Showing Normal Locomotion. Front Neurol 2022; 12:821640. [PMID: 35153994 PMCID: PMC8833075 DOI: 10.3389/fneur.2021.821640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/30/2021] [Indexed: 11/26/2022] Open
Abstract
Background Turning the head while walking (an action often required during daily living) is particularly challenging to maintain balance. It can therefore potentially reveal subtle impairments in early-stage people with multiple sclerosis who still show normal locomotion (NW-PwMS). This would help in identifying those subjects who can benefit from early preventive exercise aimed at slowing the MS-related functional decline. Objectives To analyze if the assessment of walking with horizontal head turns (WHHT) through inertial sensors can discriminate between healthy subjects (HS) and NW-PwMS and between NW-PwMS subgroups. To assess if the discriminant ability of the instrumented WHHT is higher compared to clinical scores. To assess the concurrent validity of the sensor-based metrics. Methods In this multicenter study, 40 HS and 59 NW-PwMS [Expanded Disability Status Scale (EDSS) ≤ 2.5, disease duration ≤ 5 years] were tested. Participants executed Item-6 of the Fullerton Advanced Balance scale-short (FAB-s) wearing three inertial sensors on the trunk and ankles. The item required to horizontally turn the head at a beat of the metronome (100 bpm) while walking. Signals of the sensors were processed to compute spatiotemporal, regularity, symmetry, dynamic stability, and trunk sway metrics descriptive of WHHT. Results Mediolateral regularity, anteroposterior symmetry, and mediolateral stability were reduced in NW-PwMS vs. HS (p ≤ 0.001), and showed moderate discriminant ability (area under the receiver operator characteristic curve [AUC]: 0.71–0.73). AP symmetry and ML stability were reduced (p ≤ 0.026) in EDSS: 2–2.5 vs. EDSS: 0–1.5 subgroup (AUC: 0.69–0.70). The number of NW-PwMS showing at least one abnormal instrumented metric (68%) was larger (p ≤ 0.002) than the number of participants showing abnormal FAB-s-Item6 (32%) and FAB-s clinical scores (39%). EDSS: 2–2.5 subgroup included more individuals showing abnormal instrumented metrics (86%) compared to EDSS: 0–1.5 subgroup (57%). The instrumented metrics significantly correlated with FAB-s-Item6 and FAB-s scores (|Spearman's rs| ≥ 0.37, p < 0.001), thus demonstrating their concurrent validity. Conclusion The instrumented assessment of WHHT provided valid objective metrics that discriminated, with higher sensitivity than clinical scores, between HS and NW-PwMS and between EDSS subgroups. The method is a promising tool to complement clinical evaluation, and reveal subclinical impairments in persons who can benefit from early preventive rehabilitative interventions.
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Affiliation(s)
| | | | | | - Rachele Di Giovanni
- Centro di Recupero e Rieducazione Funzionale (CRRF) Mons. Luigi Novarese, Moncrivello, Italy
| | - Andrea Tacchino
- Italian Multiple Sclerosis Foundation, Scientific Research Area, Genoa, Italy
| | - Giampaolo Brichetto
- Italian Multiple Sclerosis Foundation, Scientific Research Area, Genoa, Italy
| | | | - Claudio Solaro
- Centro di Recupero e Rieducazione Funzionale (CRRF) Mons. Luigi Novarese, Moncrivello, Italy
| | | | | | - Davide Cattaneo
- IRCSS Fondazione Don Carlo Gnocchi, Milan, Italy
- Department of Physiopathology and Transplants, University of Milan, Milan, Italy
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Ponzio M, Tacchino A, Amicizia D, Piazza MF, Paganino C, Trucchi C, Astengo M, Simonetti S, Gallo D, Sansone A, Brichetto G, Battaglia MA, Ansaldi F. Prevalence of multiple sclerosis in Liguria region, Italy: an estimate using the capture-recapture method. Neurol Sci 2021; 43:3239-3245. [PMID: 34817728 PMCID: PMC9018629 DOI: 10.1007/s10072-021-05718-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 10/30/2021] [Indexed: 11/21/2022]
Affiliation(s)
- M Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy.
| | - A Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - D Amicizia
- A.Li.Sa, Liguria Health Authority, Genoa, Italy.,Department of Health Sciences, University of Genoa, Genoa, Italy
| | - M F Piazza
- A.Li.Sa, Liguria Health Authority, Genoa, Italy
| | - C Paganino
- A.Li.Sa, Liguria Health Authority, Genoa, Italy
| | - C Trucchi
- A.Li.Sa, Liguria Health Authority, Genoa, Italy.,Department of Health Sciences, University of Genoa, Genoa, Italy
| | - M Astengo
- A.Li.Sa, Liguria Health Authority, Genoa, Italy
| | | | - D Gallo
- A.Li.Sa, Liguria Health Authority, Genoa, Italy
| | - A Sansone
- AISM Rehabilitation Centre Liguria, Italian Multiple Sclerosis Society, Genoa, Italy
| | - G Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy.,AISM Rehabilitation Centre Liguria, Italian Multiple Sclerosis Society, Genoa, Italy
| | - M A Battaglia
- Department of Life Sciences, University of Siena, Siena, Italy
| | - F Ansaldi
- A.Li.Sa, Liguria Health Authority, Genoa, Italy.,Department of Health Sciences, University of Genoa, Genoa, Italy
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Ponzio M, Amicizia D, Brichetto G, Tacchino A, Piazza MF, Paganino C, Trucchi C, Astengo M, Battaglia MA, Ansaldi F. The Prevalence of Multiple Sclerosis in Liguria region, Italy, using the capture–recapture method. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In recent years, there has been a growing interest in developing methods based on health administrative databases to estimate prevalence of chronic diseases, hoping that this would lead to more precise and reliable estimates. The capture-recapture method can be used to improve the prevalence of a disease reducing the bias of case underestimation.
Objective
To assess the prevalence of multiple sclerosis (MS) in the Liguria region in Italy using routinely collected healthcare data.
Methods
Data from three sources collected in Liguria Health Authority (A.Li.Sa.) databases - hospital discharge records, drug-dispensing records, disease-specific payment exemptions from copayment to health care - and a capture-recapture method with log-linear models were used to estimate the prevalence of MS. The accuracy of the case-finding algorithm was tested using a sample of people residents in Liguria Region with a definite diagnosis of MS extracted from clinical records of Liguria AISM Rehabilitation Service as reference standard.
Results
The case-finding algorithm to capture people with MS from routinely collected healthcare data used in our study found an observed crude prevalence of MS in Liguria region on 31 December 2017, of 202.4 cases per 100,000 inhabitants (95% CI: 195.3-209.5). After linkage to clinical data, the algorithm showed a sensitivity of 82.7%, with 22.1% of MS cases undetected on capture-recapture models. Consequently, the capture-recapture method prevalence estimate of 259.7 per 100,000 inhabitants (95% CI: 251.7-267.8) suggest that this region constitutes a high-risk area for MS.
Conclusions
Our initial study of crude MS prevalence showed an overall regional prevalence of MS of 202.4 cases per 100,000, capture-recapture analysis would add another 20%, to those figures. This method could be considered a good alternative to the population-based study design for estimating the prevalence of MS.
Key messages
Studies based on routinely collected healthcare data could help estimate the prevalence of chronic disease. To reduce the bias of case underestimation, the capture–recapture method can be useful.
