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Podda J, Marchesi G, Bellosta A, Squeri V, De Luca A, Pedullà L, Tacchino A, Brichetto G. Testing Dynamic Balance in People with Multiple Sclerosis: A Correlational Study between Standard Posturography and Robotic-Assistive Device. SENSORS (BASEL, SWITZERLAND) 2024; 24:3325. [PMID: 38894116 PMCID: PMC11174503 DOI: 10.3390/s24113325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/17/2024] [Accepted: 05/21/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Robotic devices are known to provide pivotal parameters to assess motor functions in Multiple Sclerosis (MS) as dynamic balance. However, there is still a lack of validation studies comparing innovative technologies with standard solutions. Thus, this study's aim was to compare the postural assessment of fifty people with MS (PwMS) during dynamic tasks performed with the gold standard EquiTest® and the robotic platform hunova®, using Center of Pressure (COP)-related parameters and global balance indexes. METHODS Pearson's ρ correlations were run for each COP-related measure and the global balance index was computed from EquiTest® and hunova® in both open (EO) and closed-eyes (EC) conditions. RESULTS Considering COP-related parameters, all correlations were significant in both EO (0.337 ≤ ρ ≤ 0.653) and EC (0.344 ≤ ρ ≤ 0.668). Furthermore, Pearson's analysis of global balance indexes revealed relatively strong for visual and vestibular, and strong for somatosensory system associations (ρ = 0.573; ρ = 0.494; ρ = 0.710, respectively). CONCLUSIONS Findings confirm the use of hunova® as a valid device for dynamic balance assessment in MS, suggesting that such a robotic platform could allow for a more sensitive assessment of balance over time, and thus a better evaluation of the effectiveness of personalized treatment, thereby improving evidence-based clinical practice.
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Affiliation(s)
- Jessica Podda
- Italian Multiple Sclerosis Foundation, 16149 Genoa, Italy; (J.P.); (L.P.); (G.B.)
| | - Giorgia Marchesi
- Movendo Technology S.R.L, 16149 Genoa, Italy; (G.M.); (V.S.); (A.D.L.)
| | - Alice Bellosta
- Department of Experimental Medicine, University of Genoa, 16126 Genoa, Italy;
| | - Valentina Squeri
- Movendo Technology S.R.L, 16149 Genoa, Italy; (G.M.); (V.S.); (A.D.L.)
| | - Alice De Luca
- Movendo Technology S.R.L, 16149 Genoa, Italy; (G.M.); (V.S.); (A.D.L.)
| | - Ludovico Pedullà
- Italian Multiple Sclerosis Foundation, 16149 Genoa, Italy; (J.P.); (L.P.); (G.B.)
| | - Andrea Tacchino
- Italian Multiple Sclerosis Foundation, 16149 Genoa, Italy; (J.P.); (L.P.); (G.B.)
| | - Giampaolo Brichetto
- Italian Multiple Sclerosis Foundation, 16149 Genoa, Italy; (J.P.); (L.P.); (G.B.)
- AISM Rehabilitation Service, 16149 Genoa, 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] [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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Mañago MM, Cohen ET, Cameron MH, Christiansen CL, Bade M. Reliability, Validity, and Responsiveness of the Patient-Specific Functional Scale for Measuring Mobility-Related Goals in People With Multiple Sclerosis. J Neurol Phys Ther 2023; 47:139-145. [PMID: 36897202 PMCID: PMC10329992 DOI: 10.1097/npt.0000000000000439] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
BACKGROUND AND PURPOSE This study's purpose was to investigate the reliability, validity, and responsiveness of the Patient-Specific Functional Scale (PSFS) for measuring mobility-related goals in people with multiple sclerosis (MS). METHODS Data from 32 participants with MS who underwent 8 to 10 weeks of rehabilitation were analyzed (Expanded Disability Status Scale scores 1.0-7.0). For the PSFS, participants identified 3 mobility-related areas where they had difficulty and rated them at baseline, 10 to 14 days later (before starting intervention), and immediately after intervention. Test-retest reliability and response stability of the PSFS were calculated using the intraclass correlation coefficient (ICC 2,1 ) and minimal detectable change (MDC 95 ), respectively. Concurrent validity of the PSFS was determined with the 12-item Multiple Sclerosis Walking Scale (MSWS-12) and the Timed 25-Foot Walk Test (T25FW). PSFS responsiveness was determined using Cohen's d , and minimal clinically important difference (MCID) was calculated based on patient-reported improvements on a Global Rating of Change (GRoC) scale. RESULTS The PSFS total score demonstrated moderate reliability (ICC 2,1 = 0.70, 95% CI: 0.46 to 0.84) and the MDC was 2.1 points. At baseline, the PSFS was fairly and significantly correlated with the MSWS-12 ( r = -0.46, P = 0.008) but not with the T25FW. Changes in the PSFS were moderately and significantly correlated with the GRoC scale (ρ = 0.63, P < 0.001), but not with MSWS-12 or T25FW changes. The PSFS was responsive ( d = 1.7), and the MCID was 2.5 points or more to identify patient-perceived improvements based on the GRoC scale (sensitivity = 0.85, specificity = 0.76). DISCUSSION AND CONCLUSIONS This study supports the use of the PSFS as an outcome measure in people with MS to assess mobility-related goals.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A423 ).
