1
|
Motl RW, Plummer P, Backus D, Hebert JR, Neal WN, Ng A, Lowman J, Bethoux F, Schmidt H, McBurney R, McCully KK, Cutter G. Validation of scores from a telephone administered multiple sclerosis walking scale-12 in persons with multiple sclerosis. Mult Scler Relat Disord 2024; 88:105715. [PMID: 38889558 DOI: 10.1016/j.msard.2024.105715] [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: 03/05/2024] [Revised: 05/27/2024] [Accepted: 06/08/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND The Multiple Sclerosis Walking Scale-12 (MSWS-12) has typically been delivered through paper-and-pencil or computer-based administration. PURPOSE This study examined the validity of inferences from scores derived via a telephone administration of the MSWS-12 applied as part of screening of participants with walking dysfunction into a clinical trial of exercise training in MS. METHOD The MSWS-12 was administered on two occasions separated by approximately 2 weeks through the telephone and then in-person (i.e., computer-based administration). Participants further completed the Patient Determined Disease Steps (PDDS) scale, timed 25-foot walk (T25FW), six-minute walk (6MW), Modified Fatigue Impact Scale (MFIS), and Multiple Sclerosis Impact Scale-29 (MSIS-29), and underwent a neurological exam for generating an expanded disability status scale (EDSS) score. The primary set of data (Full Sample) for analyses included all persons who passed the telephone screening for inclusion with MSWS-12 scores between 25 and 75 (N = 374). The secondary set of data (Truncated Sample) included only persons with MSWS-12 scores between 25 and 75 for both the telephone and computer administrations of the MSWS-12 (N = 248). RESULTS The results in the Full Sample indicated a difference in overall and item levels scores between the telephone and computer data collections, and the computer version had higher internal consistency and stronger unidimensionality. Nevertheless, MSWS-12 scores from both modes of administration had comparable correlations with the T25FW, 6MW, EDSS, PDDS, MFIS, and MSIS-29, but the correlation between the two MSWS-12 administrations did not approach unity. There was a systematic difference in scores between telephone and computer administrations across levels of walking dysfunction based on a Bland-Altman plot, and the difference was predicted by MFIS physical, 6MW, and EDSS scores. The comparison of results between the Full and Truncated Samples suggested that the primary analysis might have been influenced by the larger range of scores on the computer than telephone administrations of the MSWS-12. CONCLUSION The telephone administration of the MSWS-12 provides an efficient and cost-effective measure of walking dysfunction in persons with MS.
Collapse
Affiliation(s)
- Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, 1919 West Taylor St, Applied Health Sciences Building, Room 506J, Chicago IL, 60612, United States.
| | - Prudence Plummer
- Department of Physical Therapy, MGH Institute of Health Professions, United States
| | | | - Jeffrey R Hebert
- School of Medicine, University of Colorado Anschutz Medical Campus, United States
| | - Whitney N Neal
- Department of Physical Therapy, University of Alabama at Birmingham, United States
| | - Alexander Ng
- Program in Exercise Science, Department of Physical Therapy, Marquette University, United States
| | - John Lowman
- Department of Physical Therapy, University of Alabama at Birmingham, United States
| | - Francois Bethoux
- Mellen Center for MS, Cleveland Clinic, Neurological Institute, United States
| | - Hollie Schmidt
- Accelerated Cure Project for Multiple Sclerosis, United States
| | - Robert McBurney
- Accelerated Cure Project for Multiple Sclerosis, United States
| | - Kevin K McCully
- Department of Kinesiology, University of Georgia, United States
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, United States
| |
Collapse
|
2
|
Thorning M, Lambertsen KL, Skov CD, Frich LH, Jensen HB, Holsgaard-Larsen A, Nielsen HH. Criterion validity of muscle strain analyses of skeletal muscle function in patients with multiple sclerosis. Mult Scler Relat Disord 2023; 70:104478. [PMID: 36603294 DOI: 10.1016/j.msard.2022.104478] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/12/2022] [Accepted: 12/22/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Despite the wide range of existing performance measures to evaluate functional status of patients with multiple sclerosis, the heterogeneous nature of the disease hinders clinical characterization and monitoring of disease severity. Speckle tracking ultrasonography is a non-invasive technique to assess isolated muscle function by evaluating the contractile properties of muscle tissue, i.e. muscle strain. The aim of this study was to investigate whether muscle strain measured by speckle tracking ultrasonography could be a useful quantitative measure of muscle function in patients with multiple sclerosis. The criterion validity of muscle strain was compared to that of validated performance measures of upper and lower extremity function. METHODS This cross-sectional study used baseline data from an explorative observational cohort study (the MUST study). Participants recruited from a hospital outpatient MS clinic underwent speckle tracking ultrasonography of the biceps brachii, supraspinatus, and soleus muscles of the dominant side according to pre-defined submaximal isometric contractions. Participants also completed the Timed 25-Foot Walk Test, the Six Spot Step Test, the 2-minute walking test, the Nine-Hole Peg Test, the 12-item Multiple Sclerosis Walking Scale, and the Oxford Shoulder Score. Gaussian distribution was investigated by visual inspection of normal probability plots and the Shapiro-Wilk test. The Timed 25-Foot Walk Test and Nine-Hole Peg Test were selected as gold standards for function of the lower and upper extremities, respectively. Criterion validity was assessed using Spearman's rank-order correlation coefficient ρ (rho), comparing the muscle strain and performance measures against predefined gold standards. Differences in criterion validity were estimated using squared correlations on the Fischer's Z-scale, with non-parametric bootstrapping to obtain bias-corrected, accelerated bootstrap confidence intervals (95% BCa). RESULTS Criterion validity showed good to excellent correlations between the gold standard for lower extremity function and the 2-minute walking test and Six Spot Step Test, and a fair correlation to the 12-item Multiple Sclerosis Walking Scale. No significant correlation was found between the gold standard for upper extremity function and the performance measure. There were no significant correlations between the gold standards and muscle strain. CONCLUSION The absence of criterion validity for muscle strain alongside fair to strong criterion validity for the performance measures indicates that speckle tracking ultrasonography assessment of muscle strain is either invalid or evaluates other constructs of multiple sclerosis. Muscle strain assessed by speckle tracking ultrasonography cannot be recommended for the evaluation of treatment effects or disease progression in multiple sclerosis.