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Affiliation(s)
- M Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - D Amicizia
- Department of Health Sciences, University of Genoa, Genoa, Italy
- A.Li.Sa., Liguria Health Authority, Genoa, Italy
| | - G Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
- AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
| | - A Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - MF Piazza
- A.Li.Sa., Liguria Health Authority, Genoa, Italy
| | - C Paganino
- A.Li.Sa., Liguria Health Authority, Genoa, Italy
| | - C Trucchi
- Department of Health Sciences, University of Genoa, Genoa, Italy
- A.Li.Sa., Liguria Health Authority, Genoa, Italy
| | - M Astengo
- A.Li.Sa., Liguria Health Authority, Genoa, Italy
| | - MA Battaglia
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
- Department of Life Sciences, University of Siena, Siena, Italy
| | - F Ansaldi
- Department of Health Sciences, University of Genoa, Genoa, Italy
- A.Li.Sa., Liguria Health Authority, Genoa, Italy
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Giovanni RD, Grange E, Tacchino A, Spirito M, Solaro C. Development of an app (ABOUTCOME) for evaluation in multiple sclerosis. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.118086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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30
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Solaro C, Giovanni RD, Grange E, Brichetto G, Mueller M, Tacchino A, Bertoni R, Patti F, Pappalardo A, Prosperini L, Castelli L, Rosato R, Cattaneo D, Marengo D. Correlation between Manual Ability Measure-36 and three upper limb objective measures in people with multiple sclerosis. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.118102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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31
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Veldkamp R, Baert I, Kalron A, Romberg A, Tacchino A, Giffroy X, Coninx K, Feys P. Associations between clinical characteristics and dual task performance in Multiple Sclerosis depend on the cognitive and motor dual tasks used. Mult Scler Relat Disord 2021; 56:103230. [PMID: 34500177 DOI: 10.1016/j.msard.2021.103230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 08/16/2021] [Accepted: 08/27/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND In persons with Multiple Sclerosis (pwMS) performing a simultaneous cognitive task while walking often results in slower gait. Clinical characteristics associated with reduced dual task (DT) performance are not yet entirely clear. This multi-centre study aimed to determine the relationship between clinical and demographical characteristics with dual task (DT) walking performance in pwMS during multiple DT conditions. METHODS Nine DT conditions were analysed, consisting of combinations of three types of cognitive ('digit span', 'subtraction', 'vigilance') and three types of walking ('walk', 'walk with cup', 'walk over obstacles') conditions. Primary outcomes were DT gait speed (m/s) and motor DT cost of gait speed (DTCmotor, %). Secondary outcomes were clinical tests of physical and cognitive functioning and patient-reported and demographical outcomes. Firstly, univariate analyses and, subsequently, multivariate analyses with backward modelling, were conducted for each type of walking DT condition separately. Cognitive DT conditions were included in the models as main and as interaction effect with the secondary outcomes. RESULTS Analysis were performed in 81 pwMS (EDSS 3.3 ± 1.0). In the final models of DTCmotor, the significant main effects were in 'walk' DT-conditions the Symbol Digit Modalities Test (SDMT), in 'cup' conditions the SDMT and Dynamic Gait Index and in 'obstacles' conditions age. For DT gait speed, main effects were found for the 2-Minute Walking Test (2MWT) and the Multiple Sclerosis Walking Scale for all walking conditions. Additionally, interactions between cognitive DT-conditions and SDMT, age and 2MWT were found. CONCLUSION Clinical characteristics related to DT walking performance differed according to cognitive-motor DT-condition used. Still, in general, pwMS with a better mobility demonstrated higher DT gait speed, while a faster information processing speed was related to a lower DTCmotor.
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Affiliation(s)
- R Veldkamp
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium; UMSC Hasselt - Pelt, Belgium.
| | - I Baert
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - A Kalron
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - A Romberg
- Masku Neurological Rehabilitation Centre, Finnish Neuro Society, Masku, Finland
| | - A Tacchino
- Scientific Research Area, Italian MS Foundation (FISM), Genoa, Italy
| | - X Giffroy
- Centre Hospitalier Universitaire de Liège, Luik, Belgium
| | - K Coninx
- HCI and eHealth, Faculty of Sciences, Hasselt University, Hasselt, Belgium
| | - P Feys
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium; UMSC Hasselt - Pelt, Belgium
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Grange E, Marengo D, Di Giovanni R, Mueller M, Brichetto G, Tacchino A, Bertoni R, Patti F, Pappalardo A, Prosperini L, Castelli L, Rosato R, Cattaneo D, Solaro C. Italian translation and psychometric validation of the ABILHAND-26 and its correlation with upper limb objective and subjective measures in multiple sclerosis subjects. Mult Scler Relat Disord 2021; 55:103160. [PMID: 34320388 DOI: 10.1016/j.msard.2021.103160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/25/2021] [Accepted: 07/19/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Upper limb (UL) function is affected in about 50% of people with Multiple Sclerosis (PwMS). In the last decade, Patient Reported Outcome Measures (PROM) are playing an important role in clinical trial and practice. ABILIHAND-26 is a PROM that assess self-perceived manual ability defined as the capacity to manage daily activities using the upper limbs. The aim of the study is to translate the ABILHAND-26 into Italian, to explore its psychometric properties examining the associations with demographics, clinical variables, 9-Hole Peg Test (9-HPT) and Manual Ability Measures-36 (MAM-36). MATERIALS AND METHODS Subjects were recruited in five Italian neurological centers. They were evaluated through ABILHAND-26, 9-HPT and MAM-36. Confirmatory factor analysis and Rasch analysis were adopted to investigate the psychometric properties of the ABILHAND-26. RESULTS Two hundred and forty-five patients were recruited. Rasch analyses showed adequate functioning and supported the unidimensionality of the scale. ABILHAND-26 showed negative correlations with age and disease duration, moderate negative correlation with EDSS and the 9-HPT scores for both arms and strong positive associations (ρ ≥ .84) with the MAM-36. Difference in ABILHAND-26 scores only emerged when comparing patients with severe disability (EDSS ≥ 6) with patients with either mild or moderate disability. t) and when comapring relapsing-remitting and secondary progressive patients. CONCLUSION The Italian version of the ABILHAND-26 is now available. It shows adequate reliability of the score, moderate criterion validity and strong convergent validity. ABILHAND-26 could represent a valid assessment for self-perceived ability to perform manual activity, especially for PwMS with moderate-to-high level of disability.
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Affiliation(s)
- Erica Grange
- Dept. of Rehabilitation, CRRF "Mons. Luigi Novarese", Moncrivello, VC, Italy
| | | | - Rachele Di Giovanni
- Dept. of Rehabilitation, CRRF "Mons. Luigi Novarese", Moncrivello, VC, Italy
| | - Margit Mueller
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genova, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genova, Italy; Rehabilitation Centre, Italian Multiple Sclerosis Society, Italy
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genova, Italy
| | - Rita Bertoni
- IRCSS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Francesco Patti
- MS Center Institute of Neurological Sciences - University of Catania, Italy
| | - Angelo Pappalardo
- Centro Disabilità Cronica Neurologica, Presidio Ambulatoriale, Azienda Sanitaria Provinciale Catania, Catania, Italy
| | - Luca Prosperini
- S. Camillo-Forlanini Hospital, Rome, Italy; Psychiatry, Sapienza University, Rome, Italy
| | - Letizia Castelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Davide Cattaneo
- IRCSS Fondazione Don Carlo Gnocchi, Milan, Italy; Department of Physiopathology and Transplants, University of Milan, Milan, Italy
| | - Claudio Solaro
- Dept. of Rehabilitation, CRRF "Mons. Luigi Novarese", Moncrivello, VC, Italy
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Di Giovanni R, Solaro C, Grange E, Masuccio FG, Brichetto G, Mueller M, Tacchino A. A comparison of upper limb function in subjects with multiple sclerosis and healthy controls using an inertial measurement unit. Mult Scler Relat Disord 2021; 53:103036. [PMID: 34051695 DOI: 10.1016/j.msard.2021.103036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/05/2021] [Accepted: 05/12/2021] [Indexed: 11/29/2022]
Abstract
Upper limbs (UL) dysfunction is frequent in people with Multiple Sclerosis (PwMS). Several objective measures of UL function are proposed; however, their use is mostly confined to assess subjects with mild-to-moderate disability and requires fine motor skills, often impaired in high disability level subjects. Thus, a tool to score UL function in the advanced disease stage is lacking. The aim of the study is to analyse and compare UL unilateral and bilateral movements of healthy control (HC) and PwMS, at different disability levels, using an instrumented version (Inertial Measurement Unit, IMU) of the 15-seconds finger-to-nose test (FNT). Each movement cycle was segmented in going/adjusting/returning phases. The inter-hand interval (IHI) allowed assessing bilateral coordination (i.e. synchrony) in each phase. The larger IHI, the more severe the bilateral coordination impairment is. After stratifying PwMS for disability level (PwMSLOW, Expanded Disability Status Scale, EDSS≤5.5 and PwMSHIGH, EDSS≥6), the ANOVA on IHI showed significant differences between PwMS and HC (p<0.001) in all phases. However, only the going phase IHI showed significantly higher asynchrony in PwMSHIGH than PwMSLOW and HC (p<0.001) and no differences between PwMSLOW and HC. The going phase IHI seems to be a clinical marker specific for high disability level PwMS. These findings suggest inertial sensors during FNT could be an easy-to-use method for a more detailed quantitative characterization of UL function in PwMS also in subjects with EDSS greater than 6.