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Affiliation(s)
- Mark M. Mañago
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
- Department of Neurology, School of Medicine, University of Colorado, Aurora, CO
- Geriatric Research Education and Clinical Center, VA Eastern Colorado Healthcare System, Denver, CO
| | - Evan T. Cohen
- Department of Physical Therapy, Arcadia University, Glenside, PA
| | - Michelle H. Cameron
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, OR
- VA Portland Health Care System, Portland, OR
| | - Cory L. Christiansen
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
- Geriatric Research Education and Clinical Center, VA Eastern Colorado Healthcare System, Denver, CO
| | - Michael Bade
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
- Geriatric Research Education and Clinical Center, VA Eastern Colorado Healthcare System, Denver, CO
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Torchio A, Corrini C, Anastasi D, Parelli R, Meotti M, Spedicato A, Groppo E, D'Arma A, Grosso C, Montesano A, Cattaneo D, Gervasoni E. Identification of modified dynamic gait index cutoff scores for assessing fall risk in people with Parkinson disease, stroke and multiple sclerosis. Gait Posture 2022; 91:1-6. [PMID: 34628216 DOI: 10.1016/j.gaitpost.2021.09.201] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 05/17/2021] [Accepted: 09/29/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Balance and gait impairments increase fall rate and injury in people with neurological disorders(PwND). The modified Dynamic Gait Index(mDGI) is a scale assessing dynamic balance during walking, however its ability in identifying Fallers and Recurrent Fallers has not been studied. RESEARCH QUESTION To evaluate mDGI's ability in identifying retrospective Fallers and Recurrent Fallers establishing cut-off scores for its use in clinical practice. METHOD In this cross-sectional study, the number of retrospective falls and mDGI scores were collected. PwND were categorised as Non-Fallers or Fallers (falls≥1) and as Recurrent Fallers(falls≥2) or Non-Recurrent/Non-Fallers(falls<2) according to their number of retrospective falls over two months. Two generalised linear logistic models were developed using a machine learning method to detect Fallers (Model 1) and Recurrent Fallers (Model 2) based on mDGI scores. ROC curves were used to identify mDGI cut-off scores to distinguish between different fall categories. RESULTS 58 PwND (mean ± standard deviation age: 63.4 ± 12 years) including 28 people with Multiple Sclerosis, 15 people with Parkinson's disease and 15 people with Stroke were analysed. The mDGI score(median (IQR)) for Non-Fallers, Fallers, Recurrent Fallers and Non-Recurrent/Non-Fallers was respectively 50(22), 37(22), 26.5(20.25) and 46.5(20.5)points. The cut-off to identify Fallers from Non-Fallers was 49 points(sensitivity:100 %, specificity:50 %, post-test probability with mDGI ≤ cut-off: 53.2 %, post-test probability with mDGI > cut-off: 0%, AUC:0.68), while 29 points(sensitivity:60 %, specificity:79 %, post-test probability with mDGI ≤ cut-off:52.1 %, post-test probability with mDGI > cut-off:16.1 %, AUC:0.70) was the best cut-off to identify Recurrent Fallers. SIGNIFICANCE People with mDGI score>49 points have low or minimal fall risk, while people with mDGI score≤49 points should be further investigated with other scales before starting a balance-focused rehabilitation intervention. People scoring ≤29 points on the mDGI scale may need a fall prevention intervention, regardless of the results of other balance clinical measures.