Collapse
Affiliation(s)
- Maria Thorning
- Department of Neurology, Odense University Hospital, J.B. Winsloews Vej 4, 5000 Odense C, Denmark; Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, J.B. Winsloews Vej 19, 3., 5000 Odense C, Denmark; Department of Neurobiology Research, Department of Molecular Medicine, University of Southern Denmark, J.B. Winsloews Vej 21, st., 5000 Odense C, Denmark; BRIDGE - Brain Research - Inter Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, J.B. Winsloews Vej 19, 3., 5000 Odense C, Denmark.
| | - Kate Lykke Lambertsen
- Department of Neurology, Odense University Hospital, J.B. Winsloews Vej 4, 5000 Odense C, Denmark; Department of Neurobiology Research, Department of Molecular Medicine, University of Southern Denmark, J.B. Winsloews Vej 21, st., 5000 Odense C, Denmark; BRIDGE - Brain Research - Inter Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, J.B. Winsloews Vej 19, 3., 5000 Odense C, Denmark
| | - Cecilie Dollerup Skov
- Department of Neurology, Odense University Hospital, J.B. Winsloews Vej 4, 5000 Odense C, Denmark; Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, J.B. Winsloews Vej 19, 3., 5000 Odense C, Denmark
| | - Lars Henrik Frich
- Department of Neurobiology Research, Department of Molecular Medicine, University of Southern Denmark, J.B. Winsloews Vej 21, st., 5000 Odense C, Denmark; Department of Orthopaedics, Hospital Soenderjylland, Kresten Philipsens Vej 15, 6200 Aabenraa, Denmark; Department of Regional Health Research, University of Southern Denmark, J.B Winsloews Vej 19. 3,. 5000 Odense C, Denmark
| | - Henrik Boye Jensen
- Department of Brain and Nerve Diseases, Sygehus Lillebaelt, Sygehusvej 24, 6000, Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, J.B Winsloews Vej 19. 3,. 5000 Odense C, Denmark
| | - Anders Holsgaard-Larsen
- Department of Orthopaedics and Traumatology, Odense University Hospital, J.B. Winsloews Vej 4, 5000 Odense C, Denmark; Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, J.B. Winsloews Vej 19, 3., 5000 Odense C, Denmark
| | - Helle Hvilsted Nielsen
- Department of Neurology, Odense University Hospital, J.B. Winsloews Vej 4, 5000 Odense C, Denmark; Department of Neurobiology Research, Department of Molecular Medicine, University of Southern Denmark, J.B. Winsloews Vej 21, st., 5000 Odense C, Denmark; BRIDGE - Brain Research - Inter Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, J.B. Winsloews Vej 19, 3., 5000 Odense C, Denmark
| |
Collapse
|
3
|
Van Laethem D, Van de Steen F, Kos D, Naeyaert M, Van Schuerbeek P, D’Haeseleer M, D’Hooghe MB, Van Schependom J, Nagels G. Cognitive-motor telerehabilitation in multiple sclerosis (CoMoTeMS): study protocol for a randomised controlled trial. Trials 2022; 23:778. [PMID: 36104820 PMCID: PMC9473474 DOI: 10.1186/s13063-022-06697-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/27/2022] [Indexed: 11/30/2022] Open
Abstract
Background The management of cognitive impairment is an important goal in the treatment of multiple sclerosis (MS). While cognitive rehabilitation has been proven to be effective in improving cognitive performance in MS, research in the elderly indicates a higher effectiveness of combined cognitive-motor rehabilitation. Here, we present the protocol of a randomised controlled clinical trial to assess whether a combined cognitive-motor telerehabilitation programme is more effective in improving working memory than only cognitive or motor training. Methods/design The CoMoTeMS-trial is a two-centre, randomised, controlled and blinded clinical trial. A total of 90 patients with MS will receive 12 weeks of either a combined cognitive-motor telerehabilitation programme or only cognitive or motor training. The primary outcome is a change in the digit span backwards. Secondary outcomes are other cognitive changes (Brief International Cognitive Assessment for Multiple Sclerosis and Backward Corsi), Expanded Disability Status Scale (EDSS), 6-Min Walk Test, 25-Foot Walk Test, 9-Hole Peg Test, anxiety and depression, fatigue, quality of life, cognitive and physical activity level, electroencephalography and magnetic resonance imaging of the brain. Discussion We hypothesise that the improvement in digit span backwards after 12 weeks of treatment will be significantly higher in the group treated with the combined cognitive-motor telerehabilitation programme, compared to the groups receiving only cognitive and only motor training. Trial registration ClinicalTrials.gov NCT05355389. Registered on 2 May 2022. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06697-9.