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Affiliation(s)
| | - C Solaro
- CRRF "Mons. L. Novarese", Moncrivello (VC), Italy.
| | - E Grange
- CRRF "Mons. L. Novarese", Moncrivello (VC), Italy
| | - F G Masuccio
- CRRF "Mons. L. Novarese", Moncrivello (VC), Italy
| | - G Brichetto
- Italian Multiple Sclerosis Foundation (FISM), Scientific Research Area, Via Operai 40, 16149, Genoa, Italy
| | - M Mueller
- Italian Multiple Sclerosis Foundation (FISM), Scientific Research Area, Via Operai 40, 16149, Genoa, Italy
| | - A Tacchino
- Italian Multiple Sclerosis Foundation (FISM), Scientific Research Area, Via Operai 40, 16149, Genoa, Italy
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34
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Carpinella I, Gervasoni E, Anastasi D, Di Giovanni R, Tacchino A, Brichetto G, Confalonieri P, Rovaris M, Solaro C, Ferrarin M, Cattaneo D. Instrumentally assessed gait quality is more relevant than gait endurance and velocity to explain patient-reported walking ability in early-stage multiple sclerosis. Eur J Neurol 2021; 28:2259-2268. [PMID: 33864413 DOI: 10.1111/ene.14866] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/07/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE People with multiple sclerosis (PwMS) often report walking limitations even when the gold standard Expanded Disability Status Scale (EDSS) indicates normal walking endurance/autonomy. The present multicenter study on early-stage PwMS aims at analyzing which aspects are associated with patient-reported walking limitations measured with the 12-item Multiple Sclerosis Walking Scale (MSWS-12). METHODS Eighty-two PwMS (EDSS ≤ 2.5) were assessed using the Fullerton Advanced Balance Scale-short (FAB-s), the Fatigue Severity Scale (FSS) and the 6-min Walk Test (6MWT), the latter administered also to 21 healthy subjects. Participants performed the 6MWT wearing three inertial sensors on ankles and trunk. Instrumented metrics describing gait velocity (stride length and frequency) and quality (regularity, symmetry, instability) were computed from sensor data. Fatigue (FSS), balance (FAB-s), walking endurance (6MWT) and instrumented metrics were entered in a multiple regression model with MSWS-12 as dependent variable. RESULTS Gait symmetry, gait instability, fatigue and balance were significantly associated with self-rated walking ability, whilst walking endurance and velocity were not. Fatigue, balance, gait symmetry and instability were more impaired in participants reporting mild-to-moderate (MSMM-PWL , 25 ≤ MSWS-12 < 75) compared to those reporting none-to-minimal (MSnm-PWL , 0 ≤ MSWS-12 ≤ 25) perceived walking limitations. Compared to healthy subjects, gait symmetry and stability were reduced in MSnm-PWL and MSMM-PWL , even in those participants with EDSS ≤ 1.5. CONCLUSION Instrumentally assessed gait quality aspects (symmetry and instability) are associated with patient-reported walking ability in early-stage PwMS and seem sensitive biomarkers to detect subtle impairments even in the earliest stages of the disease (EDSS ≤ 1.5). Future studies should assess their ability to follow walking change due to MS progression or pharmacological/rehabilitation interventions.
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Affiliation(s)
| | | | | | | | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | | | | | | | | | - Davide Cattaneo
- IRCSS Fondazione Don Carlo Gnocchi, Milan, Italy.,Department of Physiopathology and Transplants, University of Milan, Milan, Italy
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35
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Podda J, Ponzio M, Pedullà L, Monti Bragadin M, Battaglia MA, Zaratin P, Brichetto G, Tacchino A. Predominant cognitive phenotypes in multiple sclerosis: Insights from patient-centered outcomes. Mult Scler Relat Disord 2021; 51:102919. [PMID: 33799285 DOI: 10.1016/j.msard.2021.102919] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Since combining information from different domains could be useful to increase prediction accuracy over and above what can be achieved at the level of single category of markers, this study aimed to identify distinct and predominant subtypes, i.e., cognitive phenotypes, in people with multiple sclerosis (PwMS) considering both cognitive impairment and mood disorders. METHODS A latent class analysis (LCA) was applied on data from 872 PwMS who were tested with Montreal Cognitive Assessment (MoCA), Symbol Digit Modalities Test (SDMT) and Hospital Anxiety and Depression Scale (HADS). Furthermore, the distribution of demographic (i.e., age, gender, years of education) and clinical characteristics (i.e., disease duration, disease course, disability level) was examined amongst the identified phenotypes. RESULTS Based on model fit and parsimony criteria, LCA identified four cognitive phenotypes: 1) only memory difficulties (n = 247; 28.3%); 2) minor memory and language deficits with mood disorders (n = 185; 21.2%); 3) moderate memory, language and attention impairments (n = 164; 18.8%); 4) severe memory, language, attention, information processing and executive functions difficulties (n = 276; 31.7%). CONCLUSIONS Since less is known about the progressive deterioration of cognition in PwMS, a taxonomy of distinct subtypes that consider information from different clustered domains (i.e., cognition and mood) represents both a challenge and opportunity for an advanced understanding of cognitive impairments and development of tailored cognitive treatments in MS.
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Affiliation(s)
- Jessica Podda
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy.
| | - Michela Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Ludovico Pedullà
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Margherita Monti Bragadin
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy; AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Mario Alberto Battaglia
- Department of Physiopathology, Experimental Medicine and Public Health, University of Siena, Siena, Italy
| | - Paola Zaratin
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy; AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
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Veldkamp R, Kalron A, Baert I, Hämäläinen P, Tacchino A, D'hooge M, Giffroy X, Van Geel F, Raats J, Coninx K, Van Wijmeersch B, Feys P. Differential effects and discriminative validity of motor and cognitive tasks varying in difficulty on cognitive-motor interference in persons with multiple sclerosis. Mult Scler 2021; 27:1924-1938. [PMID: 33565906 DOI: 10.1177/1352458520986960] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cognitive-motor interference (CMI) has been well recognized in persons with multiple sclerosis (pwMS); however, there are limited data on effects of task difficulty. OBJECTIVE Examine (1) the effects of motor and cognitive tasks varying in difficulty on the magnitude of CMI and (2) the discriminative validity of CMI between pwMS and healthy controls (HC). METHODS Nine cognitive-motor dual-task (DT) conditions (combinations of three cognitive and three walking tasks) were examined. Outcome measures were DT-performance and dual-task cost (DTC) of gait parameters and correct answers. Task differences and overall group-effects were analysed by mixed model analysis, plus the Wilcoxon signed-rank tests or multivariate analysis of variances (MANOVAs), respectively. RESULTS Task effects were examined in 82 pwMS (Expanded Disability Status Scale (EDSS): 3.3 ± 1.0) and discriminative validity in a subsample (35 pwMS and 33 HC). Motor-DTC and DT-performance were affected by difficulty of both the cognitive task (p < 0.001) and the walking condition (p ⩽ 0.002), while cognitive-DTC only varied between cognitive tasks with a large difference in difficulty (p ⩽ 0.005) and not between walking conditions (p ⩾ 0.125). None of the DTCs differed between groups. CONCLUSION CMI, and especially motor performance, is affected by difficulty of the DT. Although pwMS performed worse on the tasks than HC, none of the DT-conditions showed a discriminative DTC.
