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Kuettel J, Bay RC, McIsaac TL. Configuration variability of the six-minute walk test among licensed physical therapists working with neurologic conditions: a pilot survey. Physiother Theory Pract 2024; 40:1189-1205. [PMID: 36345213 DOI: 10.1080/09593985.2022.2140318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 07/13/2022] [Accepted: 10/11/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND The six-minute walk test (6MWT) is considered reliable and valid for assessing walking capacity in people with neurologic conditions. However, the consistency in the test length and configuration used is unclear. PURPOSE To determine how the 6MWT was configured by licensed physical therapists working with patients with neurologic conditions in clinical practice, identify their knowledge of the American Thoracic Society (ATS) and Academy of Neurologic Physical Therapy (ANPT) guidelines for the 6MWT and assess relationships between therapist demographic characteristics and knowledge of the 6MWT guidelines. METHODS One hundred forty-six therapists completed a survey related to the configuration they used for the 6MWT. RESULTS Configuration of the 6MWT varied widely. Space limitation was the most frequently selected reason for reported configurations. Over half had available the standardized 100-feet straight walkway but fewer than one-third used this configuration of the ATS guidelines. Fewer than half knew of the ATS guidelines and nearly three-fourths knew of the ANPT guidelines. American Physical Therapy Association membership and having a higher percentage of neurologic patients were associated with knowledge of both guidelines. CONCLUSION The 6MWT must be completed within the constraints of the working environment, and this requirement is clinically relevant when comparing patient results to normative values and measurements across clinics. Our results suggest a need for updated norms that are more congruent with space constraints in current practice settings.
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Affiliation(s)
- Jamie Kuettel
- Department of Physical Therapy, Arizona School of Health Sciences, A.T. Still University, Mesa, AZ, USA
| | - Ralph Curtis Bay
- Department of Interdisciplinary Sciences, Arizona School of Health Sciences, A.T. Still University, Mesa, AZ, USA
| | - Tara L McIsaac
- Department of Physical Therapy, Arizona School of Health Sciences, A.T. Still University, Mesa, AZ, USA
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Yska HAF, Turk BR, Fatemi A, Goodman J, Voermans M, Amos D, Amanat M, van de Stadt S, Engelen M, Smith-Fine A, Keller J. International validation of meaningfulness of postural sway and gait to assess myeloneuropathy in adults with adrenoleukodystrophy. J Inherit Metab Dis 2024. [PMID: 38795020 DOI: 10.1002/jimd.12753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/10/2024] [Accepted: 05/06/2024] [Indexed: 05/27/2024]
Abstract
BACKGROUND The most common manifestation of X-linked adrenoleukodystrophy (ALD) is a slowly progressive myeloneuropathy, which leads to imbalance and gait disturbances. The variable progression of the disease complicates evaluation of its progression rate. Wearable sensors allow for easy and frequent balance and gait collection. This study reports baseline data from a longitudinal study on the quantitative assessment of balance and gait with wearable sensors and their clinical relevance. METHODS Data were collected from adult patients in two institutions. Postural body sway and gait parameters were measured using accelerometers. Disease severity was measured by the Expanded Disability Severity Scale (EDSS). Falling frequency and quality of life (QOL) were collected in men. The relationship between sway and gait variables and EDSS score, participants' use of a walking aid, and falling frequency was evaluated. RESULTS One hundred twenty individuals with ALD were included. Sway variables significantly differentiate participants' assistive device use. Sway and gait variables were correlated to the EDSS in both sexes. Both gait speed and sway were correlated with falling frequency in men from one institution. Select QOL subscores were correlated with the EDSS in males from one institution. Accelerometry generated comparable results across sites. DISCUSSION This study confirms the clinical correlation between spinal cord disease and imbalance and gait in ALD. For the first time, this study shows clinically meaningful relationships for sway and gait with use of an assistive device, falling frequency and QOL. Wearable accelerometers are a valid means to measure sway and gait in ALD. These measures are promising outcomes for clinical trial designs to assess myeloneuropathy in ALD and to monitor disease progression in individuals.