Collapse
|
4
|
Study Protocol: Strategies and Techniques for the Rehabilitation of Cognitive and Motor Deficits in Patients with Multiple Sclerosis. NEUROSCI 2022. [DOI: 10.3390/neurosci3030029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
MS clinical features vary between patients. In approximately 60% of cases, cognitive deficits are associated with motor disabilities, with consequences on both walking and maintaining balance and cognitive efficiency. Multimodal programs are very infrequent for MS patients and cognitive rehabilitation is not provided by the Italian health system, which only favors access to motor rehabilitation. Dual-task studies showed how motor and cognitive skills are closely associated. Therefore, physiotherapy exercises may favor an indirect improvement in cognition. The aim of this study is to understand which rehabilitative approach may increase both cognitive and motor efficiency, avoiding the waste of time and resources. In this multi-site single-blind parallel controlled clinical trial, we will compare three rehabilitative approaches: cognitive training, motor training and combined cognitive–motor training. We also aim to evaluate: whether self-perception and objective improvement correspond; the impact of each rehabilitation program on patients’ QoL, mood and self-perception; and long-term effects. A total of 60 patients will be randomly assigned to one of the three treatments for two 45-min sessions/week for 12 weeks. All participants will undergo a complete cognitive, motor, clinical assessment together with mood, self-perception, and QoL questionnaires before, immediately after and 6 months after the training period.
Collapse
|
5
|
The association between cognition and motor performance is beyond structural damage in relapsing–remitting multiple sclerosis. J Neurol 2022; 269:4213-4221. [DOI: 10.1007/s00415-022-11044-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/24/2022] [Accepted: 02/18/2022] [Indexed: 10/18/2022]
|
6
|
Baird JF, Motl RW. Cognitive Function and Whole-Brain MRI Metrics Are Not Associated with Mobility in Older Adults with Multiple Sclerosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084232. [PMID: 33923592 PMCID: PMC8073870 DOI: 10.3390/ijerph18084232] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/08/2021] [Accepted: 04/14/2021] [Indexed: 11/16/2022]
Abstract
Due to advances in disease-modifying medications and earlier management of comorbidities, adults with multiple sclerosis (MS) are living longer, and this coincides with the aging of the general population. One major problem among older adults with and without MS is limited mobility, a consequence of aging that often negatively affects quality of life. Identifying factors that contribute to mobility disability is needed to develop targeted rehabilitation approaches. This study examined cognitive processing speed and global brain atrophy as factors that may contribute to mobility disability in older adults with and without MS. Older adults (≥55 years) with MS (n = 31) and age- and sex-matched controls (n = 22) completed measures of mobility (Short Physical Performance Battery) and cognitive processing speed (Symbol Digit Modalities Test) and underwent an MRI to obtain whole-brain metrics (gray matter volume, white matter volume, ventricular volume) as markers of atrophy. Mobility was significantly worse in the MS group than in the control group (p = 0.004). Spearman correlations indicated that neither cognitive processing speed (MS: rs = 0.26; Control: rs = 0.08) nor markers of global brain atrophy (MS: rs range = −0.30 to −0.06; Control: rs range = −0.40 to 0.16) were significantly associated with mobility in either group. Other factors such as subcortical gray matter structures, functional connectivity, exercise/physical activity, and cardiovascular fitness should be examined as factors that may influence mobility in aging adults with and without MS.
