Comparison of trunk impairment scale versions 1.0 and 2.0 in people with multiple sclerosis: A validation study

Measurement properties of the Trunk Impairment Scale-modified Norwegian version among people with mild to moderate multiple sclerosis

PURPOSE

The Trunk Impairment Scale-modified Norwegian version (TIS-modNV) measures trunk control for clinical and research purposes. This study examined the validity and reliability of the TIS-modNV in people with multiple sclerosis (pwMS).

MATERIALS AND METHODS

Sixty-eight pwMS (mild to moderate) participated. The TIS-modNV and the Mini-Balance Evaluation Systems Test (Mini-BESTest) scores were compared for construct validity using Spearman's rho (rs). TIS-modNV performance was videotaped and rated by four physiotherapists on two occasions. The inter- and intrarater reliability was analyzed via intraclass correlation coefficients (ICC), standard errors of measurement (SEM), Bland-Altman plots, and kappa statistics (k).

RESULTS

Validity was demonstrated (rs = 0.55-0.61). Interrater reliability for the total score was moderate to good (ICC(A,1) =0.67; ICC(C,1) = 0.78), and the SEM was 2 points (12.8%). Interrater reliability varied across the rater pairs (ICC(A,1) = 0.54-0.81) as displayed in the Bland-Altman plots. Item-level interrater agreement varied from poor to good (k = 0.10-0.79). Intrarater reliability of the total scores was moderate to good (ICC(A,1) = 0.67-0.82).

CONCLUSION

This study supports the construct validity and overall reliability of the TIS-modNV in pwMS with mild to moderate disability. However, variations in rater reliability need to be addressed.

Trunk control in people with multiple sclerosis with different disability level: a cross-sectional study

BACKGROUND

Trunk control is significant for a quality movement. Trunk control is reduced in people with Multiple Sclerosis compared to healthy individuals.

OBJECTIVE

The study aims to compare trunk control in people with Multiple Sclerosis according to disability level and to examine the relationship between disability level and trunk control.

METHODS

A total of one hundred-two people with Multiple Sclerosis were included in the study. The disability level was recorded with the Expanded Disability Status Scale score. Trunk control was evaluated with the Trunk Impairment Scale and core stability tests. Additionally, people with Multiple Sclerosis were divided into subgroups according to their disability levels (Expanded Disability Status Scale ≤ 3 and ≥ 3.5).

RESULTS

Trunk Impairment Scale scores and core stability test results were statistically significantly lower in the group of people with Multiple Sclerosis with a higher Expanded Disability Status Scale score (3.5-6.5) than in the group with a lower Expanded Disability Status Scale score (1-3) (p = 0.001). A correlation was found between the level of disability and all parameters of trunk control in the total sample (p = 0.001). A significant relationship was detected between the disability level and most trunk control parameters in the Expanded Disability Status Scale ≤ 3 and ≥ 3.5 subgroups (p < 0.05).

CONCLUSIONS

As the level of disability increases in people with Multiple Sclerosis, trunk control decreases, suggesting that care should be taken regarding trunk control during the progression of the disease. Evaluation of trunk control will be guiding when creating treatment programs.

Validity and reliability of the Persian version of the trunk impairment scale in people with multiple sclerosis

BACKGROUND

In order to provide an important measuring tool for the assessment, prognosis of recovery, and treatment of people with multiple sclerosis (PWMS), the aim of this research is to examine the validity and reliability of the Trunk Impairment Scale (TIS) in Persian.

METHODS

The research included 105 PWMS. The TIS questionnaire was translated and culturally equivalent according to the IQOLA approach. The Intra Class Correlations (ICC) and Cronbach's alpha were used to assess the internal consistency of the questionnaire. Barthel Index (BI), Time Up and Go (TUG), Multiple Sclerosis Walking Scale-12 (MSWS-12), and Trunk Control Test (TCT) scores were correlated with the TIS score in order to assess validity.

RESULTS

86 of 105 participants in this study were female. For several subscales, the ICC correlation coefficient ranged from 0.89 to 0.98. The Cronbach's alpha value of the TIS total score indicates that the TIS questionnaire has quite good internal consistency. (Cronbach's alpha=0.97). The TIS and the MSWS-12, BI, TUG, and TCT questionnaires have correlation coefficients of 0.78, 0.72, 0.60, and 0.71, respectively, indicating strong construct and concurrent validity.

CONCLUSION

The results of the research showed that the TIS in Persian is a relevant and reliable tool for assessing trunk abnormalities in Persian-speaking PWMS.

Impaired trunk control and its relationship with balance, functional mobility, and disease severity in patients with cervical dystonia

BACKGROUND

Impaired trunk control is common in neurological disorders; however, trunk control has not been examined in patients with cervical dystonia (CD). Therefore, the primary aim was to compare trunk control between patients with CD and healthy people. The secondary aim was to investigate the relationship between trunk control and balance, functional mobility, and disease severity in patients with CD.

METHODS

]This cross-sectional study included 32 patients with CD and 32 healthy people. Trunk control was compared using the trunk impairment scale (TIS) that consists of three subscales: static sitting balance, dynamic sitting balance, and trunk coordination between two groups. Balance was assessed using Berg Balance Scale, four square step test, and one-leg stance test. The Timed Up and Go Test was measured to determine functional mobility. Toronto Western Spasmodic Torticollis Rating Scale was used to evaluate disease severity.]></AbstractText> <AbstractText Label="RESULTS"><![CDATA[ Patients with CD demonstrated worse performance on the TIS-total with TIS-dynamic sitting subscale and TIS-trunk coordination subscale (p < 0.001, p < 0.001, and p < 0.001), except for TIS-static sitting subscale (p = 0.078) compared to healthy people. TIS-total scores had moderate to strong correlations with balance, functional mobility, and disease severity (range r between 0.786 and 0.536, p < 0.05 for all). There was no correlation between TIS-total scores and disease severity (p = 0.102).