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Affiliation(s)
- Hemmo A F Yska
- Emma Children's Hospital, Department of Neurology and Pediatric Neurology, Amsterdam Leukodystrophy Center, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Bela R Turk
- Kennedy Krieger Institute, Baltimore, Maryland, USA
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ali Fatemi
- Kennedy Krieger Institute, Baltimore, Maryland, USA
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Marije Voermans
- Emma Children's Hospital, Department of Neurology and Pediatric Neurology, Amsterdam Leukodystrophy Center, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Dan Amos
- Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Man Amanat
- Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Stephanie van de Stadt
- Emma Children's Hospital, Department of Neurology and Pediatric Neurology, Amsterdam Leukodystrophy Center, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Marc Engelen
- Emma Children's Hospital, Department of Neurology and Pediatric Neurology, Amsterdam Leukodystrophy Center, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Amena Smith-Fine
- Kennedy Krieger Institute, Baltimore, Maryland, USA
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jennifer Keller
- Kennedy Krieger Institute, Baltimore, Maryland, USA
- Department of Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Hamad AA, Amer BE, Abbas NB, Alnajjar AZ, Meshref M. Prevalence and correlates of fatigue in amyotrophic lateral sclerosis: A systematic review and meta-analysis. Neurol Sci 2024; 45:485-493. [PMID: 37837507 PMCID: PMC10791750 DOI: 10.1007/s10072-023-07119-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 10/04/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVES This systematic review and meta-analysis aimed to determine the frequency and correlates of fatigue in patients with amyotrophic lateral sclerosis (ALS). METHODS Three databases were searched up to 2nd May 2023 to identify studies reporting fatigue frequency in ALS. Studies included had to identify ALS patients through one of ALS diagnostic criteria and measure fatigue by a validated tool with a specific cut-off value. Meta-analysis was conducted using RStudio's "meta" package with a random-effects model. Subgroup analyses and meta-regression explored the relationship between fatigue frequency in ALS and different covariates. RESULTS Eleven studies, compromising 1072 patients, met the inclusion criteria and were included in our analysis. The pooled frequency of fatigue across all studies was 48% (95% CI = 40% to 57%). Our subgroup analysis based on the ALSFRS-R revealed a higher frequency of fatigue in studies with lower scores (< 30) compared to those with higher scores (≥ 30), with a pooled frequency of 62% (95% CI = 43% to 79%) and 43% (95% CI = 37% to 49%), respectively. Also, the meta-regression analysis showed a significant negative association between fatigue and ALSFRS-R mean (P = 0.02). The included studies reported an association between fatigue and lower functional status and poorer quality of life in patients with ALS. CONCLUSION Our findings suggest that fatigue is prevalent in almost half of ALS patients and is associated with lower functional status and poorer quality of life, highlighting the importance of assessing and managing fatigue in ALS patients.
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Affiliation(s)
| | | | | | - Asmaa Zakria Alnajjar
- Faculty of Medicine, Al-Azhar University, Gaza, Palestine
- Medical Research Group of Egypt, Negida Academy, Arlington, MA, USA
| | - Mostafa Meshref
- Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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Gatti MA, Broggi MS, Rivas ME, Muzio D, Bonetto M, Alessandro L. [Physical performance in patients with amyotrophic lateral sclerosis and its relationship with wheelchairs and walking aids use]. Rehabilitacion (Madr) 2022; 56:279-283. [PMID: 35637028 DOI: 10.1016/j.rh.2022.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 02/04/2022] [Accepted: 03/23/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION AND OBJECTIVES Gait deficits and falls in patients with amyotrophic lateral sclerosis (ALS) restrict mobility. The aim of this study is to examine the appropriate use of walking aids and wheelchairs, based on the risk of falling and walking speed of patients with ALS. METHODS Retrospective data from patients from the ALS clinic were included. Age, gender, evolution time, wheelchair use, walking aids, gait speed and the Berg Balance Scale were registered. Categorical variables were related to the Chi Square test and Fisher's exact test. RESULTS Fifty eight patients met the inclusion criteria. Twenty-seven (46.55%) had adequate use of a wheelchair based on walking speed (p=.50). This association decreases to 6% in patients who walked at a speed lower than 0.88m/s. Forty-two (70.69%) had adequate use of an assistive device based on the risk of falls (p=.001). Of the subgroup with Berg Balance score ≤ 45, 38% did not use the appropriate device (p=.06). CONCLUSION Patients with severe gait and balance deficits had inappropriate use of walking aids and/or wheelchairs. The findings of this study may mean a contribution that could be considered in the clinical evaluations of patients with ALS to minimize risks and improve the participation of this group of people.