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Affiliation(s)
- Alessandro Torchio
- IRCSS Fondazione Don Carlo Gnocchi, Via Capecelatro, 66 - 20148, Milano, Italy
| | - Chiara Corrini
- IRCSS Fondazione Don Carlo Gnocchi, Via Capecelatro, 66 - 20148, Milano, Italy
| | - Denise Anastasi
- IRCSS Fondazione Don Carlo Gnocchi, Via Capecelatro, 66 - 20148, Milano, Italy
| | - Riccardo Parelli
- IRCSS Fondazione Don Carlo Gnocchi, Via Capecelatro, 66 - 20148, Milano, Italy
| | - Matteo Meotti
- IRCSS Fondazione Don Carlo Gnocchi, Via Capecelatro, 66 - 20148, Milano, Italy
| | - Albino Spedicato
- IRCSS Fondazione Don Carlo Gnocchi, Via Capecelatro, 66 - 20148, Milano, Italy
| | - Elisabetta Groppo
- Clinica Neurologica III, Università degli Studi di Milano, Polo Universitario San Paolo, ASST Santi Paolo e Carlo, Via Antonio di Rudinì 8, 20142, Milano, Italy
| | - Alessia D'Arma
- IRCSS Fondazione Don Carlo Gnocchi, Via Capecelatro, 66 - 20148, Milano, Italy
| | - Cristina Grosso
- IRCSS Fondazione Don Carlo Gnocchi, Via Capecelatro, 66 - 20148, Milano, Italy
| | - Angelo Montesano
- IRCSS Fondazione Don Carlo Gnocchi, Via Capecelatro, 66 - 20148, Milano, Italy
| | - Davide Cattaneo
- IRCSS Fondazione Don Carlo Gnocchi, Via Capecelatro, 66 - 20148, Milano, Italy; Department of Physiopathology and Transplants, University of Milan, 20100 Milan, Italy.
| | - Elisa Gervasoni
- IRCSS Fondazione Don Carlo Gnocchi, Via Capecelatro, 66 - 20148, Milano, Italy
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Effects of Virtual Reality vs Conventional Balance Training on Balance and Falls in People With Multiple Sclerosis: A Randomized Controlled Trial. Arch Phys Med Rehabil 2020; 102:290-299. [PMID: 33161005 DOI: 10.1016/j.apmr.2020.09.395] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 09/03/2020] [Accepted: 09/26/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess the efficacy of virtual reality (VR)-based vs conventional balance training on the improvement of balance and reduction of falls in people with multiple sclerosis (PwMS). DESIGN Single-blinded, randomized, controlled trial. SETTING Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences. PARTICIPANTS PwMS (N=39), randomized into VR (n=19) and control (n=20) groups. INTERVENTION The VR group performed exergames using Kinect, while the control group accomplished conventional balance exercises. Both groups received 18 training sessions for 6 weeks. MAIN OUTCOME MEASURES Limits of stability, timed Up and Go (TUG) test, and 10-m walk tests with and without cognitive task and their dual-task costs (DTCs), Berg Balance Scale, Multiple Sclerosis Walking Scale-12, Fall Efficacy Scale-International, Activities-specific Balance Confidence Scale, and fall history were obtained pre- and post intervention and after a 3-month follow-up. RESULTS At both post intervention and follow-up, TUGcognitive and DTCs on the TUG were significantly lower and the 10-m walkcognitive was significantly higher in the VR group. At follow-up, reaction time and the number of falls demonstrated significant differences favoring the VR group, whereas the directional control revealed significant difference in favor of the control group (P<.05). The other outcomes showed no statistically significant difference at post intervention or follow-up. CONCLUSIONS Both the VR-based and conventional balance exercises improved balance and mobility in PwMS, while each acted better in improving certain aspects. VR-based training was more efficacious in enhancing cognitive-motor function and reducing falls, whereas conventional exercises led to better directional control. Further studies are needed to confirm the effectiveness of recruiting VR-based exercises in clinical settings.