Collapse
Affiliation(s)
- Jessica F. Baird
- Correspondence: (J.F.B.); (R.W.M.); Tel.: +1-205-934-5905 (R.W.M.)
| | - Robert W. Motl
- Correspondence: (J.F.B.); (R.W.M.); Tel.: +1-205-934-5905 (R.W.M.)
| |
Collapse
|
7
|
Sandroff BM, Silveira SL, Baird JF, Huynh T, Motl RW. Cognitive Processing Speed Impairment Does Not Influence the Construct Validity of Six-Spot Step Test Performance in People With Multiple Sclerosis. Phys Ther 2020; 101:6054188. [PMID: 33373454 PMCID: PMC7910025 DOI: 10.1093/ptj/pzaa227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 08/20/2020] [Accepted: 11/29/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVE There is evidence supporting the construct validity of Six-Spot Step Test (SSST) performance as a functional mobility measure in people with multiple sclerosis (MS); however, it is unknown if cognitive processing speed impairment confounds the construct validity of SSST performance in MS, as this test seemingly requires intact cognitive processing. The objective of this study was to examine the influence of cognitive processing speed impairment on the construct validity and precision of SSST performance as a functional mobility measure in MS. METHODS Participants (N = 213) completed the SSST, timed 25-foot walk, 6-Minute Walk Test, Timed "Up and Go" Test, Multiple Sclerosis Walking Scale-12, device-measured steps per day, and Late-Life Function and Disability Inventory, Patient-Determined Disease Steps, and the Symbol-Digit Modalities Test as a cognitive processing speed measure. The overall sample was divided into subsamples with (n = 75) and without (n = 138) cognitive processing speed impairment based on normative Symbol-Digit Modalities Test data. Correlations between SSST performance with other mobility outcomes in the overall sample and cognitive processing speed impairment subsamples were examined and compared. SSST performance was compared relative to other mobility measures for differentiating MS walking function levels in people with and without cognitive processing speed impairment. RESULTS SSST performance was significantly and strongly correlated with most mobility outcomes in the overall sample and cognitive processing speed impairment subsamples. The magnitudes of correlations between SSST performance with most mobility outcomes were not statistically different among subsamples. Cognitive processing speed impairment did not diminish the relative precision of SSST performance for differentiating walking function levels. CONCLUSION The presence of cognitive processing speed impairment is not a source of invalidity or imprecision when interpreting SSST performance as a functional mobility measure among people with MS. IMPACT The SSST is a high-quality endpoint for inclusion in interventions targeting mobility in MS, regardless of cognitive processing speed status. This information is critical for rehabilitation research and clinical practice given that mobility and cognitive impairment are highly prevalent, co-occurring, and disabling in MS.
Collapse
Affiliation(s)
| | - Stephanie L Silveira
- University of Alabama at Birmingham, Department of Physical Therapy, Birmingham, Alabama, USA
| | - Jessica F Baird
- University of Alabama at Birmingham, Department of Physical Therapy, Birmingham, Alabama, USA
| | - Trinh Huynh
- University of Alabama at Birmingham, Department of Physical Therapy, Birmingham, Alabama, USA
| | - Robert W Motl
- University of Alabama at Birmingham, Department of Physical Therapy, Birmingham, Alabama, USA
| |
Collapse
|
8
|
Kalron A, Ehling R, Baert I, Smedal T, Rasova K, Heric-Mansrud A, Elorriage I, Nedeljkovic U, Tachino A, Gargul L, Gusowski K, Cattaneo D, Borgers S, Hebert J, Dalgas U, Feys P. Improving our understanding of the most important items of the Multiple Sclerosis Walking Scale-12 indicating mobility dysfunction: Secondary results from a RIMS multicenter study. Mult Scler Relat Disord 2020; 46:102511. [PMID: 32949848 DOI: 10.1016/j.msard.2020.102511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/08/2020] [Accepted: 09/13/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The 12-item Multiple Sclerosis Walking Scale (MSWS-12) is currently the most widely validated, patient-reported outcome measure assessing patients' perception of the impact of multiple sclerosis (MS) on walking ability. To date, the majority of previous studies investigating the MSWS-12 have focused on the total score despite individual items being potentially informative. Therefore, our objective was to examine the associations between the individual items of the MSWS-12 and mobility and whether these associations depend on disability level. METHODS Participants completed the MSWS-12, Two-Minute Walk Test (2MWT), Timed 25-Foot Walk (T25FW), Timed Up and Go Test (TUG) and the Four Square Step Test (FSST). Subsequently, they were divided into two groups according to their disability level, classified as either "mildly" or "moderately-severely" disabled. The correlation between individual items of the MSWS-12 and clinical measures of mobility were separately examined by Spearman's correlation coefficients; linear regression analyses were performed for each disability group, with/without adjusting for cognition, age and gender. RESULTS 242 people with MS (PwMS), 108 mildly and 134 moderately-severely disabled, were included. Stronger correlations between the MSWS-12 items and mobility tests were found in the mildly disabled compared to the moderately-severely disabled group. The linear regression analysis showed that in the mildly disabled, item 9 (use of support outdoors) explained 35.4%, 30.8%, and 23.7% of the variance related to the 2MWT, T25FW and TUG, respectively. As for the moderately-severely disabled, the linear regression analysis presented a model which included item 8 (use of support indoors), explaining 31.6%, 18.0%, 20.2% and 9.5% of the variance related to the 2MWT, T25FWT, TUG and FSST, respectively. CONCLUSIONS Items 8 and 9 of the MSWS-12 focusing on the patient's use of walking support in and outdoors, provide a robust indicator of mobility capabilities for mildly and moderately-severely disabled PwMS.