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Affiliation(s)
- M A Gatti
- Unidad de Terapia Física, FLENI, Buenos Aires, Argentina.
| | - M S Broggi
- Unidad de Terapia Física, FLENI, Buenos Aires, Argentina
| | - M E Rivas
- Unidad de Terapia Física, FLENI, Buenos Aires, Argentina
| | - D Muzio
- Departamento de Medicina física, FLENI, Buenos Aires, Argentina
| | - M Bonetto
- Unidad de Terapia Ocupacional, FLENI, Buenos Aires, Argentina
| | - L Alessandro
- Departamento de Neurología, FLENI, Buenos Aires, Argentina
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Sanfilippo MJ, Layshock ME, Keniston L. Exploring the association between outcome measures to guide clinical management in patients with amyotrophic lateral sclerosis. J Phys Ther Sci 2022; 34:532-539. [PMID: 35937622 PMCID: PMC9345750 DOI: 10.1589/jpts.34.532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/02/2022] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The usefulness and limitations of outcome measures changes throughout
functional decline of patients with Amyotrophic Lateral Sclerosis (ALS). This study aims
to describe associations between outcome measures in patients with ALS over time.
[Participants and Methods] Participant data was collected at a multidisciplinary ALS
clinic during regular clinic visits, including gait velocity, Timed Up and Go, the ALS
Functional Rating Scale-Revised, and it’s Gross Motor Subscale. [Results] All gait
velocity measures were <1.2 m/sec; average Timed Up and Go was >13.5 sec. There was
strong internal consistency between ALS Functional Rating Scale-Revised and its functional
mobility components and a strong, significant correlation between the Timed Up and Go and
the Gross Motor Subscale. [Conclusion] Patients with ALS are not community ambulators and
demonstrate risk for falls. We found concurrent validity between objective and
self-reported measures. The strong association between the Gross Motor Subscale and the
Timed Up and Go may allow PTs to utilize the self-reported Gross Motor Subscale to predict
fall risk. Clinically, when the Timed Up and Go and gait velocity are no longer
appropriate due to disease progression, the Gross Motor Subscale can provide insight into
functional decline.