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Affiliation(s)
- Renee Veldkamp
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Alon Kalron
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ilse Baert
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Paivi Hämäläinen
- Masku Neurological Rehabilitation Centre, Finnish Neuro Society, Masku, Finland
| | - Andrea Tacchino
- Scientific Research Area, Italian MS Foundation (FISM), Genoa, Italy
| | - Mieke D'hooge
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium/National MS Center Melsbroek, Steenokkerzeel, Belgium
| | - Xavier Giffroy
- Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Fanny Van Geel
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Joke Raats
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium/De Mick AZ Klina Brasschaat, Brasschaat, Belgium
| | - Karin Coninx
- Expertise Centre for Digital Media, Faculty of Sciences, Hasselt University, Hasselt, Belgium
| | - Bart Van Wijmeersch
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium/Rehabilitation and MS Center Overpelt, Pelt, Belgium
| | - Peter Feys
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
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Cattaneo D, Gervasoni E, Anastasi D, Di Giovanni R, Brichetto G, Carpinella I, Cavalla P, Confalonieri P, Groppo E, Prosperini L, Tacchino A, Rovaris M, Solaro C. Prevalence and patterns of subclinical motor and cognitive impairments in non-disabled individuals with early multiple sclerosis: a multicenter cross-sectional study. Ann Phys Rehabil Med 2021; 65:101491. [PMID: 33454397 DOI: 10.1016/j.rehab.2021.101491] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 11/10/2020] [Accepted: 11/12/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Motor and cognitive disorders appear early in the course of multiple sclerosis (MS) and develop gradually over time. OBJECTIVE To study the frequency and pattern of subtle functional disorders in people with MS (PwMS) with no overt signs of disability in an early phase of the disease and their association with walking impairments in daily activities. METHODS In this cross-sectional study, we recruited PwMS with an Expanded Disability Status Scale (EDSS) score ≤ 2.5 and disease duration ≤ 5 years. Participants were assessed with functional scales rating walking endurance (6-Min Walk Test), perceived walking ability (Twelve-item Multiple Sclerosis Walking Scale), balance (Fullerton Advanced Balance scale_short), manual dexterity (Nine Hole Peg Test), fatigue (Fatigue Severity Scale), and cognitive impairments (Brief International Cognitive Assessment). RESULTS About 90% of the 82 PwMS (mean [SD] EDSS score 1.5 [0.7] and disease duration 2.2 [1.7] years) showed endurance values below the expected score; almost 30% showed impairment, and for 57%, perceived walking ability score was abnormal. Balance was impaired in 48% of participants, as was manual dexterity (29%) and fatigue (24%), but only a few showed cognitive impairments. Only 11% of PwMS had no abnormal score on the scales used in the assessment. As compared with EDSS score 0 to 1.5, with EDSS score 2 to 2.5, performance was worse for endurance (difference ±61.0 m, p=0.016), perceived walking ability (-11 points, p=0.002), balance (+1.9 points, p=0.005), manual dexterity (-2.8 sec, p=0.004), and fatigue (-1.3 points, p=0.013). Factors that predicted perceived walking ability were balance (B = -1.37, p<0.001) and fatigue (B = 5.11, p<0.001) rather than endurance (B = -0.01, p=048). CONCLUSION Even PwMS with no clinical disability and classified as having "no problem walking" present walking and other functional deficits when assessed with specific functional tests. The addition of specific tools could better identify subtle motor and cognitive deficits. Finally, the assessment of balance disorders and fatigue is important to understand individuals' perceived walking impairments in daily activities.
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Affiliation(s)
- Davide Cattaneo
- IRCSS Fondazione Don Carlo Gnocchi, Via Capecelatro 66, 20148 Milano, Italy
| | - Elisa Gervasoni
- IRCSS Fondazione Don Carlo Gnocchi, Via Capecelatro 66, 20148 Milano, Italy.
| | - Denise Anastasi
- IRCSS Fondazione Don Carlo Gnocchi, Via Capecelatro 66, 20148 Milano, Italy
| | - Rachele Di Giovanni
- Rehabilitation Department, CRRF Mons L Novarese, 13040 Loc. Trompone, Moncrivello (VC), Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), via Operai 40, 16149 Genoa, Italy
| | - Ilaria Carpinella
- IRCSS Fondazione Don Carlo Gnocchi, Via Capecelatro 66, 20148 Milano, Italy
| | - Paola Cavalla
- MS Center, Department of Neuroscience and Mental Health, City of Health and Science, University Hospital of Torino, via Cherasco 15, Turin, Italy
| | - Paolo Confalonieri
- Multiple Sclerosis Center, IRCCS Foundation "Carlo Besta" Neurological Institute, Milan, Italy
| | - Elisabetta Groppo
- IRCSS Fondazione Don Carlo Gnocchi, Via Capecelatro 66, 20148 Milano, Italy; Clinica Neurologica III, Università degli Studi di Milano, Polo Universitario San Paolo, ASST Santi Paolo e Carlo, Via Antonio di Rudinì, 820142 Milano, Italy
| | - Luca Prosperini
- Department of Neurosciences, S. Camillo-Forlanini Hospital, c.ne Gianicolense 87, 00152 Rome, Italy
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), via Operai 40, 16149 Genoa, Italy
| | - Marco Rovaris
- IRCSS Fondazione Don Carlo Gnocchi, Via Capecelatro 66, 20148 Milano, Italy
| | - Claudio Solaro
- Rehabilitation Department, CRRF Mons L Novarese, 13040 Loc. Trompone, Moncrivello (VC), Italy
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Prada V, Tacchino A, Podda J, Pedullà L, Konrad G, Battaglia MA, Brichetto G, Monti Bragadin M. MAM-36 and ABILHAND as outcome measures of multiple sclerosis hand disability: an observational study. Eur J Phys Rehabil Med 2020; 57:520-526. [PMID: 33305546 DOI: 10.23736/s1973-9087.20.06446-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Impaired upper limb functionality and dexterity are common in people with multiple sclerosis (PwMS) and lead to increased dependency and reduced quality of life. AIM The aim of this study was to compare the ability of the Manual Abilites Measure 36 (MAM-36) and the ABILHAND questionnaire to recognize an involvement of the upper limbs in PwMS, and to compare their results with those of other patient reported outcomes (PRO) evaluating disability, functional independence, symptoms of anxiety and depression, fatigue and quality of life. DESIGN The study design was observational. SETTING The setting of the study was outpatient. POPULATION The study population included fifty-one PwMS (mean age of 56.31 years, age range of 33-82 years, 72.5% of patients were females). METHODS For each patient were collected MAM-36, ABILHAND questionnaire, expanded disability status scale (EDSS), Functional Independence measure (FIM), Hospital Anxiety and Depression Scale (HADS), Modified Fatigue Impact Scale (MFIS) and Life Satisfaction Index (LSI). RESULTS A strong correlation between MAM-36 and the ABILHAND questionnaire (Spearman r: 0.79; P<0.0001) were found. We obtained a significant correlation between MAM-36 and EDSS (Spearman r: -0.5; P=0.0002), FIM (Spearman r: 0.55; P<0.0001); we did not observe a correlation with MFIS (Spearman r: -0.33; P=0.02); moreover we found a similar trend between ABILHAND and EDSS (Spearman r: -0.47; P=0.0005), FIM (Spearman r: 0.61; P<0.0001), MFIS (Spearman r: -0.41; P=0.002). CONCLUSIONS In PwMS the assessment of upper limbs is fundamental since it closely related to the level of disability of the person. Both MAM-36 and ABILHAND Questionnaire are equally able to detect upper limb dysfunctions in PwMS. CLINICAL REHABILITATION IMPACT Both MAM-36 and ABILHAND can be used for upper limbs evaluation, within a multidimensional approach that seems to be the best way to evaluate PwMS.