Collapse
Affiliation(s)
- Alon Kalron
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel; Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Israel.
| | - Rainer Ehling
- Department of Neurology, Clinic for Rehabilitation Münster, Münster, Austria; Karl Landsteiner Institut für Interdisziplinäre Forschung am Reha Zentrum Münster, Münster, Austria
| | - Ilse Baert
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine & Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Tori Smedal
- Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, and Department of Physiotherapy, Haukeland University Hospital, Bergen, Norway
| | - Kamila Rasova
- Department of Rehabilitation, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Iratxe Elorriage
- Association of Multiple Sclerosis of Biscay (ADEMBI), Bilbao, Spain
| | - Una Nedeljkovic
- Clinic of Physical Medicine and Rehabilitation, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Andrea Tachino
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Leszek Gargul
- John Paul II Rehabilitation Centre for People with Multiple Sclerosis, Borne Sulinowo, Poland
| | - Klaus Gusowski
- Neurological Rehabilitation Centre Quellenhof, Sana AG, Germany
| | - Davide Cattaneo
- LaRiCE Lab: Gait and Balance Disorders Laboratory, Don Gnocchi Foundation I.R.C.C.S, Milan, Italy
| | | | - Jeffrey Hebert
- School of Medicine, University of Colorado Anschutz Medical Campus, United States
| | - Ulrik Dalgas
- The Research Unit in Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Peter Feys
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| |
Collapse
|
9
|
Motl RW, Sandroff BM, Benedict RH, Hubbard EA, Pilutti LA, Sutton BP. Do subcortical gray matter volumes and aerobic capacity account for cognitive-motor coupling in multiple sclerosis? Mult Scler 2020; 27:401-409. [PMID: 32228278 DOI: 10.1177/1352458520914822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is evidence of cognitive-motor coupling in multiple sclerosis (MS) such that the slowing of cognitive processing speed correlates with the worsening of walking speed and endurance. OBJECTIVE The current study first established the presence of cognitive-motor coupling and second examined the possibility that volumes of subcortical gray matter (SGM) structures and aerobic capacity might explain the coupling of cognitive and motor functions in persons with MS. METHODS We included data from 62 persons with clinically definite MS who underwent assessments of cognitive processing speed, walking performance, and aerobic capacity, and completed magnetic resonance imaging (MRI) within 7 days of the aforementioned assessments. RESULTS The strong correlations between cognitive processing speed and walking performance were attenuated in magnitude and not statistically significant when controlling for aerobic capacity alone and aerobic capacity and SGM volumes together. The associations between cognitive processing speed and walking performance remained statistically significant when controlling for SGM volumes alone. CONCLUSION Aerobic capacity may be an important target for neurorehabilitation-based approaches for managing co-occurring cognitive and motor dysfunction in MS.
Collapse
Affiliation(s)
- Robert W Motl
- Department of Physical Therapy, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brian M Sandroff
- Department of Physical Therapy, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ralph Hb Benedict
- Department of Neurology, University at Buffalo, The State University of New York, New York, NY, USA
| | | | - Lara A Pilutti
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Bradley P Sutton
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| |
Collapse
|
10
|
The Intersection of Physical Function, Cognitive Performance, Aging, and Multiple Sclerosis: A Cross-sectional Comparative Study. Cogn Behav Neurol 2019; 32:1-10. [PMID: 30896571 DOI: 10.1097/wnn.0000000000000179] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the associations between physical function (walking speed and endurance and functional mobility) and cognitive function (information processing speed and verbal memory) in older adults with multiple sclerosis (MS) and healthy controls. BACKGROUND Older adults with MS have worse physical and cognitive function than older adults without MS and young and middle-aged adults with MS. To date, little is known about the associations between, or coupling of, physical and cognitive function outcomes in older adults with MS. METHODS We administered physical and cognitive function measures to 40 older adults with MS and 40 demographically matched healthy controls. Pearson product moment correlations were used to examine bivariate linear relationships in the overall sample and in the subsamples of (a) older adults with MS and (b) healthy controls. Linear regression analyses were used to examine the independent associations between demographic characteristics and physical and cognitive function variables in the two subsamples. RESULTS In the overall sample, all physical function variables were significantly correlated with cognitive function, as measured by information processing speed, and these correlations were mainly due to the subsample of older adults with MS. The linear regression analyses further indicated that information processing speed and years of education consistently explained variance in all physical function variables, beyond the influence of demographic variables, in older adults with MS. CONCLUSIONS Physical function and information processing speed are strongly correlated in older adults with MS. Future research should examine underlying neurobehavioral mechanisms associated with physical and cognitive function as well as behavioral strategies for jointly improving these functions in older adults with MS.