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Affiliation(s)
- Michelle J Sanfilippo
- Department of Physical Therapy, University of Maryland Eastern Shore: 1 College Backbone Road, Princess Anne, MD 21853, USA
| | - Mary E Layshock
- Department of Physical Therapy, University of Maryland Eastern Shore: 1 College Backbone Road, Princess Anne, MD 21853, USA
| | - Leslie Keniston
- Department of Physical Therapy, University of Maryland Eastern Shore: 1 College Backbone Road, Princess Anne, MD 21853, USA
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Alencar MA, Guedes MCB, Pereira TAL, Rangel MFDA, Abdo JS, Souza LCD. Functional ambulation decline and factors associated in amyotrophic lateral sclerosis. FISIOTERAPIA EM MOVIMENTO 2022. [DOI: 10.1590/fm.2022.35127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Amyotrophic lateral sclerosis (ALS) is a disabling neurodegenerative disease, which compromises locomotion and functional independence. As the goal of physical therapy is to maintain the individual's locomotion capacity and independence as long as possible, it is necessary to gain a better understanding of the possible factors associated with the loss of this capacity. Objective: To evaluate functional ambulation in patients with ALS and possible factors associated with its decline. Methods: A cross-sectional study was conducted with sporadic ALS patients. Demographic and clinical/functional aspects were evaluated. ALS Functional Rating Scale-Revised (ALSFRS-R), Functional Ambulation Category, Medical Research Council scale and Fatigue Severity Scale were used. Descriptive and comparative analyses were conducted of the groups capable and incapable of functional ambulation. Binary logistic regression (stepwise forward method) was performed to determine potential factors associated with the loss of functional ambulation. Results: Among the 55 patients (mean age: 56.9 ± 11.2 years), 74.5% were able to walk functionally. Differences were found between groups regarding time of diagnosis, number of falls, pain, use of noninvasive ventilation, gastrostomy, ability to turn in bed, mobility aids, home adaptations, functional performance, muscle strength and fatigue. The possible predictors of walking disability were overall muscle strength (OR = 0.837; p = 0.003) and fatigue (OR =1.653; p = 0.034). Conclusion: Muscle strength and fatigue are associated with the decline in ambulation capacity in patients with ALS. In view of the complexity of elements involved in walking, further studies are needed to investigate the influence of these aspects in this population.
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Sukockienė E, Ferfoglia RI, Poncet A, Janssens JP, Allali G. Longitudinal Timed Up and Go Assessment in Amyotrophic Lateral Sclerosis: A Pilot Study. Eur Neurol 2021; 84:375-379. [PMID: 34167113 DOI: 10.1159/000516772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/19/2021] [Indexed: 11/19/2022]
Abstract
Progressive loss of walking ability in amyotrophic lateral sclerosis (ALS) has been scarcely studied as a potential predictive factor for survival in motor neuron disease. We aimed to assess the progression of gait decline and its association with mortality in ALS using the Timed Up and Go test (TUG). Patients were followed up prospectively at the Centre for ALS and Related Disorders in Geneva University Hospitals between 2012 and 2016. The TUG was performed at baseline and subsequent evaluations occurred every 3 months. At inclusion, patients were classified as unable to perform the TUG, "slow TUG" (>10.6 s), and "fast TUG" (≤10.6 s). In total, 68 patients with ALS (mean ± SD age: 68.6 ± 11.9 years; 50% female) were included. Baseline TUG was negatively correlated with the total ALSFRS-R score (r = -0.63, p < 0.001). At baseline, ALS patients with bulbar onset performed the TUG faster (9.9 ± 3.7 s) than the non-bulbar ones (17.3 ± 14.9 s, p = 0.008). Thirty of 68 (44%) patients died by the end of the follow-up period. The TUG performance at the first visit did not predict mortality. While we did not find any association with mortality in ALS and gait quantification, the TUG was feasible in a majority of ALS patients, was correlated with functional status, and could be of interest in the follow-up of non-bulbar ALS patients.
