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Wasem J, Heer Y, Karamasioti E, Muros-Le Rouzic E, Marcelli G, Di Maio D, Braune S, Kobelt G, Dillon P. Cost and Quality of Life of Disability Progression in Multiple Sclerosis Beyond EDSS: Impact of Cognition, Fatigue, and Limb Impairment. PHARMACOECONOMICS - OPEN 2024:10.1007/s41669-024-00501-x. [PMID: 38949748 DOI: 10.1007/s41669-024-00501-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/28/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND AND OBJECTIVE Understanding the socioeconomic burden of multiple sclerosis (MS) is essential to inform policymakers and payers. Real-world studies have associated increasing costs and worsening quality of life (QoL) with disability progression. This study aims to further evaluate the impact of cognition, fatigue, upper and lower limb function (ULF, LLF) impairments, and disease progression per Expanded Disability Status Scale (EDSS) level, on costs and QoL. METHODS This was a cross-sectional cohort study including 20,988 patients from the German NeuroTransData MS registry from 2009 to 2019. QoL analyses were based on EQ-5D-5L. Cost analyses included indirect/direct medical and non-medical costs. Eight subgroups, ranging from 439 to 1812 patients were created based on presence of measures for disease progression (EDSS), cognition (Symbol Digit Modalities Test [SDMT]), fatigue (Modified Fatigue Impact 5-Item Scale [MFIS-5]), ULF (Nine-Hole Peg Test [9HPT]), and LLF (Timed 25-Foot Walk [T25FW]). Multivariable linear regression assessed the independent effect of each test's score on QoL and costs, while adjusting for EDSS and 12 other confounders. RESULTS Lower QoL was associated with decreasing cognition (p < 0.001), worsening ULF (p = 0.025), and increasing fatigue (p < 0.0001); however, the negative impact of LLF worsening on QoL was not statistically significant (p = 0.54). Higher costs were associated with decreasing cognition (p < 0.001), worsening of ULF (p = 0.0058) and LLF (p = 0.049), and increasing fatigue (p < 0.0001). Each 1-scale-step worsening function of SDMT, MFIS-5, 9HPT, and T25FW scores resulted in €170, €790, €330, and €520 higher costs, respectively. Modeling disability progression based on SDMT, MFIS-5, 9HPT, and T25FW scores as an interaction with EDSS strata found associations with lower QoL and higher costs at variable EDSS ranges. CONCLUSIONS Disease progression in MS measured by 9HPT, SDMT, and MFIS-5 had a significant negative impact on QoL and broad socioeconomic costs independent of EDSS. T25FW had a significant negative association with costs. Cognition, fatigue, ULF, and LLF have stronger impact on costs and QoL in patients with higher EDSS scores. Additional determinants of MS disability status, including SDMT, MFIS-5, 9HPT, and T25FW, should be considered for assessing cost effectiveness of novel therapeutics for MS.
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Affiliation(s)
- Jürgen Wasem
- Faculty of Economics, University of Duisburg-Essen, Essen, Germany
| | - Yanic Heer
- PricewaterhouseCoopers (PwC), Zurich, Switzerland
| | | | | | | | | | | | - Gisela Kobelt
- EHE International, St Moritz, Switzerland
- European Health Economics, Mulhouse, France
| | - Paul Dillon
- F. Hoffmann-La Roche Ltd., Basel, Switzerland
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Jesus VEAD, Ribeiro MDCR, Garcia Azevedo S, Schaper FC, Amaral JMSDS, Polese JC, Lana RDC, Aguiar LT. Fatigue in individuals with multiple sclerosis: Is there a relationship with walking speed and mobility? Mult Scler Relat Disord 2024; 88:105714. [PMID: 38901370 DOI: 10.1016/j.msard.2024.105714] [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: 01/29/2024] [Revised: 05/08/2024] [Accepted: 06/08/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Fatigue is a common symptom in patients with multiple sclerosis and it can lead to activity limitations. Thus, it is important to analyze the