Collapse
|
11
|
Satchidanand N, Drake A, Smerbeck A, Hojnacki D, Kolb C, Patrick K, Weinstock-Guttman B, Motl R, Benedict RHB. Dalfampridine benefits ambulation but not cognition in multiple sclerosis. Mult Scler 2018; 26:91-98. [DOI: 10.1177/1352458518815795] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: Impaired cognition and ambulation are common in multiple sclerosis (MS). Dalfampridine is the first Food and Drug Administration (FDA)–approved medication to treat impaired ambulation in MS. Dalfampridine may benefit patients with cognitive impairment, given its effects on saltatory conduction and the association between cognitive and motor function. Objective: To examine the effects of dalfampridine on cognition in MS. To determine if the anticipated improved cognition is grounded in dalfampridine’s effects on ambulation. Methods: Adults with MS were randomized to dalfampridine ( n = 45) or placebo ( n = 16) for 12 weeks. Cognition and motor function were assessed at baseline and end-point. Results: T25FW and 6-minute walk (6MW) performance improved at end-point in the treatment group but not in the placebo group ( p < 0.05). Our primary outcome, performance on the Symbol Digit Modalities Test, did not improve. About 30% ( n = 12) of the dalfampridine group demonstrated ⩾20% improved ambulation and were categorized “responders.” Among “responders”, Symbol Digit Modalities test performance did not improve. However, performance on the Paced Auditory Serial Addition Test improved among “responders” ( p < 0.05). Conclusion: Dalfampridine benefits timed ambulation but not cognition. Some improvement among ambulation “responders” is consistent with prior reports of cognition-motor coupling in MS ( ClinicalTrials.gov #: NCT02006160).
Collapse
Affiliation(s)
- Nikhil Satchidanand
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Allison Drake
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - A Smerbeck
- Rochester Institute of Technology, Rochester, NY, USA
| | - David Hojnacki
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Channa Kolb
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Kara Patrick
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Robert Motl
- Department of Physical Therapy, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ralph HB Benedict
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| |
Collapse
|
12
|
Ahn C, Fang X, Silverman P, Zhang Z. A quantitative method for measuring the relationship between an objective endpoint and patient reported outcome measures. PLoS One 2018; 13:e0205845. [PMID: 30359417 PMCID: PMC6201893 DOI: 10.1371/journal.pone.0205845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 10/02/2018] [Indexed: 12/02/2022] Open
Abstract
Patient reported outcome measures (PROMs) become increasingly important for assessing the effectiveness of a drug or medical device. In order for a PROM to be claimed in labeling, the PROM has to be valid, reliable and able to detect a change if the targeted disease status changes. One approach to assess the quality of a patient reported outcome measure (PROM) is to investigate the association between the PROM and an objective clinical endpoint measuring the status of a disease/condition. However, methods assessing the association between continuous and discrete variables are limited, especially for correlated measurements. In this paper, we propose a method to assess such association with any type of samples with or without correlation. The method involves estimating the probability revealing the status of a subject’s disease/condition (called truth thereafter) through the subject’s reported outcomes. The probability is a conditional probability revealing truth given the relative location of the subject’s objective outcome compared to the subject-specific latent threshold in the objective endpoint. A consistent estimator for the probability is derived. The operating characteristics of the consistent estimator are illustrated using simulation. Our method is applied to hypothetical clinical trial data generated for an ophthalmic device as an illustration.
Collapse
Affiliation(s)
- Chul Ahn
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Xin Fang
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland, United States of America
- * E-mail:
| | - Phyllis Silverman
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Zhiwei Zhang
- Department of Statistics, University of California, Riverside, CA, United States of America
| |
Collapse
|
13
|
Motl RW, Sandroff BM, McAuley E. Naturally occurring change in Multiple Sclerosis Walking Scale-12 scores over time in multiple sclerosis. Neurodegener Dis Manag 2018; 8:315-322. [PMID: 30226109 DOI: 10.2217/nmt-2018-0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM This study examined the trajectory and pattern of naturally occurring change in perceived walking impairment over a 30-month period in relapsing-remitting multiple sclerosis (RRMS). PATIENTS & METHODS Two hundred and sixty-nine persons with RRMS completed the 12-item Multiple Sclerosis Walking Scale (MSWS-12) every 6 months over a 30-month period. Data were analyzed using latent growth curve modeling and latent class growth curve modeling. RESULTS Latent growth curve modeling demonstrated that a linear trajectory adequately described the group-level pattern of change in MSWS-12 scores over time. Latent class growth curve modeling supported a three-class model for describing the heterogeneity of changes in MSWS-12 scores over time. CONCLUSION Walking impairment does change over time in RRMS, and this can be described by three patterns of change trajectories that differed based on initial status of walking impairment.