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Hsieh KL, Mirelman A, Shema-Shiratzky S, Galperin I, Regev K, Shen S, Schmitz-Hübsch T, Karni A, Paul F, Devos H, Sosnoff JJ, Hausdorff JM. A multi-modal virtual reality treadmill intervention for enhancing mobility and cognitive function in people with multiple sclerosis: Protocol for a randomized controlled trial. Contemp Clin Trials 2020; 97:106122. [PMID: 32858229 DOI: 10.1016/j.cct.2020.106122] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/25/2020] [Accepted: 07/06/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Gait and cognitive impairments are common in individuals with Multiple Sclerosis (MS) and can interfere with everyday function. Those with MS have difficulties executing cognitive tasks and walking simultaneously, a reflection of dual-task interference. Therefore, dual-task training may improve functional ambulation. Additionally, using technology such as virtual reality can provide personalized rehabilitation while mimicking real-world environments. The purpose of this randomized controlled trial is to establish the benefits of a combined cognitive-motor virtual reality training on MS symptoms compared to conventional treadmill training. METHODS This study will be a single-blinded, two arm RCT with a six-week intervention period. 144 people with MS will be randomized into a treadmill training alone group or treadmill training with virtual reality group. Both groups will receive 18 sessions of training while walking on a treadmill, with the virtual reality group receiving feedback from the virtual system. Primary outcome measures include dual-task gait speed and information processing speed, which will be measured prior to training, one-week post-training, and three months following training. DISCUSSION This study will provide insight into the ability of a multi-modal cognitive-motor intervention to reduce dual-task cost and to enhance information processing speed in those with MS. This is one of the first studies that is powered to understand whether targeted dual-task training can improve MS symptoms and increase functional ambulation. We anticipate that those in the virtual reality group will have a significantly greater increase in dual-task gait speed and information processing speed than those achieved via treadmill training alone.
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Affiliation(s)
- K L Hsieh
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA; Illinois Multiple Sclerosis Research Collaborative, Interdisciplinary Health Science Institute, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - A Mirelman
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Shema-Shiratzky
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - I Galperin
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - K Regev
- Neuroimmunology and Multiple Sclerosis Unit of the Neurology Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - S Shen
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - T Schmitz-Hübsch
- NeuroCure, Charité - Universitaetsmedizin Berlin, Berlin, Germany; Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - A Karni
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Neuroimmunology and Multiple Sclerosis Unit of the Neurology Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - F Paul
- NeuroCure, Charité - Universitaetsmedizin Berlin, Berlin, Germany; Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitaetsmedizin Berlin, Berlin, Germany; Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - H Devos
- Laboratory for Advanced Rehabilitation Research in Simulation, Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - J J Sosnoff
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA; Illinois Multiple Sclerosis Research Collaborative, Interdisciplinary Health Science Institute, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - J M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
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Monjezi S, Molhemi F, Shaterzadeh Yazdi MJ, Salehi R, Mehravar M, Kashipazha D. Responsiveness and clinically meaningful changes for the Persian versions of the multiple sclerosis walking scale-12 and the modified fatigue impact scale following balance and gait rehabilitation in people with multiple sclerosis. Physiother Theory Pract 2020; 38:464-470. [PMID: 32431220 DOI: 10.1080/09593985.2020.1762267] [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] [Indexed: 10/24/2022]
Abstract
Background and Purpose: The Multiple sclerosis walking scale-12 (MSWS-12) and the Modified Fatigue Impact Scale (MFIS) are two popular outcome measures applied widely for assessing self-perceived walking ability and fatigue in people with multiple sclerosis (PwMS). The present study aimed to examine responsiveness and clinically meaningful changes for the Persian versions of the MSWS-12 and the MFIS following balance and gait rehabilitation in PwMS.Methods: Fifty-eight PwMS completed the Persian versions of the MSWS-12 and the MFIS before and after 4 weeks of balance and gait rehabilitation. Also, a 7-point global rating scale as an external criterion of change was completed at the post-intervention evaluation. The area under the receiver operating characteristics curve (AUC) and the correlation analysis were used to assess the responsiveness. In addition, the minimally clinically important change (MCIC) was measured to determine clinically meaningful changes following rehabilitation.Results: The AUC values for the Persian MSWS-12 and MFIS were 0.74 and 0.73, respectively. There were good to excellent correlations between the global rating scale of change and the Persian MSWS-12 (Gamma = 0.77) also MFIS (Gamma = 0.80) change scores (p = .001). Moreover, the MCICs of 7.5 and 4 points were obtained for the Persian MSWS-12 and MFIS, respectively.Conclusion: The Persian versions of the MSWS-12 and the MFIS were responsive outcome measures for monitoring changes in walking and fatigue after balance and gait rehabilitation in PwMS. The calculation of MCIC values would enhance the interpretation of changes in clinical and research settings.