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Affiliation(s)
- Eglė Sukockienė
- Division of Neurology, Department of Clinical Neurosciences, Center for ALS and Related Disorders, Geneva University Hospitals, Geneva, Switzerland.,Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, Hospital of Lithuanian University of Health Sciences Kauno klinikos, Kaunas, Lithuania
| | - Ruxandra Iancu Ferfoglia
- Division of Neurology, Department of Clinical Neurosciences, Center for ALS and Related Disorders, Geneva University Hospitals, Geneva, Switzerland
| | - Antoine Poncet
- Center for Clinical Research & Division of Clinical-Epidemiology, Department of Health and Community Medicine, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland
| | - Jean-Paul Janssens
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Gilles Allali
- Division of Cognitive and Motor Aging, Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, Bronx, New York, USA.,Division of Neurology, Department of Clinical Neurosciences, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Geronimo A, Martin AE, Simmons Z. Inertial sensing of step kinematics in ambulatory patients with ALS and related motor neuron diseases. J Med Eng Technol 2021; 45:486-493. [PMID: 34016013 DOI: 10.1080/03091902.2021.1922526] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive disorder which impairs gait and elevates the risk for falls. Current methods of assessing gait in these patients are infrequent and subjective. The goal of this study was to evaluate wearable-based methods for assessing gait to facilitating better monitoring of ambulatory health and ultimately lessen fall risk. Thirty ambulatory patients seen in ALS clinic were guided by a physical therapist on a short walk, during which inertial sensors recorded their movement. Two methods, utilising sensors at the waist or foot, were used independently to estimate gait parameters. Decreased stride length, increased stride duration and decreased walking speed were associated with lower functional walking scores, and the presence of a cane or walker. Overall, there was no group-wide mean walking speed differences between methods, though the waist method overestimated stride length and walking speed in those with more significant gait dysfunction compared to the foot method. Reconstruction of movement using the foot-based sensor resulted in route segments that were 94 ± 1% standard error of the mean (SEM) the length of a centre-to-centre hallway reference vector, with an angular error of 0.66 ± 0.28° SEM.
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Affiliation(s)
- Andrew Geronimo
- Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA
| | - Anne E Martin
- Department of Mechanical Engineering, Penn State University, University Park, PA, USA
| | - Zachary Simmons
- Departments of Neurology and Humanities, Penn State College of Medicine, Hershey, PA, USA
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Santos NCD, Soares NS, Anjos JLMD, Matos BSD, Carvalho DB. Testes funcionais validados em indivíduos hospitalizados e não hospitalizados: revisão sistemática. REVISTA CIÊNCIAS EM SAÚDE 2020. [DOI: 10.21876/rcshci.v10i4.960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objetivo: Realizar uma revisão sistemática sobre os testes funcionais validados em diferentes perfis de indivíduos hospitalizados e não hospitalizados e avaliar as evidências psicométricas para confiabilidade e validade. Métodos: Trata-se de uma revisão sistemática. Foram utilizadas as bases de dados EMBASE, MEDLINE, Lilacs e SciELO com as palavras-chave Functional Tests (Walk Test, Gait Speed Test, Chair Stand Test, Timed Up And Go, Step Test),Validation Studies as Topic e sinônimos. Foram incluídos estudos de validação de testes funcionais em indivíduos hospitalizados ou não hospitalizados que utilizaram os critérios de validade e/ou confiabilidade e relacionaram os testes a diferentes variáveis. Esses artigos poderiam ser observacionais longitudinais ou de corte transversal ou estudos de validação que utilizaram dados de ensaios clínicos. Foram excluídos os artigos que não apresentaram características importantes da amostra e a descrição do teste. Resultados: A pesquisa resultou em 36.150 artigos, e 89 foram incluídos. Os estudos foram organizados em tabelas com informações como autor, ano; critérios de validação; amostra; teste; variáveis associadas; resultados. A qualidade dos artigos foi avaliada por meio da Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Conclusão: Os testes funcionais são válidos e confiáveis para a avaliação de indivíduos hospitalizados e não hospitalizados, estando associados à força muscular, capacidade de caminhar, controle postural, atividades de vida diária, risco de quedas, hospitalização e mortalidade.