relationship between fatigue and activity outcomes, such as walking speed and mobility. OBJECTIVES To investigate the relationship between fatigue and walking speed and mobility in individuals with multiple sclerosis. METHODS A cross-sectional study was performed. Adults with multiple sclerosis, without cognitive impairments and who were able to walk were recruited. Fatigue was assessed with the Modified Fatigue Impact Scale (MFIS). Walking speed, usual and fast, was assessed with the 10-meter Walk Test (10MWT), and mobility with the Timed Up and Go Test (TUG). Pearson correlation analysis was performed. A significance level of 5 % was used. RESULTS Thirty participants were included, most of the relapsing-remitting multiple sclerosis (n = 24, 80 %). A mean age of 41 (11) years and the median Expanded Disability Status Scale (EDSS) score was 2.65 (2.18) points. Mean MFIS score was 41.87 ± 19.42 points, mean usual walking speed was 1.02 ± 0.28 m/s, mean fast walking speed was 1.55 ± 0.48 m/s, and the mean total time in the TUG was 10.07 ± 3.05 s. A significant negative correlation of moderate magnitude was found between fatigue and usual walking speed (r=₋0.51, p < 0.05). A significant negative correlation of moderate magnitude was found between fatigue and fast walking speed (r=₋0.54, p < 0.05). A significant, positive correlation of moderate magnitude was found between fatigue and mobility (r = 0.54, p < 0.05). CONCLUSION There was a correlation between fatigue and walking speed and mobility in individuals with multiple sclerosis. These results highlight the need to assess fatigue in individuals with multiple sclerosis, since the presence of fatigue is associated with reduced walking speed and mobility.
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Monaghan PG, Takla TN, Chargo AN, Edwards EM, Yu B, Myers E, Daugherty AM, Fritz NE. Measurement Properties of Backward Walking and Its Sensitivity and Feasibility in Predicting Falls in People With Multiple Sclerosis. Int J MS Care 2024; 26:155-166. [PMID: 38915880 PMCID: PMC11195663 DOI: 10.7224/1537-2073.2023-091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
BACKGROUND People with multiple sclerosis (MS) experience mobility impairments that elevate fall risk, increasing the need to identify clinical measures that accurately predict falls. Backward walking (BW) better differentiates fallers from nonfallers in MS. However, no studies have reported the measurement properties of the backward walking Timed 25-Foot Walk (B-T25-FW) and BW metrics, like BW velocity. Additionally, it is unknown whether BW can predict future falls in MS or its link to activity levels. This study assessed the reliability and responsiveness of B-T25-FW and BW metrics, including BW velocity. It also examined whether BW could predict falls at 3 and 6 months and its association with activity levels. METHODS During 2 separate visits, 23 people with MS completed the forward walking Timed 25-Foot Walk (F-T25-FW) and B-T25-FW, as well as forward walking and BW assessments in which spatiotemporal measures were recorded. Test-retest reliability was determined with intraclass correlation coefficients, and minimum detectable changes were calculated. Correlation analyses explored the relationship between BW velocity, B-T25-FW, prospective falls, and activity levels. RESULTS B-T25-FW and BW velocity exhibited excellent test-retest reliability. Large effect sizes to interpret clinically meaningful change in the B-T25-FW and BW velocity were also found. Both metrics demonstrated modest negative correlations with falls at 3 and 6 months and correlated strongly with very active minutes at 3- and 6-months post study. CONCLUSIONS The B-T25-FW and BW velocity are effective and reliable in clinical use for evaluating functional mobility in people with MS, are sensitive enough to detect subtle changes, and may be a meaningful marker for tracking disease progression and treatment efficacy.