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Affiliation(s)
- Valeria Prada
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genoa, Genoa, Italy -
| | - Andrea Tacchino
- Italian Multiple Sclerosis Society Research Foundation (FISM), Genoa, Italy
| | - Jessica Podda
- Italian Multiple Sclerosis Society Research Foundation (FISM), Genoa, Italy
| | - Ludovico Pedullà
- Italian Multiple Sclerosis Society, AISM Rehabilitation Center, Genoa, Italy
| | - Giovanna Konrad
- Italian Multiple Sclerosis Society, AISM Rehabilitation Center, Genoa, Italy
| | - Mario A Battaglia
- Department of Physiopathology, Experimental Medicine and Public Health, University of Siena, Siena, Italy
| | - Giampaolo Brichetto
- Italian Multiple Sclerosis Society Research Foundation (FISM), Genoa, Italy.,Italian Multiple Sclerosis Society, AISM Rehabilitation Center, Genoa, Italy
| | - Margherita Monti Bragadin
- Italian Multiple Sclerosis Society Research Foundation (FISM), Genoa, Italy.,Italian Multiple Sclerosis Society, AISM Rehabilitation Center, Genoa, Italy
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Podda J, Tacchino A, Pedullà L, Monti Bragadin M, Battaglia MA, Brichetto G. Focus on neglected features of cognitive rehabilitation in MS: Setting and mode of the treatment. Mult Scler 2020; 28:1009-1019. [PMID: 33045916 PMCID: PMC9131413 DOI: 10.1177/1352458520966300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cognitive rehabilitation in multiple sclerosis (MS) aims at reducing patients’
cognitive impairments, improving their awareness and ability to take cognitive
difficulties into account in their daily living. However, at this moment, more
high-quality randomized trials are needed to draw conclusion about the
effectiveness of cognitive interventions in MS. Although existing studies
provide clear descriptions of intervention key ingredients (e.g. targeted
cognitive domain as well as treatment frequency and duration) and the practical
details needed to manage these key elements (e.g. restorative approaches,
compensatory strategies, or environmental modifications), other crucial aspects
received less attention in rehabilitation research. The aim of this topical
review is to try to elucidate some critical issues that were only partly
addressed and analyzed by the scientific literature: setting (center-based vs
home-based) and mode (individual vs group) of the cognitive rehabilitation
treatment.
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Affiliation(s)
- Jessica Podda
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Ludovico Pedullà
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Margherita Monti Bragadin
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy/AISM Rehabilitation Center, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Mario Alberto Battaglia
- Department of Physiopathology, Experimental Medicine and Public Health, University of Siena, Siena, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy/AISM Rehabilitation Center, Italian Multiple Sclerosis Society, Genoa, Italy
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40
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Solaro C, Di Giovanni R, Grange E, Mueller M, Messmer Uccelli M, Bertoni R, Brichetto G, Tacchino A, Patti F, Pappalardo A, Prosperini L, Castelli L, Rosato R, Cattaneo D, Marengo D. Box and block test, hand grip strength and nine-hole peg test: correlations between three upper limb objective measures in multiple sclerosis. Eur J Neurol 2020; 27:2523-2530. [PMID: 32619066 DOI: 10.1111/ene.14427] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/18/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Limited data are available in the literature for upper limb impairment in multiple sclerosis (MS). This study aimed to report the distribution of values of hand grip strength (HGS), of the box and block test (BBT) and of the nine-hole peg test (9HPT) correlated with demographic and clinical data in subjects with MS. METHODS This study involved five Italian neurological centres. The inclusion criteria were age ≥ 18, MS diagnosis, stable disease phase, right-hand dominance. All subjects underwent HGS, BBT and 9-HPT evaluation. RESULTS In all, 202 subjects with MS were enrolled: 137 females; mean age 48.4 years; mean Expanded Disability Status Scale (EDSS) 4.17; mean disease duration 14.12 years; disease course 129 relapsing-remitting, 21 primary progressive and 52 secondary progressive MS subjects; mean right HGS 25.3 kg, left 23.2 kg; mean right BBT 45.7 blocks, left 44.9 blocks; mean right 9-HPT 30.7 s, left 33.4 s. All results were statistically significantly different compared to healthy controls. HGS, BBT and 9-HPT were associated with age, EDSS and disease duration, whilst disease course correlated with BBT and 9-HPT. The BBT and 9-HPT scores significantly differed according to level of disability (EDSS ≤3.0, 3.5-5.5, ≥6.0). CONCLUSION Hand grip strength and BBT value distribution in a large MS population is reported. Correlations between HGS, BBT and 9-HPT were generally low.
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Affiliation(s)
- C Solaro
- Department of Rehabilitation, CRRF 'Mons. Luigi Novarese', Moncrivello, Italy
| | - R Di Giovanni
- Department of Rehabilitation, CRRF 'Mons. Luigi Novarese', Moncrivello, Italy
| | - E Grange
- Department of Rehabilitation, CRRF 'Mons. Luigi Novarese', Moncrivello, Italy
| | - M Mueller
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genova, Italy
| | - M Messmer Uccelli
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genova, Italy
| | - R Bertoni
- IRCCS Fondazione Don Carlo Gnocchi, Milano, Italy
| | - G Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genova, Italy
| | - A Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genova, Italy
| | - F Patti
- MS Center Institute of Neurological Sciences - University of Catania, Catania, Italy
| | - A Pappalardo
- MS Center Institute of Neurological Sciences - University of Catania, Catania, Italy
| | - L Prosperini
- Department of Neurosciences, S. Camillo-Forlanini Hospital, Roma, Italy
| | - L Castelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC neuroriabilitazione ad Alta Intensità, Roma, Italy
| | - R Rosato
- Department of Psychology, University of Turin, Torino, Italy
| | - D Cattaneo
- IRCCS Fondazione Don Carlo Gnocchi, Milano, Italy
| | - D Marengo
- Department of Psychology, University of Turin, Torino, Italy
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Brichetto G, Pedullà L, Podda J, Tacchino A. Beyond center-based testing: Understanding and improving functioning with wearable technology in MS. Mult Scler 2020; 25:1402-1411. [PMID: 31502913 DOI: 10.1177/1352458519857075] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Wearable sensors are designed to be worn on the body or embedded into portable devices (e.g. smartphones and smartwatches), allowing continuous patient-based monitoring, objective outcomes measuring, and feedback delivering on daily-life activities. Within the medicine domain, there has been a rapid increase in the development, testing, and use of wearable technologies especially in the context of neurological diseases. Although wearables represent promising tools also in multiple sclerosis (MS), the research on their application in MS is still ongoing, and further studies are required to assess their reliability and accuracy to monitor body functions and disability in people with MS (pwMS). Here, we provided a comprehensive overview of the opportunities, potential challenges, and limitations of the wearable technology use in MS. In particular, we classified previous findings within this field into macro-categories, considered crucial for disease management: assessment, monitoring, intervention, advice, and education. Given the increasing pivotal role played by wearables, current literature suggests that for pwMS, the time is right to shift from a center-based traditional therapeutic paradigm toward a personalized patient-based disease self-management. On this way, we present two ongoing initiatives aimed at implementing a continuous monitoring of pwMS and, consequently, providing timely and appropriate care interventions.
