Factors associated with excessive sitting time in multiple sclerosis

Sedentary behaviour and related factors in people with multiple sclerosis

BACKGROUND

Sedentary behaviour is a major problem in persons with multiple sclerosis (pwMS). However, little is known about the related factors of sedentary behaviour in MS. Our study aimed to examine the association between sedentary behaviour and physical activity level, fear of falling, and fatigue.

METHOD

Demographic and clinical data have been recorded. Sedentary behaviour was assessed with the Marshall Sitting Questionnaire, physical activity level was evaluated with the Godin Leisure Time Exercise Questionnaire, fear of falling was evaluated with the Fall Efficacy Scale International, and fatigue was evaluated with the modified fatigue impact scale (MFIS). The Timed 25-Foot Walk, 6-Minute Walk Test, Timed Up and Go Test, and 12-Item Multiple Sclerosis Walking Scale were also used to assess walking and perceived walking disability.

RESULTS

We recruited 71 pwMS [49 were female (69 %), mean age:38.08 years, median EDSS:1.5]. The mean daily sitting time was 593.54 min (∼10 h). No significant correlation was found between sitting times and demographics, leisure time physical activity, fear of falling, walking, perceived walking disability, and neurological disability level (p > 0.05). Logistic regression analysis indicated that being male increased the risk of sedentary behaviour by 3.08 times, being employed increased the risk of sitting by 4.65 times, and each point increase in MFIS scores resulted in a 1.03-fold elevation in the odds of prolonged sitting.

CONCLUSION

The fact that pwMS, even with a mild disability spend almost 10 h sitting highlights the significance of sedentary behaviour in this population. Developing strategies to address modifiable factors, such as fatigue, may be effective in reducing sedentary behaviour.

Perspectives From Persons With Multiple Sclerosis for a Comprehensive Real-World Change Therapy for Mobility

Objective

To assess the personal perspectives of persons with multiple sclerosis (MS) on the acceptability of a novel physical therapy program that is designed to transfer gains from the clinic to their real-world lower extremity (LE) use, termed LE constraint-induced therapy (CIT). The program includes several behavior change techniques (prescribed home exercises, daily structured therapist interviews and problem solving for LE activities, keeping an activity diary) and a concentrated physical treatment schedule.

Design

Anonymous internet survey.

Setting

Participants accessed the survey from computers in the community.

Participants

Five hundred adults (N=500) were recruited from an MS support organization's registry for having indicated from mild to total limb spasticity because they were anticipated to have markedly impaired LE use in the community.

Interventions

Not applicable.

Main Outcome Measures

Participants were offered the options on a nonnumerical Likert scale of “Very likely,” “Likely,” “Neutral,” “Unlikely,” or “Very unlikely” to indicate their personal acceptability for each of 5 different key treatment procedures after these were explained. Totals for each option within each key procedure were analyzed for their acceptability.

Results

Of the 281 persons who responded, 90% expressed interest in participating in LE CIT. A large majority of persons who completed the survey selected either “Very likely” or “Likely” for each key procedure (median=88%, range=65%-90%, P<.01). This indicated strong acceptance for the procedures of LE CIT. In addition, more respondents who already had had previous physical therapy accepted LE CIT than did respondents who had not had physical therapy (P<.01).

Conclusions

The results suggest there is strong acceptance of CIT for mobility with preliminary evidence of benefiting community LE use for persons with MS. The results support further clinical trials of LE CIT for persons with MS.

COVID-19 vaccine hesitancy in multiple sclerosis: A cross-sectional survey

BACKGROUND

Vaccine willingness among people living with multiple sclerosis (PwMS) requires assessment following the approval of the first COVID-19 vaccines, since there remains uncertainty on multiple aspects of COVID-19 vaccination in immunosuppressed patients.

OBJECTIVE

To understand COVID-19 and influenza vaccine willingness and its associations among PwMS, following the approval of the first two mRNA COVID-19 vaccines.

METHODS

A survey was distributed to PwMS via an online platform from December 2020 to February 2021. Logistic regression models were constructed to determine the relationship between (1) COVID-19 and (2) influenza vaccination willingness with demographic and clinical characteristics.