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Affiliation(s)
- Patrick G. Monaghan
- From the Neuroimaging and Neurorehabilitation Laboratory, Wayne State University, Detroit, MI, USA
- Department of Health Care Sciences, Wayne State University, Detroit, MI, USA
| | - Taylor N. Takla
- From the Neuroimaging and Neurorehabilitation Laboratory, Wayne State University, Detroit, MI, USA
- Translational Neuroscience Program, Wayne State University, Detroit, MI, USA
| | - Alexis N. Chargo
- Department of Psychology, Wayne State University, Detroit, MI, USA
- Institute of Gerontology, Wayne State University, Detroit, MI, USA
| | - Erin M. Edwards
- From the Neuroimaging and Neurorehabilitation Laboratory, Wayne State University, Detroit, MI, USA
- Translational Neuroscience Program, Wayne State University, Detroit, MI, USA
| | - Biaohua Yu
- From the Neuroimaging and Neurorehabilitation Laboratory, Wayne State University, Detroit, MI, USA
| | - Emily Myers
- From the Neuroimaging and Neurorehabilitation Laboratory, Wayne State University, Detroit, MI, USA
| | - Ana M. Daugherty
- Translational Neuroscience Program, Wayne State University, Detroit, MI, USA
- Department of Psychology, Wayne State University, Detroit, MI, USA
- Institute of Gerontology, Wayne State University, Detroit, MI, USA
| | - Nora E. Fritz
- From the Neuroimaging and Neurorehabilitation Laboratory, Wayne State University, Detroit, MI, USA
- Translational Neuroscience Program, Wayne State University, Detroit, MI, USA
- Department of Health Care Sciences, Wayne State University, Detroit, MI, USA
- Department of Neurology, Wayne State University, Detroit, MI, USA
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Rainka MM, Aladeen TS, Mattle AG, Lewandowski E, Vanini D, McCormack K, Mechtler L. Multiple Sclerosis and Use of Medical Cannabis: A Retrospective Review of a Neurology Outpatient Population. Int J MS Care 2023; 25:111-117. [PMID: 37250194 PMCID: PMC10211357 DOI: 10.7224/1537-2073.2022-006] [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] [Indexed: 11/02/2023]
Abstract
BACKGROUND Patients diagnosed as having multiple sclerosis (MS) experience a wide range of symptoms requiring pharmacologic management, and many do not achieve adequate symptom control. The purpose of this study was to evaluate the role of medical cannabis (MC) as part of a comprehensive treatment plan for patients with MS. METHODS A retrospective medical record review of 141 patients with MS receiving MC for symptom management was conducted. Data were collected for up to 4 follow-up appointments after initiation of MC. Outcomes included changes in MS symptoms, medication changes, adverse events, and changes in cognition and mobility. RESULTS Patients experienced extensive MS symptom improvement after initiation of MC, with alleviation of pain (72% of patients) and spasticity (48% of patients) and improvement in sleep (40% of patients) the most common. There was a significant reduction in concomitant opioid use after initiating MC as evidenced by a significant decrease in daily morphine milligram equivalents among patients prescribed opioid analgesics (P = .01). Decreases in muscle relaxant use and benzodiazepine use did not reach significance (P > .05). The most common adverse reaction to MC was fatigue (11% of patients). CONCLUSIONS In many patients with MS, MC was well tolerated, eased pain and spasticity, improved sleep and other symptoms, and reduced use of concomitant opioid analgesics. Prospective studies are needed to further investigate the role of MC in the treatment of patients with MS.
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Affiliation(s)
- Michelle M. Rainka
- From the Dent Neurologic Institute, Buffalo, NY, USA (MMR, TSA, AGM, KM, LM)
- The University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY, USA (MMR, TSA, AGM, EL, DV)
| | - Traci S. Aladeen
- From the Dent Neurologic Institute, Buffalo, NY, USA (MMR, TSA, AGM, KM, LM)
- The University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY, USA (MMR, TSA, AGM, EL, DV)
| | - Anna G. Mattle
- From the Dent Neurologic Institute, Buffalo, NY, USA (MMR, TSA, AGM, KM, LM)
- The University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY, USA (MMR, TSA, AGM, EL, DV)
| | - Emily Lewandowski
- The University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY, USA (MMR, TSA, AGM, EL, DV)
| | - Denis Vanini
- The University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY, USA (MMR, TSA, AGM, EL, DV)