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Affiliation(s)
- Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy/Rehabilitation Center, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Ludovico Pedullà
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy/Department of Experimental Medicine, University of Genoa, Genoa, Italy
| | - Jessica Podda
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy/Rehabilitation Center, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
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42
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Tacchino A, Ponzio M, Pedullà L, Podda J, Bragadin MM, Pedrazzoli E, Konrad G, Battaglia MA, Mokkink L, Brichetto G. Italian validation of the Arm Function in Multiple Sclerosis Questionnaire (AMSQ). Neurol Sci 2020; 41:3273-3281. [DOI: 10.1007/s10072-020-04363-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 03/20/2020] [Indexed: 12/20/2022]
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Tacchino A, Veldkamp R, Coninx K, Brulmans J, Palmaers S, Hämäläinen P, D'hooge M, Vanzeir E, Kalron A, Brichetto G, Feys P, Baert I. Design, Development, and Testing of an App for Dual-Task Assessment and Training Regarding Cognitive-Motor Interference (CMI-APP) in People With Multiple Sclerosis: Multicenter Pilot Study. JMIR Mhealth Uhealth 2020; 8:e15344. [PMID: 32343258 PMCID: PMC7218603 DOI: 10.2196/15344] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 01/22/2020] [Accepted: 02/26/2020] [Indexed: 01/22/2023] Open
Abstract
Background Dual tasking constitutes a large portion of most activities of daily living; in real-life
situations, people need to not only maintain balance and mobility skills, but also perform other cognitive or motor tasks at the same time. Interest toward dual-task training (DTT) is increasing as traditional interventions may not prepare patients to adequately face the challenges of most activities of daily living. These usually involve simultaneous cognitive and motor tasks, and they often show a decline in performance. Cognitive-motor interference (CMI) has been investigated in different neurological populations, but limited evidence is present for people with multiple sclerosis (MS). The use of computerized tools is mandatory to allow the application of more standardized assessment and rehabilitation intervention protocols and easier implementation of multicenter and multilanguage studies. Objective To describe the design and development of CMI-APP, an adaptive and interactive technology tablet-based app, and to present the preliminary results of a multicenter pilot study involving people with MS performed in several European centers for evaluating the feasibility of and adherence to a rehabilitation program based on CMI-APP. Methods CMI-APP includes user-friendly interfaces for personal data input and management, assessment of CMI, and DTT. A dedicated team developed CMI-APP for Android tablets above API level 14 (version 4.0), using C# as the programming language and Unity and Visual Studio as development tools. Three cognitive assessment tests for working memory, information processing speed, and sustained attention and four motor assessment tests for walking at different difficulty levels were implemented. Dual cognitive-motor tasks were performed by combining single cognitive and motor tasks. CMI-APP implements exercises for DTT involving the following 12 cognitive functions: sustained attention, text comprehension, verbal fluency, auditory discrimination, visual discrimination, working memory, information processing speed, auditory memory, visual memory, verbal analog reasoning, visual analog reasoning, and visual spatial planning, which can be performed during walking or stepping on the spot. Fifteen people with MS (mean age 52.6, SD 8.6 years; mean disease duration 9.4, SD 8.4 years; mean Expanded Disability Status Scale score 3.6, SD 1.1) underwent DTT (20 sessions). Adherence to the rehabilitation program was evaluated according to the percentage of performed sessions, perceived exertion during the training (Borg 15-point Ratings of Perceived Exertion [RPE] Scale), and subjective experience of the training (Intrinsic Motivation Inventory [IMI]). Results The adherence rate was 91%. DTT was perceived as “somewhat difficult” (mean RPE Scale score 12.6, SD 1.9). IMI revealed that participants enjoyed the training and felt that it was valuable and, to some extent, important, without feelings of pressure. They felt competent, although they did not always feel they could choose the exercises, probably because the therapist chose the exercises and many exercises had few difficulty levels. Conclusions CMI-APP is safe, highly usable, motivating, and well accepted for DTT by people with MS. The findings are fundamental for the preparation of future large-sample studies examining CMI and the effectiveness of DTT interventions with CMI-APP in people with MS.
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Affiliation(s)
- Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Renee Veldkamp
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Karin Coninx
- Expertise Centre for Digital Media, Faculty of Sciences, Hasselt University, Hasselt, Belgium
| | - Jens Brulmans
- Expertise Centre for Digital Media, Faculty of Sciences, Hasselt University, Hasselt, Belgium
| | | | | | - Mieke D'hooge
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium.,National MS Center Melsbroek, Melsbroek, Belgium
| | - Ellen Vanzeir
- Rehabilitation and MS Center Overpelt, Overpelt, Belgium
| | - Alon Kalron
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy.,AISM Rehabilitation Service of Genoa, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Peter Feys
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Ilse Baert
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
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Solaro C, Di Giovanni R, Grange E, Brichetto G, Mueller M, Tacchino A, Bertoni R, Patti F, Pappalardo A, Prosperini L, Castelli L, Rosato R, Cattaneo D, Marengo D. Italian translation and psychometric validation of the Manual Ability Measure-36 (MAM-36) and its correlation with an objective measure of upper limb function in patients with multiple sclerosis. Neurol Sci 2020; 41:1539-1546. [DOI: 10.1007/s10072-020-04263-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 01/18/2020] [Indexed: 12/25/2022]
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45
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Kalkers NF, Galan I, Kerbrat A, Tacchino A, Kamm CP, O'Connell K, McGuigan C, Edan G, Montalban X, Uitdehaag BM, Mokkink LB. Differential item functioning of the Arm function in Multiple Sclerosis Questionnaire (AMSQ) by language, a study in six countries. Mult Scler 2019; 27:90-96. [PMID: 31845614 DOI: 10.1177/1352458519895450] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The Arm function in Multiple Sclerosis Questionnaire (AMSQ) has been developed as a self-reported measure of arm and hand functioning for patients with multiple sclerosis (MS). The AMSQ was originally developed in Dutch and to date translated into five languages (i.e. English, German, Spanish, French, and Italian). OBJECTIVE The aim of this study was to evaluate differential item functioning (DIF) of the AMSQ in these languages. METHODS We performed DIF analyses, using "language" as the polytomous group variable. To detect DIF, logistic regression and item response theory principles were applied. Multiple logistic regression models were evaluated. We used a pseudo R2 value of 0.02 or more as the DIF threshold. RESULTS A total of 1733 male and female patients with all subtypes of MS were included. The DIF analysis for the whole dataset showed no uniform or non-uniform DIF on any of the 31 items. All R2 values were below 0.02. CONCLUSION The AMSQ is validated in six languages. All items have the same meaning to MS patients in Dutch, English, German, Spanish, French, and Italian. This validation study enables use of the AMSQ in international studies, for monitoring treatment response and disease progression.
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Affiliation(s)
- Nynke F Kalkers
- Department of Neurology, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands/Department of Neurology, OLVG, Amsterdam, The Netherlands
| | - Ingrid Galan
- Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Anne Kerbrat
- Department of Neurology, Rennes University Hospital, Rennes, France
| | - Andrea Tacchino
- Scientific Research Area, Italian MS Foundation (FISM), Genoa, Italy
| | - Christian P Kamm
- Neurology and Neurorehabilitation Center, Lucerne Cantonal Hospital, Lucerne, Switzerland/Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Karen O'Connell
- Department of Neurology, St. Vincent's University Hospital and University College Dublin, Dublin, Ireland
| | - Chris McGuigan
- Department of Neurology, St Vincent's University Hospital and University College Dublin, Dublin, Ireland
| | - Gilles Edan
- Department of Neurology, Rennes University Hospital, Rennes, France
| | - Xavier Montalban
- Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitario Vall d'Hebron, Barcelona, Spain/Department of Neurology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Bernard Mj Uitdehaag
- Department of Neurology, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Lidwine B Mokkink
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Location VUmc and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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46
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Veldkamp R, Baert I, Kalron A, Tacchino A, D’hooge M, Vanzeir E, Van Geel F, Raats J, Goetschalckx M, Brichetto G, Shalmoni N, Hellinckx P, De Weerdt N, De Wilde D, Feys P. Structured Cognitive-Motor Dual Task Training Compared to Single Mobility Training in Persons with Multiple Sclerosis, a Multicenter RCT. J Clin Med 2019; 8:E2177. [PMID: 31835502 PMCID: PMC6947084 DOI: 10.3390/jcm8122177] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/01/2019] [Accepted: 12/05/2019] [Indexed: 12/03/2022] Open
Abstract
The aim was to compare the effectiveness of dual-task training (DTT) compared to single mobility training (SMT) on dual-task walking, mobility and cognition, in persons with Multiple Sclerosis (pwMS). Forty pwMS were randomly assigned to the DTT or SMT groups. The DTT-group performed dual-task exercises using an interactive tablet-based application, while the SMT-group received conventional walking and balance exercises. Both interventions were supervised and identical in weeks (8) and sessions (20). Nine cognitive-motor dual-task conditions were assessed at baseline, after intervention and at 4-weeks follow-up (FU). The dual-task cost (DTC), percentage change of dual-task performance compared to single-task performance, was the primary outcome. Mobility and cognition were secondarily assessed. Mixed model analyses were done with group, time and the interaction between group and time as fixed factors and participants as random factors. Significant time by group interactions were found for the digit-span walk and subtraction walk dual-task conditions, with a reduction in DTC (gait speed) for the DTT maintained at FU. Further, absolute dual-task gait speed during walking over obstacles only improved after the DTT. Significant improvements were found for both groups in various motor and cognitive measures. However, the DTT led to better dual-task walking compared to the SMT.