Collapse
Affiliation(s)
- Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA 35294
| | - Brian M Sandroff
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA 35294
| | - Edward McAuley
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA 61801
| |
Collapse
|
14
|
Langeskov-Christensen D, Feys P, Baert I, Riemenschneider M, Stenager E, Dalgas U. Performed and perceived walking ability in relation to the Expanded Disability Status Scale in persons with multiple sclerosis. J Neurol Sci 2017; 382:131-136. [DOI: 10.1016/j.jns.2017.09.049] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/06/2017] [Accepted: 09/30/2017] [Indexed: 11/28/2022]
|
15
|
Motl RW, Cohen JA, Benedict R, Phillips G, LaRocca N, Hudson LD, Rudick R. Validity of the timed 25-foot walk as an ambulatory performance outcome measure for multiple sclerosis. Mult Scler 2017; 23:704-710. [PMID: 28206828 PMCID: PMC5405807 DOI: 10.1177/1352458517690823] [Citation(s) in RCA: 250] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Multiple Sclerosis Outcome Assessments Consortium (MSOAC) includes representatives from advocacy organizations, Food and Drug Administration (FDA), European Medicines Agency (EMA), National Institute of Neurological Disorders and Stroke (NINDS), academic institutions, and industry partners along with persons living with multiple sclerosis (MS). One of the MSOAC goals is acceptance and qualification by regulators of performance outcomes that are highly reliable and valid, practical, cost-effective, and meaningful in MS. This article addresses the history, application, and psychometric properties of one such MSOAC metric of ambulation or walking namely, the timed 25-foot walk (T25FW). The T25FW has strong reliability over both brief and long periods of time in MS across a large range of disability levels. The outcome of walking speed from the T25FW has obvious real-world relevance and has correlated strongly with other measures of walking and lower extremity function. The T25FW is responsive for capturing intervention effects in pharmacological and rehabilitation trials and has an established value for capturing clinically meaningful change in ambulation. Directions for future research involve validating clinically meaningful improvements on the T25FW as well as determining whether 20% change is clinically meaningful across the disability spectrum. Researchers might further consider synchronizing accelerometers and motion sensors with the T25FW for capturing walking speed in everyday life and the patient's real environment.
Collapse
Affiliation(s)
- Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeffrey A Cohen
- Mellen Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ralph Benedict
- Department of Neurology, University at Buffalo, Buffalo, NY, USA
| | | | | | | | | | -
- Multiple Sclerosis Outcome Assessments Consortium (MSOAC), Critical Path Institute, Tucson, AZ, USA
| |
Collapse
|
16
|
Costa SL, Genova HM, DeLuca J, Chiaravalloti ND. Information processing speed in multiple sclerosis: Past, present, and future. Mult Scler 2016; 23:772-789. [PMID: 27207446 DOI: 10.1177/1352458516645869] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Information processing speed (IPS) is a prevalent cognitive impairment in multiple sclerosis (MS). OBJECTIVES This review aims to summarize the methods applied to assess IPS in MS and its theoretical conceptualization. A PubMed search was performed to select articles published between 1 January 2004 and 31 December 2013, resulting in 157 articles included. RESULTS The majority (54%) of studies assessed IPS with heterogeneous samples (several disease courses). Studies often report controlling for presence of other neurological disorders (60.5%), age (58.6%), education (51.6%), alcohol history (47.8%), or use of steroids (39.5%). Potential confounding variables, such as recent relapses (50.3%), history of developmental disorders (19.1%), and visual problems (29.9%), were often neglected. Assessments used to study IPS were heterogeneous (ranging from simple to complex tasks) among the studies under review, with 62 different tasks used. Only 9.6% of articles defined the construct of IPS and 22.3% discussed IPS in relation to a theoretical model. FUTURE DIRECTIONS The challenges for the upcoming decade include clarification of the definition of IPS as well as its theoretical conceptualization and a consensus on assessment. Based on the results obtained, we propose a new theoretical model, the tri-factor model of IPS.
Collapse
Affiliation(s)
- Silvana L Costa
- Neuropsychology & Neuroscience Laboratory, Kessler Foundation, West Orange, NJ, USA/Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Helen M Genova
- Neuropsychology & Neuroscience Laboratory, Kessler Foundation, West Orange, NJ, USA/Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - John DeLuca
- Neuropsychology & Neuroscience Laboratory, Kessler Foundation, West Orange, NJ, USA/Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA/Department of Neurology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Nancy D Chiaravalloti
- Neuropsychology & Neuroscience Laboratory, Kessler Foundation, West Orange, NJ, USA/Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| |
Collapse
|
17
|
Motl RW, Zivadinov R, Bergsland N, Benedict RHB. Thalamus volume and ambulation in multiple sclerosis: a cross-sectional study. Neurodegener Dis Manag 2016; 6:23-9. [DOI: 10.2217/nmt.15.71] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This cross-sectional study examined if subcortical gray matter (SGM) structures accounted for differences in timed 25-foot walk (T25FW) speed between multiple sclerosis (MS) patients and controls. Methods: Subjects underwent brain MRI and completed the T25FW. Volumes of the thalamus, caudate, putamen and pallidum were calculated from 3D T1-weighted structural brain images. T2 lesion volume (T2LV) was determined by using a semiautomated edge detection contouring-thresholding technique. Results: There were differences in T25FW speed, SGM volumes and T2LV between MS and controls. T25FW speed was associated with SGM volumes and T2LV in MS and controls. Thalamic volume partially accounted for the difference in T25FW speed between the MS and controls. Conclusion: The reduction of thalamus volume is associated with compromised ambulation in MS patients.