| | - Katelyn McCormack
- From the Dent Neurologic Institute, Buffalo, NY, USA (MMR, TSA, AGM, KM, LM)
| | - Laszlo Mechtler
- From the Dent Neurologic Institute, Buffalo, NY, USA (MMR, TSA, AGM, KM, LM)
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Granja Domínguez A, Romero Sevilla R, Alemán A, Durán C, Hochsprung A, Navarro G, Páramo C, Venegas A, Lladonosa A, Ayuso GI. Study for the validation of the FeetMe® integrated sensor insole system compared to GAITRite® system to assess gait characteristics in patients with multiple sclerosis. PLoS One 2023; 18:e0272596. [PMID: 36758111 PMCID: PMC9910712 DOI: 10.1371/journal.pone.0272596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 07/23/2022] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVE To determine the concordance and statistical precision in gait velocity in people with multiple sclerosis (pwMS), measured with FeetMe® (insoles with pressure and motion sensors) compared with GAITRite® (classic reference system of gait analysis) in the timed 25-Feet Walk test (T25WT). METHODS This observational, cross-sectional, prospective, single center study was conducted between September-2018 and April-2019 in pwMS aged 18-55 years, with Expanded Disability Status Scale (EDSS) 0-6.5 and relapse free ≥30 days at baseline. Primary endpoint was gait velocity. Secondary endpoints were ambulation time, cadence, and stride length assessment, while the correlation between gait variables and the clinical parameters of MS subjects was assessed as an exploratory endpoint. RESULTS A total of 207 MS subjects were enrolled, of whom, 205 were considered in primary analysis. Most subjects were women (66.8%) and had relapsing-remitting MS (RRMS) (82.9%), with overall mean (standard deviation [SD]) age of 41.5 (8.0) year and EDSS 3.1 (2.0). There was a statistically significant (p<0.0001) and strong agreement (intra-class correlation coefficient (ICC) >0.830) in gait velocity, ambulation time and cadence assessment between FeetMe® and GAITRite®. CONCLUSIONS Agreement between devices was strong (ICC≥0.800). FeetMe® is the first validated wearable medical device that allows gait monitoring in MS subjects, being potentially able to assess disease activity, progression, and treatment response.
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Affiliation(s)
- Anabel Granja Domínguez
- Departamento de Neurología, Fundación para el Desarrollo de la Investigación y Asistencia de Enfermedades Neurológicas y Afines Crónicas (DINAC), Castilleja de la Cuesta, Sevilla, Spain
- Departamento de Neurología, Hospital Vithas Nisa, Unidad de Investigación y Tratamiento de la Esclerosis Múltiple, Sevilla, Spain
| | | | - Aurora Alemán
- Departamento de Neurología, Fundación para el Desarrollo de la Investigación y Asistencia de Enfermedades Neurológicas y Afines Crónicas (DINAC), Castilleja de la Cuesta, Sevilla, Spain
- Departamento de Neurología, Hospital Vithas Nisa, Unidad de Investigación y Tratamiento de la Esclerosis Múltiple, Sevilla, Spain
| | - Carmen Durán
- Departamento de Neurología, Fundación para el Desarrollo de la Investigación y Asistencia de Enfermedades Neurológicas y Afines Crónicas (DINAC), Castilleja de la Cuesta, Sevilla, Spain
| | - Anja Hochsprung
- Departamento de Neurología, Fundación para el Desarrollo de la Investigación y Asistencia de Enfermedades Neurológicas y Afines Crónicas (DINAC), Castilleja de la Cuesta, Sevilla, Spain
| | - Guillermo Navarro
- Departamento de Neurología, Fundación para el Desarrollo de la Investigación y Asistencia de Enfermedades Neurológicas y Afines Crónicas (DINAC), Castilleja de la Cuesta, Sevilla, Spain
| | - Cristina Páramo
- Departamento de Neurología, Fundación para el Desarrollo de la Investigación y Asistencia de Enfermedades Neurológicas y Afines Crónicas (DINAC), Castilleja de la Cuesta, Sevilla, Spain
- Departamento de Neurología, Hospital Vithas Nisa, Unidad de Investigación y Tratamiento de la Esclerosis Múltiple, Sevilla, Spain
| | - Ana Venegas
- Departamento de Neurología, Fundación para el Desarrollo de la Investigación y Asistencia de Enfermedades Neurológicas y Afines Crónicas (DINAC), Castilleja de la Cuesta, Sevilla, Spain
- Departamento de Neurología, Hospital Vithas Nisa, Unidad de Investigación y Tratamiento de la Esclerosis Múltiple, Sevilla, Spain
| | - Ana Lladonosa
- Neurociencias, Novartis Farmacéutica, S.A., Barcelona, Spain
| | - Guillermo Izquierdo Ayuso