DISCUSSION

Patients with CD had impaired trunk control, especially in dynamic sitting balance and trunk coordination. Impaired trunk control was also associated with balance and functional mobility but not disease severity. These findings suggest that trunk control deficits should receive attention in the assessment and treatment of patients with CD.

Effect of Dynamic Neuromuscular Stabilization on Balance, Trunk Function, Falling, and Spasticity in People With Multiple Sclerosis: A Randomized Controlled Trial

OBJECTIVE

To compare the effects of core stabilization (CS) and dynamic neuromuscular stabilization (DNS) on balance, trunk function, mobility, falling, and spasticity, in people with multiple sclerosis (PWMS).

DESIGN

Two-group randomized controlled trial.

SETTING

General community and referral center.

PARTICIPANTS

A total of 64 PWMS, between 30 and 50 years old, and an expanded disability status scale between 2 and 5, participated in this study (N=64).

INTERVENTIONS

Participants were randomly assigned to CS (n=32) and DNS (n=32) groups. Both groups received a total of 15 sessions of CS or DNS exercises, 60 minutes per session, 3 times a week during the 5 weeks.

OUTCOME MEASURES

Balance function was measured as the primary outcome measure. Trunk function, postural stability, falling rate, fear of falling, falling index, mobility, and spasticity were measured as secondary outcomes.

RESULTS

DNS group had significant improvement in Berg balance scale, trunk impairment scale, postural stability, activities-specific balance confidence, reduced falling rate, the timed Up and Go (TUG), multiple sclerosis walking scale-12, and multiple sclerosis spasticity scale in PWMS compared with the CS group, (P<.0001) after 5 weeks of intervention and 17 weeks of follow-up. Except for the modified Ashworth scale (MAS), significant improvements were seen in all outcome measures in both groups after 5 weeks of intervention.

CONCLUSION

This is the first clinical evidence to support the importance of DNS exercise in improving balance, trunk function, and fall prevention in PWMS. This study provides clinical evidence that DNS may be more effective for PWMS than CS.

The content and effects of trunk rehabilitation on trunk and upper limb performance in people with multiple sclerosis: a systematic review

INTRODUCTION

Persons with multiple sclerosis (pwMS) could have an impaired trunk and reduced postural control, which negatively impacts activities of daily living. Evidence is growing to consider the positive effects of trunk training on fall incidence and balance problems. Effects on trunk and upper limb performance is unknown. This systematic review provides an overview of trunk training programs and their effects in MS, specifically focusing on the content of training modalities and the effects on trunk and upper limb performance.

EVIDENCE ACQUISITION

Two electronic databases were used: PubMed and Web Of Science (WOS). Intervention studies (with- and without control group) published in English, investigating the effects of active trunk training on trunk and upper limb performance in pwMS, were included.

EVIDENCE SYNTHESIS

Sixteen studies met the criteria, investigating different rehabilitation modalities. The included interventions in the review varied between more generic postural interventions such as Pilates (N.=8) and Ai Chi (N.=1), with a focus on abdominal muscle activation, breathing, neutral position and lower extremity movements. Further, specifically developed trunk training programs like GroupCoreDIST/ SIT / CoDuSe (N.=6) and Bobath based trunk training (N.=1) are detected, with the main focus on trunk strengthening and dynamic movements. An overall improvement in trunk performance was reported in several tests on trunk strength, stability and coordination. While the majority of the programs integrated the upper limb, only half of them used upper limb outcome measures to evaluate the effect. Here, overall significant improvements were found for the upper limb.

CONCLUSIONS

This systematic review showed that different types of trunk training programs can improve trunk and upper limb function in PwMS. The findings of this review suggest that a focus on trunk training to achieve effects on upper limb is reasonable. Future research is needed to further explore relations and the effect sizes.

What is the distribution of trunk impairments and its relationship with disability level in individuals with multiple sclerosis?

BACKGROUND

Trunk control is essential for movement, balance and walking and is ignored in the regular medical follow-up.

OBJECTIVE

First, to describe the distribution of trunk impairments in the full range of disability levels in individuals with MS. Second, to identify the relationship between trunk control, measured by the Trunk Impairment Scale (TIS 2.0.), and general disability measured by the Expanded Disability Status Scale (EDSS).

METHODS

154 individuals with MS were included (mean age 53.6; SD 11.06), EDSS ranging from 1.0- 8.5 (mean 4.47; SD 2.55). The relationship between EDSS and TIS 2.0. was calculated by Spearman correlation coefficient for the total sample and subgroups, EDSS ≤ 4 versus EDSS ≥ 4.5.

RESULTS

Trunk impairments were detected throughout the full range of disability, including individuals with low disability. Pelvic elevation and lower trunk rotation appeared most difficult to perform. In the total sample, a moderate correlation was found (rho= -0.608**) between disability (EDSS) and trunk performance (TIS 2.0.). Sub-analyses revealed a poor correlation (rho= -0.193) for the EDSS ≤ 4 subgroup and a strong correlation for the EDSS ≥ 4.5 subgroup (rho= -0.712**).

CONCLUSION

The results advocate for including trunk assessment already at early disease stages of MS, particularly of pelvic elevation and trunk rotation, and dedicated rehabilitation strategies.