RESULTS

Of 701 responding PwMS, 76.6% were COVID-19 vaccine willing. COVID-19 vaccine willingness was significantly associated with influenza vaccine willingness (p < 0.001). In multivariable models, older age increased the odds of COVID-19 and influenza vaccine willingness (odds ratios (ORs) > 1) and other race decreased the odds of COVID-19 and influenza vaccine willingness (ORs < 1); higher functional disability decreased the odds of COVID-19 vaccine willingness (OR = 0.88, 95% confidence interval = 0.80-0.96). Prevalent vaccine-related concerns include safety (n = 244) and efficacy (n = 122).

CONCLUSION

Our findings identify demographic and clinical factors as well as concerns influencing vaccine hesitancy in PwMS. These results may inform effective public health interventions to improve vaccine acceptability in this at-risk group.

Comparison of sedentary behaviour questionnaires in people with multiple sclerosis

Background: People with multiple sclerosis are at risk of developing co-morbidities associated with sedentary behaviour. Despite an increase in studies examining sedentary behaviour in multiple sclerosis, researchers have not yet examined the appropriateness of the content or format of questionnaires assessing sedentary behaviour in multiple sclerosis.Objective: Evaluate perceptions of sedentary behaviour questionnaires for people with multiple sclerosis.Methods: Fifteen people with multiple sclerosis completed six validated sedentary behaviour questionnaires: Longitudinal Ageing Study Amsterdam, Marshall Sitting Questionnaire, International Physical Activity Questionnaire, Measure of Older Adults Sedentary Time, Sedentary Behaviour Questionnaire and SIT-Q. Participants' perceptions regarding questionnaire content and format were explored by interviews.Results: Self-reported sedentary time ranged between a mean of 470 (standard deviation 260) (Measure of Older Adults Sedentary Time) and 782 (322) min (Longitudinal Ageing Study Amsterdam) per weekday. Analysis of variance revealed a significant effect of questionnaire on mean sitting time: Longitudinal Ageing Study Amsterdam and SIT-Q yielded higher mean estimates of weekday sitting time than other questionnaires. The questionnaires were viewed as being suitable for use in multiple sclerosis but failed to capture some sedentary activities. Variability of symptoms yielded difficulties in describing a "typical day".Conclusions: The questionnaires were considered suitable for multiple sclerosis but produced variation in estimated sedentary time. Future work might validate questionnaire data with device-based assessments of sedentary time.Implications for rehabilitationSelf-reported sitting time ranged from 7.8 to 13.0 h per day in people with multiple sclerosis.Sedentary behaviour questionnaires are suitable for multiple sclerosis but yield variable estimates of sitting time.Watching television was the most prevalent sedentary activity and may have implications for interventions that break up sedentary time.

Validity of the Marshall Sitting Questionnaire in people with multiple sclerosis

This study examines the validity of the Marshall Sitting Questionnaire (MSQ) in people with multiple sclerosis (MS) and presents a prediction model to improve the accuracy of the MSQ estimates. Participants (n = 63 [15M and 48F], age: 56.6 ± 7.3 years) wore an accelerometer on the hip for a 7-day period and completed the MSQ. Sedentary behaviour (SB) estimates were computed as min/day for both the MSQ and accelerometer. Associations between the two methods were examined using the Pearson correlation and agreement was assessed using a Bland-Altman plot. A linear prediction model was developed to improve the accuracy of the MSQ estimates using a selection of predictor variables routinely collected in MS research. There was a moderate correlation between MSQ and accelerometer SB estimates (r = 0.34, p < 0.01). The Bland-Altman plot indicated that the MSQ overestimated SB (mean bias: 80.54 min/day, 95% limits of agreement: -410.5 to 571.5 min/day). The prediction model improved the MSQ estimates by 39% and virtually eliminated measurement bias (mean bias:-0.21 min/day; 95% limits of agreement:-109.8 to 109.4 min/day). The results indicate preliminary evidence for the validity of the MSQ in people with MS, and support the application of an alternative prediction model to improve the accuracy of the MSQ estimates. Abbreviations: SB = sedentary behaviour; MS = multiple sclerosis; MSQ = Marshall Sitting Questionnaire; PA = physical activity; EDSS = Expanded Disability Status Scale; LPA = light physical activity; MVPA = moderate-to-vigorous physical activity; GLTEQ = Godin Leisure Time Exercise Questionnaire; PDDS = Patient-Determined Disease Steps; RMSE = root mean square error.