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Affiliation(s)
- Renee Veldkamp
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3500 Hasselt, Belgium (P.F.)
| | - Ilse Baert
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3500 Hasselt, Belgium (P.F.)
| | - Alon Kalron
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv 6997801, Tel-Aviv, Israel
| | - Andrea Tacchino
- Scientific Research Area, Italian MS Foundation (FISM), 16149 Genoa, Italy
| | - Mieke D’hooge
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3500 Hasselt, Belgium (P.F.)
- National MS Center Melsbroek, 1820 Steenokkerzeel, Belgium
| | - Ellen Vanzeir
- Rehabilitation and MS Center Overpelt, 3900 Pelt, Belgium
| | - Fanny Van Geel
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3500 Hasselt, Belgium (P.F.)
| | - Joke Raats
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3500 Hasselt, Belgium (P.F.)
- De Mick AZ Klina, 2930 Brasschaat, Belgium
| | - Mieke Goetschalckx
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3500 Hasselt, Belgium (P.F.)
| | - Giampaolo Brichetto
- Scientific Research Area, Italian MS Foundation (FISM), 16149 Genoa, Italy
- AISM Rehabilitation Service of Genoa, Italian Multiple Sclerosis Society, 16149 Genoa, Italy
| | - Nov Shalmoni
- Multiple Sclerosis Center, Sheba Medical Center, Derech Sheba 2, Ramat Gan 5262100, Tel-hashomer, Israel
| | | | | | | | - Peter Feys
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3500 Hasselt, Belgium (P.F.)
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47
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Brichetto G, Monti Bragadin M, Fiorini S, Battaglia MA, Konrad G, Ponzio M, Pedullà L, Verri A, Barla A, Tacchino A. The hidden information in patient-reported outcomes and clinician-assessed outcomes: multiple sclerosis as a proof of concept of a machine learning approach. Neurol Sci 2019; 41:459-462. [PMID: 31659583 PMCID: PMC7005074 DOI: 10.1007/s10072-019-04093-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 09/28/2019] [Indexed: 11/30/2022]
Abstract
Machine learning (ML) applied to patient-reported (PROs) and clinical-assessed outcomes (CAOs) could favour a more predictive and personalized medicine. Our aim was to confirm the important role of applying ML to PROs and CAOs of people with relapsing-remitting (RR) and secondary progressive (SP) form of multiple sclerosis (MS), to promptly identifying information useful to predict disease progression. For our analysis, a dataset of 3398 evaluations from 810 persons with MS (PwMS) was adopted. Three steps were provided: course classification; extraction of the most relevant predictors at the next time point; prediction if the patient will experience the transition from RR to SP at the next time point. The Current Course Assignment (CCA) step correctly assigned the current MS course with an accuracy of about 86.0%. The MS course at the next time point can be predicted using the predictors selected in CCA. PROs/CAOs Evolution Prediction (PEP) followed by Future Course Assignment (FCA) was able to foresee the course at the next time point with an accuracy of 82.6%. Our results suggest that PROs and CAOs could help the clinician decision-making in their practice.
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Affiliation(s)
- Giampaolo Brichetto
- Department of Research, Italian Multiple Sclerosis Foundation, Genoa, Italy. .,AISM Rehabilitation Center of Liguria, Genoa, Italy.
| | - Margherita Monti Bragadin
- Department of Research, Italian Multiple Sclerosis Foundation, Genoa, Italy.,AISM Rehabilitation Center of Liguria, Genoa, Italy
| | - Samuele Fiorini
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genoa, Italy
| | | | | | - Michela Ponzio
- Department of Research, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Ludovico Pedullà
- Department of Research, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Alessandro Verri
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genoa, Italy
| | - Annalisa Barla
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genoa, Italy
| | - Andrea Tacchino
- Department of Research, Italian Multiple Sclerosis Foundation, Genoa, Italy
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48
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Boffa G, Tacchino A, Sbragia E, Schiavi S, Droby A, Piaggio N, Bommarito G, Girardi G, Mancardi GL, Brichetto G, Inglese M. Preserved brain functional plasticity after upper limb task‐oriented rehabilitation in progressive multiple sclerosis. Eur J Neurol 2019; 27:77-84. [DOI: 10.1111/ene.14059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 08/05/2019] [Indexed: 12/21/2022]
Affiliation(s)
- G. Boffa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of GenovaGenoaItaly
| | - A. Tacchino
- Scientific Research Area Italian Multiple Sclerosis Foundation Genoa Italy
| | - E. Sbragia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of GenovaGenoaItaly
| | - S. Schiavi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of GenovaGenoaItaly
| | - A. Droby
- Department of Neurology and Neuroscience Icahn School of Medicine at Mount Sinai New York New York USA
| | - N. Piaggio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of GenovaGenoaItaly
| | - G. Bommarito
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of GenovaGenoaItaly
| | - G. Girardi
- Scientific Research Area Italian Multiple Sclerosis Foundation Genoa Italy
| | - G. L. Mancardi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of GenovaGenoaItaly
- IRCCS Istituti Clinici Scientifici Maugeri Pavia Italy
- Ospedale Policlinico San Martino-IRCCS Genoa Italy
| | - G. Brichetto
- Scientific Research Area Italian Multiple Sclerosis Foundation Genoa Italy
| | - M. Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of GenovaGenoaItaly
- Department of Neurology and Neuroscience Icahn School of Medicine at Mount Sinai New York New York USA
- Ospedale Policlinico San Martino-IRCCS Genoa Italy
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49
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Solari A, Giovannetti AM, Giordano A, Tortorella C, Torri Clerici V, Brichetto G, Granella F, Lugaresi A, Patti F, Salvetti M, Pesci I, Pucci E, Centonze D, Danni MC, Bonavita S, Ferraro D, Gallo A, Gajofatto A, Nociti V, Grimaldi L, Grobberio M, Lanzillo R, Di Giovanni R, Gregori S, Manni A, Pietrolongo E, Bertagnoli S, Ronzoni M, Compagnucci L, Fantozzi R, Allegri B, Arena S, Buscarinu MC, Sabattini L, Quartuccio ME, Tsantes E, Confaloneri P, Tacchino A, Schiffmann I, Rahn AC, Kleiter I, Messmer Uccelli M, Barabasch A, Heesen C, The ManTra Project. Conversion to Secondary Progressive Multiple Sclerosis: Patient Awareness and Needs. Results From an Online Survey in Italy and Germany. Front Neurol 2019; 10:916. [PMID: 31507519 PMCID: PMC6713887 DOI: 10.3389/fneur.2019.00916] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 08/07/2019] [Indexed: 12/15/2022] Open
Abstract
Background: Few studies have investigated the experiences of patients around the conversion to secondary progressive multiple sclerosis (SPMS). ManTra is a mixed-method, co-production research project conducted in Italy and Germany to develop an intervention for newly-diagnosed SPMS patients. In previous project actions, we identified the needs and experiences of patients converting to SPMS via literature review and qualitative research which involved key stakeholders. Aims: The online patient survey aimed to assess, on a larger and independent sample of recently-diagnosed SPMS patients: (a) the characteristics associated to patient awareness of SPMS conversion; (b) the experience of conversion; (c) importance and prioritization of the needs previously identified. Methods: Participants were consenting adults with SPMS since ≤5 years. The survey consisted of three sections: on general and clinical characteristics; on experience of SPMS diagnosis disclosure (aware participants only); and on importance and prioritization of 33 pre-specified needs. Results: Of 215 participants, those aware of their SPMS diagnosis were 57% in Italy vs. 77% in Germany (p = 0.004). In both countries, over 80% of aware participants received a SPMS diagnosis from the neurologist; satisfaction with SPMS disclosure was moderate to high. Nevertheless, 28-35% obtained second opinions, and 48-56% reported they did not receive any information on SPMS. Participants actively seeking further information were 63% in Germany vs. 31% in Italy (p < 0.001). Variables independently associated to patient awareness were geographic area (odds ratio, OR 0.32, 95% CI 0.13-0.78 for Central Italy; OR 0.21, 95% CI 0.08-0.58 for Southern Italy [vs. Germany]) and activity limitations (OR 7.80, 95% CI 1.47-41.37 for dependent vs. autonomous patients). All pre-specified needs were scored a lot or extremely important, and two prioritized needs were shared by Italian and German patients: "physiotherapy" and "active patient care involvement." The other two differed across countries: "an individualized health care plan" and "information on social rights and policies" in Italy, and "psychological support" and "cognitive rehabilitation" in Germany. Conclusions: Around 40% of SPMS patients were not aware of their disease form indicating a need to improve patient-physician communication. Physiotherapy and active patient care involvement were prioritized in both countries.