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Affiliation(s)
- Saeideh Monjezi
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Farshad Molhemi
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Reza Salehi
- Rehabilitation Research Center, Department of Rehabilitation Management, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mehravar
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Davood Kashipazha
- Department of Neurology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Monjezi S, Negahban H, Tajali S, Mofateh R, Molhemi F, Mostafaee N. Psychometric properties of the Persian-version of the Activities-specific Balance Confidence scale and Fall Efficacy Scale-International in Iranian patients with multiple sclerosis. Physiother Theory Pract 2019; 37:935-944. [PMID: 31455119 DOI: 10.1080/09593985.2019.1658247] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE Balance impairment and fear of falling are two common risk factors for falls in people with multiple sclerosis (PwMS). Clinicians should use valid, reliable, and responsive tools to assess these risk factors and identify individuals at increased risk for falls. So, this study aimed to examine psychometric properties of the Persian-version of the Activities-specific Balance Confidence (ABC) scale and Fall Efficacy Scale-International (FES-I) in Iranian PwMS. METHODS One hundred and fifty-three PwMS completed the Persian versions of ABC, FES-I, Multiple Sclerosis Walking Scale-12 (MSWS-12), and Berg Balance Scale (BBS) in the first session. To assess the test-retest reliability, 50 PwMS filled out ABC, and FES-I in retest session with an interval of 2-7 days. Also, for evaluating responsiveness, 50 PwMS completed ABC and FES-I before and after a 4-week treatment. RESULTS Intra-class Correlation Coefficients were 0.96 and 0.93 and Cronbach's alpha coefficients were 0.96 and 0.99 for the ABC and FES-I, respectively. There were significant correlations (p < .001) between ABC and BBS (r = 0.55), FES-I and BBS (r = -0.56), ABC and MSWS-12 (r = -0.72), and FES-I and MSWS-12 (r = 0.76). No floor or ceiling effect was found. ABC and FES-I had acceptable responsiveness (AUC > 0.70), and their minimally important difference (MID) were 10.5 and 9.5 points, respectively. CONCLUSION The Persian-versions of ABC and FES-I are reliable, valid, and responsive measures to quantify balance confidence and fear of falling in PwMS at both clinical and research settings. The MID can help clinicians to make a decision based on the clinical significance of changes in patients' status.
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Affiliation(s)
- Saeideh Monjezi
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hossein Negahban
- Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.,Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shirin Tajali
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Razieh Mofateh
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Farshad Molhemi
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Neda Mostafaee
- Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
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Feys P, Giovannoni G, Dijsselbloem N, Centonze D, Eelen P, Lykke Andersen S. The importance of a multi-disciplinary perspective and patient activation programmes in MS management. Mult Scler 2018; 22:34-46. [PMID: 27465614 DOI: 10.1177/1352458516650741] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 04/23/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a progressive disease associated with a large variety of symptoms and changing patients' needs during the disease course. In order to provide appropriate care in every disease stage and let patients live their lives to the full, a multi-disciplinary approach and patient activation is needed. OBJECTIVE To summarise the multi-disciplinary perspective of MS, with focus on the organisation of a multi-disciplinary care team and possibilities to support patient activation. METHODS This review reflects the content of the presentations, audience polling results and discussions on the multi-disciplinary perspective of MS during the second Pan-European MS Multi-stakeholder Colloquium. RESULTS In many countries, the neurologist with or without the support of an MS nurse is responsible for the long-term care of MS patients. When needed, they should refer to other (non-)medical specialists. However, the patient should be empowered as well to manage his/her disease and to implement a physically active lifestyle in order to improve treatment outcomes and quality of life. CONCLUSION To create equal access to care for MS patients across Europe, evidence-based standards of care, symptom self-monitoring tools and educational programmes for patients and healthcare professionals including non-medical treatment strategies should be developed at the European level.