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Sharma A, Sane H, Paranjape A, Pradhan R, Das R, Biju H, Gokulchandran N, Badhe P. Multiple doses of cell therapy and neurorehabilitation in amyotrophic lateral sclerosis: A case report. Clin Pract 2020; 10:1242. [PMID: 33072247 PMCID: PMC7533601 DOI: 10.4081/cp.2020.1242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/18/2020] [Indexed: 12/13/2022] Open
Abstract
Cell therapy, along with intensive rehabilitation has been shown to significantly improve outcomes in amyotrophic lateral sclerosis (ALS), in addition to standard therapy. We present a 40-years-old male ALS patient, suffering for the past four years, who underwent multiple doses of cell therapy at our institution. Along with riluzole treatment and lithium co-administration, his treatment involved multiple intrathecal transplants of autologous bone marrow-derived mononuclear cells, followed by multidisciplinary neurorehabilitation. The outcome measures of ALSFunctional Rating Scale Revised score remained stable, and importantly, Six Minute Walk Test distance improved from 475.2 m to 580.8 m, over a span of 16 months. Improved outcomes are indicative of slowing down of disease progression. Multiple doses of intrathecal autologous cell therapy along with rehabilitation and lithium, in addition to standard riluzole treatment is a novel approach for decelerating disease progression and qualitatively improving living conditions for ALS patients and their caregivers.
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Affiliation(s)
- Alok Sharma
- NeuroGen Brain and Spine Institute, Navi Mumbai, Maharashtra, India
| | - Hemangi Sane
- NeuroGen Brain and Spine Institute, Navi Mumbai, Maharashtra, India
| | - Amruta Paranjape
- NeuroGen Brain and Spine Institute, Navi Mumbai, Maharashtra, India
| | - Radhika Pradhan
- NeuroGen Brain and Spine Institute, Navi Mumbai, Maharashtra, India
| | - Rohit Das
- NeuroGen Brain and Spine Institute, Navi Mumbai, Maharashtra, India
| | - Hema Biju
- NeuroGen Brain and Spine Institute, Navi Mumbai, Maharashtra, India
| | | | - Prerna Badhe
- NeuroGen Brain and Spine Institute, Navi Mumbai, Maharashtra, India
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The 6-min walk test as a new outcome measure in Amyotrophic lateral sclerosis. Sci Rep 2020; 10:15580. [PMID: 32968168 PMCID: PMC7511965 DOI: 10.1038/s41598-020-72578-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 08/24/2020] [Indexed: 12/02/2022] Open
Abstract
One of the issues highlighted in amyotrophic lateral sclerosis (ALS) clinical trials is the lack of appropriate outcome measures. The aim of this multicentric study was to evaluate the 6-min walk test (6MWT) as tool to monitor the natural history of a cohort of ALS patients followed up over a 6-month interval. Forty-four ambulant patients were assessed at baseline and after 1, 3 and 6 months. Eight out of forty-four lost the ability to walk before the end of the study. The 6MWT and the objective measures linked to motor function, such as 10 m walking test (10MWT) and Time-up and go (TUG), the ALSFRS-R and the ALSFRS-R items 7–9 showed a good responsiveness to change over the 6-month interval. There was a strong correlation between 6 and 10MWT, TUG, ALSFRS-R, ALSFRS-R items 7–9 and FVC% at baseline. There was no correlation with Edinburgh Cognitive and Behavioural ALS Screen (ECAS) and Modified Borg Scale (MBS). The Δ of 6MWT from T0 to T6 significantly correlated with the Δs of 10MWT and TUG. There was no correlation with the Δs of ALSFRS-R, ALSFRS-R items 7 9, ECAS, MBS and FVC%. The discordance between changes of the 6MWT and ALSFRS-R at 6 month highlights the different content validity among these instruments. The concordance among 6MWT, 10MWT and TUG indicates that the 6MWT is an objective, sensitive and robust tool to measure motor performances in a longitudinal setting. The main limitations of our study were the small sample size and the high percentage of patients (18%) lost at follow-up. Therefore, further studies on larger cohorts, and exploring the relation between 6MWT and need of ventilator support or survival could strengthen our results.
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Babu S. Upper motor neuron burden measurement in motor neuron diseases: Does one scale fit all? Muscle Nerve 2020; 61:431-432. [DOI: 10.1002/mus.26836] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/08/2020] [Accepted: 02/15/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Suma Babu
- Department of NeurologySean M. Healey & AMG Center for ALS, Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
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