Collapse
Affiliation(s)
- Robert W Motl
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine & Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14214, USA
- MR Imaging Clinical Translational Research Center, School of Medicine & Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14214, USA
| | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine & Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14214, USA
- IRCCS ‘Santa Maria Nascente’, Don Gnocchi Foundation, Milan, Italy
| | - Ralph HB Benedict
- Department of Neurology, School of Medicine & Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14214, USA
| |
Collapse
|
18
|
Motl RW, Sandroff BM, DeLuca J. Exercise Training and Cognitive Rehabilitation. Neurorehabil Neural Repair 2015; 30:499-511. [DOI: 10.1177/1545968315606993] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The current review develops a rationale and framework for examining the independent and combined effects of exercise training and cognitive rehabilitation on walking and cognitive functions in persons with multiple sclerosis (MS). To do so, we first review evidence for improvements in walking and cognitive outcomes with exercise training and cognitive rehabilitation in MS. We then review evidence regarding cognitive–motor coupling and possible cross-modality transfer effects of exercise training and cognitive rehabilitation. We lastly present a macro-level framework for considering mechanisms that might explain improvements in walking and cognitive dysfunction with exercise and cognitive rehabilitation individually and combined in MS. We conclude that researchers should consider examining the effects of exercise training and cognitive rehabilitation on walking, cognition, and cognitive–motor interactions in MS and the possible physiological and central mechanisms for improving these functions.
Collapse
Affiliation(s)
- Robert W. Motl
- University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | | | - John DeLuca
- Kessler Foundation, West Orange, NJ, USA
- Rutgers, New Jersey Medical School, Newark, NJ, USA
| |
Collapse
|
19
|
Longitudinal changes in self-reported walking ability in multiple sclerosis. PLoS One 2015; 10:e0125002. [PMID: 25932911 PMCID: PMC4416760 DOI: 10.1371/journal.pone.0125002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 03/19/2015] [Indexed: 12/03/2022] Open
Abstract
Background Patient-reported outcomes are increasingly used to understand the clinical meaningfulness of multiple sclerosis disability and its treatments. For example, the 12-item Multiple Sclerosis Walking Scale (MSWS-12) measures the patient-reported impact of the disease on walking ability. Objective We studied longitudinal changes in walking ability using the MSWS-12 in a cohort of 108 patients with relapsing-remitting multiple sclerosis and moderate-to-severe disability from a single US center cohort study investigating multiple sclerosis symptoms and physical activity. Methods The MSWS-12 was completed every 6 months over 2 years together with self-reported measures of disease impact on daily life (Multiple Sclerosis Impact Scale) and walking disability (Patient Determined Disease Steps scale). Results The results revealed a high frequency of self-reported changes in walking ability at the individual level, affecting approximately 80% of patients for all four time periods. MSWS-12 scores remained stable at the group level for all four time periods. The magnitude of observed changes at the individual level was higher than the proposed minimal clinically important differences of 4 or 6 points and correlated better with Multiple Sclerosis Impact Scale physical scores than psychological scores, but little with self-reported Patient Determined Disease Steps Scale scores. Conclusions This novel finding of frequent fluctuations in self-reported walking ability is new and requires further investigation.
Collapse
|
20
|
Hubbard EA, Motl RW. Sedentary behavior is associated with disability status and walking performance, but not cognitive function, in multiple sclerosis. Appl Physiol Nutr Metab 2015; 40:203-6. [DOI: 10.1139/apnm-2014-0271] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Eighty-two persons with multiple sclerosis wore an accelerometer as a measure of sedentary time (min/day) and completed measures of disability status (self-reported Expanded Disability Status Scale), walking performance (timed 25-foot walk and 6-min walk), and cognitive function (symbol digit modalities test). Accelerometry-measured sedentary time was significantly correlated with disability status scores (r = 0.31, p < 0.01), 6-min walk distance (r = –0.40, p < 0.01), and timed 25-foot walk performance (r = 0.35, p < 0.01), but not cognitive function performance (r = –0.12, p = 0.29).
Collapse
Affiliation(s)
- Elizabeth A. Hubbard
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Robert W. Motl
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| |
Collapse
|