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Affiliation(s)
- Peter Feys
- REVAL Rehabilitation Research Centre, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, University of Hasselt, Diepenbeek, Belgium
| | - Gavin Giovannoni
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, UK
| | | | - Diego Centonze
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy/IRCCS Neuromed, Pozzilli, Italy
| | - Piet Eelen
- National Multiple Sclerosis Centre, Melsbroek, Belgium
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Nilsagård Y, Carling A, Davidsson O, Franzén L, Forsberg A. Comparison of trunk impairment scale versions 1.0 and 2.0 in people with multiple sclerosis: A validation study. Physiother Theory Pract 2017; 33:772-779. [PMID: 28715271 DOI: 10.1080/09593985.2017.1346025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Trunk control impairment often accompanies multiple sclerosis (MS). Trunk stability is necessary for movements of extremities, as are selective trunk movements for normal gait. Measuring trunk function is thus of interest. METHODS We examined the relationships between the Trunk Impairment Scale (TIS1.0 and TIS2.0) and the Berg Balance Scale (BBS), 5 sit-to-stand test (5STS), Timed Up and Go test (TUG), 10-m timed walk test (10TW), 2-min walk test (2MWT), Falls Efficacy Scale - International, and 12-item MS Walking Scale (MSWS-12) in 47 outpatients. We determined construct validity by calculating the degree to which the TIS versions produced different scores between known groups: use or nonuse of walking aid, MS disability status, and whether participants experienced a fall or not during 14 weeks. RESULTS TIS correlated moderately with BBS and 5STS; moderately (TIS1.0) or weakly (TIS2.0) with TUG, 10TW, and 2MWT; and weakly to moderately with MSWS-12 in subgroups with Expanded Disability Status Scale (EDSS) >6.0. No other clear correlation patterns were found. TIS did not discriminate between known groups. CONCLUSIONS TIS1.0 is recommended for individuals with MS (EDSS score 4.0-7.5). Better trunk function correlates with better balance and walking ability. TIS has limited value in fall risk screening.
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Affiliation(s)
- Ylva Nilsagård
- a Health Care Management, Faculty of Medicine and Health , University Health Care Research Center, Örebro University , Örebro , Sweden
| | - Anna Carling
- b Department of Physiotherapy, Faculty of Medicine and Health , Örebro University , Örebro , Sweden
| | | | | | - Anette Forsberg
- a Health Care Management, Faculty of Medicine and Health , University Health Care Research Center, Örebro University , Örebro , Sweden
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Ross E, Purtill H, Coote S. Inter-rater reliability of mini balance evaluation system test in ambulatory people with multiple sclerosis. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2016. [DOI: 10.12968/ijtr.2016.23.12.583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Elaine Ross
- Clinical specialist physiotherapist, St James Hospital, Dublin; Department of Clinical Therapies, University of Limerick, Ireland
| | - Helen Purtill
- Lecturer in statistics, Department of Mathematics and Statistics, University of Limerick, Ireland
| | - Susan Coote
- Associate professor of physiotherapy, Department of Clinical Therapies and Health Research Institute, University of Limerick
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Effects on Balance and Walking with the CoDuSe Balance Exercise Program in People with Multiple Sclerosis: A Multicenter Randomized Controlled Trial. Mult Scler Int 2016; 2016:7076265. [PMID: 28042485 PMCID: PMC5155099 DOI: 10.1155/2016/7076265] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 10/30/2016] [Indexed: 11/17/2022] Open
Abstract
Background. Balance and walking impairments are frequent in people with multiple sclerosis (MS). Objective. The aim was to investigate the effects of a group-based balance exercise program targeting core stability, dual tasking, and sensory strategies (CoDuSe) on balance, postural sway, walking, perceived walking limitations, and balance confidence. Design. A single-blinded randomized multicenter trial. No intervention was given to controls. Participants. People with MS able to walk 100 meters but unable to maintain tandem stance ≥30 seconds. Eighty-seven participants were randomized to intervention or control. Intervention. The 60-minute CoDuSe group program, twice weekly for seven weeks, supervised by physical therapists. Measurements. Primary outcome was dynamic balance (Berg Balance Scale (BBS)). Secondary outcomes were postural sway, walking (Timed-Up and Go test; Functional Gait Assessment (FGA)), MS Walking Scale, and Activities-specific Balance Confidence (ABC) Scale. Assessments were performed before and after (week 8) the intervention. Results. 73 participants fulfilled the study. There were significant differences between the intervention and the control groups in change in the BBS and in the secondary measures: postural sway with eyes open, FGA, MS Walking Scale, and ABC scale in favor of the intervention. Conclusions. The seven-week CoDuSe program improved dynamic balance more than no intervention.