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Affiliation(s)
- Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Ambra Mara Giovannetti
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Multiple Sclerosis Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Andrea Giordano
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Department of Psychology, University of Turin, Turin, Italy
| | - Carla Tortorella
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
| | | | - Giampaolo Brichetto
- Rehabilitation Centre, Italian Multiple Sclerosis Society, Genoa, Italy.,Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Franco Granella
- Neurosciences Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Alessandra Lugaresi
- UOSI Riabilitazione Sclerosi Multipla, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Francesco Patti
- Sezione Neuroscienze, Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università di Catania, Catania, Italy.,Centro Sclerosi Multipla, PO Policlinico "G. Rodolico", Catania, Italy
| | - Marco Salvetti
- IRCCS Neuromed, Pozzilli, Italy.,Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - Ilaria Pesci
- Unità di Neurologia, Centro Sclerosi Multipla, Ospedale di Vaio, Fidenza, Italy
| | - Eugenio Pucci
- UOC Neurologia, Ospedale "A. Murri", ASUR Marche-AV4, Fermo, Italy
| | - Diego Centonze
- IRCCS Neuromed, Pozzilli, Italy.,Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | | | - Simona Bonavita
- II Clinica Neurologica, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Diana Ferraro
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonio Gallo
- I Clinica Neurologica, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Alberto Gajofatto
- Dipartimento di Neuroscienze, Biomedicina e Movimento, Università di Verona, Verona, Italy
| | - Viviana Nociti
- Istituto di Neurologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Luigi Grimaldi
- UOC Neurologia e Centro Regionale SM, Fondazione Istituto "G. Giglio", Cefalù, Italy
| | - Monica Grobberio
- Laboratory of Clinical Neuropsychology, Department of Neurology and Psychology, ASST Lariana, Como, Italy
| | - Roberta Lanzillo
- Neurosciences, Reproductive and Odontostomatological Sciences Department, Federico II University of Naples, Naples, Italy
| | | | - Silvia Gregori
- UOC Neurologia, Ospedale San Camillo de Lellis, Rieti, Italy
| | - Alessia Manni
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, Aldo Moro University of Bari, Bari, Italy
| | - Erika Pietrolongo
- Department of Neuroscience, Imaging and Clinical Sciences, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | | | - Marco Ronzoni
- Centro Sclerosi Multipla, Ospedale "G. Salvini"-ASST Rhodense, Garbagnate Milanese, Italy
| | - Laura Compagnucci
- Clinica Neurologica, Università Politecnica delle Marche, Ancona, Italy
| | | | - Beatrice Allegri
- Unità di Neurologia, Centro Sclerosi Multipla, Ospedale di Vaio, Fidenza, Italy
| | - Sebastiano Arena
- Sezione Neuroscienze, Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università di Catania, Catania, Italy.,Centro Sclerosi Multipla, PO Policlinico "G. Rodolico", Catania, Italy
| | - Maria Chiara Buscarinu
- Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - Loredana Sabattini
- UOSI Riabilitazione Sclerosi Multipla, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | | | - Elena Tsantes
- Neurosciences Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Paolo Confaloneri
- Multiple Sclerosis Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Insa Schiffmann
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Christin Rahn
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ingo Kleiter
- Kempfenhausen Centre for Treatment of Multiple Sclerosis, Marianne-Strauß-Klinik, Berg, Germany
| | | | - Anna Barabasch
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - The ManTra Project
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Multiple Sclerosis Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Department of Psychology, University of Turin, Turin, Italy.,Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy.,Rehabilitation Centre, Italian Multiple Sclerosis Society, Genoa, Italy.,Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy.,Neurosciences Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy.,UOSI Riabilitazione Sclerosi Multipla, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy.,Sezione Neuroscienze, Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università di Catania, Catania, Italy.,Centro Sclerosi Multipla, PO Policlinico "G. Rodolico", Catania, Italy.,IRCCS Neuromed, Pozzilli, Italy.,Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy.,Unità di Neurologia, Centro Sclerosi Multipla, Ospedale di Vaio, Fidenza, Italy.,UOC Neurologia, Ospedale "A. Murri", ASUR Marche-AV4, Fermo, Italy.,Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy.,Clinica Neurologica, Università Politecnica delle Marche, Ancona, Italy.,II Clinica Neurologica, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy.,Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy.,I Clinica Neurologica, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy.,Dipartimento di Neuroscienze, Biomedicina e Movimento, Università di Verona, Verona, Italy.,Istituto di Neurologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,UOC Neurologia e Centro Regionale SM, Fondazione Istituto "G. Giglio", Cefalù, Italy.,Laboratory of Clinical Neuropsychology, Department of Neurology and Psychology, ASST Lariana, Como, Italy.,Neurosciences, Reproductive and Odontostomatological Sciences Department, Federico II University of Naples, Naples, Italy.,Rehabilitation Unit, Mons. L. Novarese Hospital, Moncrivello, Italy.,UOC Neurologia, Ospedale San Camillo de Lellis, Rieti, Italy.,Department of Basic Medical Sciences, Neurosciences and Sense Organs, Aldo Moro University of Bari, Bari, Italy.,Department of Neuroscience, Imaging and Clinical Sciences, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy.,Italian Multiple Sclerosis Society, Mantua, Italy.,Centro Sclerosi Multipla, Ospedale "G. Salvini"-ASST Rhodense, Garbagnate Milanese, Italy.,Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Kempfenhausen Centre for Treatment of Multiple Sclerosis, Marianne-Strauß-Klinik, Berg, Germany.,Italian Multiple Sclerosis Society Research Foundation (FISM), Genoa, Italy
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50
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Bonzano L, Pedullà L, Tacchino A, Brichetto G, Battaglia MA, Mancardi GL, Bove M. Upper limb motor training based on task-oriented exercises induces functional brain reorganization in patients with multiple sclerosis. Neuroscience 2019; 410:150-159. [DOI: 10.1016/j.neuroscience.2019.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 10/26/2022]
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