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Cohort Study Comparing the Berg Balance Scale and the Mini-BESTest in People Who Have Multiple Sclerosis and Are Ambulatory. Phys Ther 2016; 96:1448-55. [PMID: 26916925 DOI: 10.2522/ptj.20150416] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 02/13/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Berg Balance Scale (BBS) is a balance measure commonly used for people with multiple sclerosis (MS). The Mini-BESTest is an alternative based on balance systems. OBJECTIVE The study objective was to compare the BBS and the Mini-BESTest for sensitivity to change, likelihood ratios for walking aid use and falls, and associations with clinical variables in people who have MS and are ambulatory. DESIGN This was a cohort study with measurements before and after exposure to 8 weeks of routine physical therapy intervention. METHODS For 52 participants who had a primary diagnosis of MS and who were independently mobile, with or without an aid, demographic details and a history of falls and near falls were collected. Participants completed the Mini-BESTest, Multiple Sclerosis Impact Scale-29, Multiple Sclerosis Walking Scale-12, BBS, Modified Fatigue Impact Scale, and Six-Minute Walk Test. RESULTS No participant started with a baseline Mini-BESTest maximum score of 28, whereas 38.5% (n=20) started with a baseline BBS maximum score of 56. Statistically significant changes in the Mini-BESTest score (X̅=5.31, SD=3.5) and the BBS score (X̅=1.4, SD=1.9) were demonstrated. Effect sizes for the Mini-BESTest and the BBS were 0.70 and 0.37, respectively; standard response means for the Mini-BESTest and the BBS were 1.52 and 0.74, respectively. Areas under the receiver operating characteristic curves for the Mini-BESTest and the BBS were 0.88 and 0.77, respectively, for detecting mobility device use and 0.88 and 0.75, respectively, for detecting self-reported near falls. The Mini-BESTest had a higher correlation for each secondary measure than did the BBS. LIMITATIONS This study involved a sample of convenience; 61% of the participants did not use a walking aid. The order of testing was not randomized, and fall status was obtained through retrospective recall. CONCLUSIONS The Mini-BESTest had a lower ceiling effect and higher values on responsiveness tests. These findings suggest that the Mini-BESTest may be better at detecting changes in balance in people who have MS, are ambulatory, and have relatively little walking disability.
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Uszynski MK, Coote S. The effects of whole-body vibration (WBV) intervention on body functions, activity limitations, and participation restrictions in people with neurological conditions. PHYSICAL THERAPY REVIEWS 2014. [DOI: 10.1179/1743288x14y.0000000153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Nilsagård Y, Gunn H, Freeman J, Hoang P, Lord S, Mazumder R, Cameron M. Falls in people with MS--an individual data meta-analysis from studies from Australia, Sweden, United Kingdom and the United States. Mult Scler 2014; 21:92-100. [PMID: 24948687 PMCID: PMC4361466 DOI: 10.1177/1352458514538884] [Citation(s) in RCA: 168] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Falls are common in people with multiple sclerosis (PwMS). Previous studies have generally included small samples and had varied methods. Objectives: The objectives of this paper are to compile fall rates across a broad range of ages and disease severity and to definitively assess the extent to which MS-associated and demographic factors influence fall rates. Methods: Individual data from studies in four countries that prospectively measured falls for three months were analyzed. We determined fall rates, prevalence of fallers (≥1 falls) and frequent fallers (≥2 falls), location and timing of falls, and fall-related demographic factors. Results: A total of 537 participants reported 1721 falls: 56% were fallers and 37% frequent fallers. Most falls occurred indoors (65%) between 6 a.m. and 6 p.m. (75%). Primary progressive MS was associated with significantly increased odds of being a faller (odds ratio (OR) 2.02; CI 1.08–3.78). Fall risk peaked at EDSS levels of 4.0 and 6.0 with significant ORs between 5.30 (2.23–12.64) and 5.10 (2.08–12.47). The fall rate was lower in women than men (relative risk (RR) 0.80; CI 0.67–0.94) and decreased with increasing age (RR 0.97 for each year, CI 0.95–0.98). Conclusion: PwMS are at high risk of falls and there are important associations between falls and MS-associated disability, gender and age.
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Affiliation(s)
- Y Nilsagård
- Centre of Health Care Sciences, Örebro County Council, Sweden/School of Health and Medical Sciences, Örebro University, Sweden
| | - H Gunn
- School of Health Professions, Plymouth University, UK
| | - J Freeman
- School of Health Professions, Plymouth University, UK
| | - P Hoang
- Neuroscience Research Australia (NeuRA), University of NSW, Australia
| | - S Lord
- Neuroscience Research Australia (NeuRA), University of NSW, Australia
| | | | - Michelle Cameron
- Oregon Health and Science University, USA/Portland VA Medical Center, Oregon Health and Science University, USA
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