- Departamento de Neurología, Fundación para el Desarrollo de la Investigación y Asistencia de Enfermedades Neurológicas y Afines Crónicas (DINAC), Castilleja de la Cuesta, Sevilla, Spain
- Departamento de Neurología, Hospital Vithas Nisa, Unidad de Investigación y Tratamiento de la Esclerosis Múltiple, Sevilla, Spain
- * E-mail:
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Edwards EM, Stanley JA, Daugherty AM, Lynn J, Borich MR, Fritz NE. Associations between myelin water imaging and measures of fall risk and functional mobility in multiple sclerosis. J Neuroimaging 2023; 33:94-101. [PMID: 36266780 DOI: 10.1111/jon.13064] [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: 07/25/2022] [Revised: 09/26/2022] [Accepted: 10/08/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND AND PURPOSE Myelin water fraction (MWF) deficits as measured by myelin water imaging (MWI) have been related to worse motor function in persons with multiple sclerosis (PwMS). However, it is unknown if measures from MWI metrics in motor areas relate to fall risk measures in PwMS. The objective of this study was to examine the relationship between MWI measures in motor areas to performance on clinical measures of fall risk and disability in PwMS. METHODS Sixteen individuals with relapsing-remitting MS participated (1 male, 15 female; age 47.1 years [12.3]; Expanded Disability Status Scale 4.0 [range 0-6.5]) and completed measures of walking and fall risk (Timed 25 Foot Walk [T25FW] and Timed Up and Go). MWF and the geometric mean of the intra-/extracellular water T2 (geomT2IEW ) values reflecting myelin content and contribution of large-diameter axons/density, respectively, were assessed in three motor-related regions. RESULTS The geomT2IEW of the corticospinal tract (r = -.599; p = .018) and superior cerebellar peduncles (r = -.613; p = .015) demonstrated significant inverse relationships with T25FW, suggesting that decreased geomT2IEW was related to slower walking. Though not significant, MWF in the corticospinal tract and superior cerebellar peduncles also demonstrated fair relationships with the T25FW, suggesting that worse performance on the T25FW was associated with lower MWF values. CONCLUSIONS MWI of key motor regions was associated with walking performance in PwMS. Further MWI studies are needed to identify relationships between pathology and clinical function in PwMS to guide targeted rehabilitation therapies aimed at preventing falls.
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Affiliation(s)
- Erin M Edwards
- Translational Neuroscience Program, Wayne State University, Detroit, Michigan, USA.,Neuroimaging and Neurorehabilitation Laboratory, Wayne State University, Detroit, Michigan, USA
| | - Jeffrey A Stanley
- Translational Neuroscience Program, Wayne State University, Detroit, Michigan, USA.,Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan, USA
| | - Ana M Daugherty
- Department of Psychology, Wayne State University, Detroit, Michigan, USA.,Institute of Gerontology, Wayne State University, Detroit, Michigan, USA
| | - Jonathan Lynn
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan, USA
| | - Michael R Borich
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nora E Fritz
- Translational Neuroscience Program, Wayne State University, Detroit, Michigan, USA.,Neuroimaging and Neurorehabilitation Laboratory, Wayne State University, Detroit, Michigan, USA.,Department of Health Care Sciences, Wayne State University, Detroit, Michigan, USA.,Department of Neurology, Wayne State University, Detroit, Michigan, USA
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Neurorehabilitation in Multiple Sclerosis-A Review of Present Approaches and Future Considerations. J Clin Med 2022; 11:jcm11237003. [PMID: 36498578 PMCID: PMC9739865 DOI: 10.3390/jcm11237003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Multiple sclerosis is an increasingly prevalent disease, representing the leading cause of non-traumatic neurological disease in Europe and North America. The most common symptoms include gait deficits, balance and coordination impairments, fatigue, spasticity, dysphagia and an overactive bladder. Neurorehabilitation therapeutic approaches aim to alleviate symptoms and improve the quality of life through promoting positive immunological transformations and neuroplasticity. The purpose of this study is to evaluate the current treatments for the most debilitating symptoms in multiple sclerosis, identify areas for future improvement, and provide a reference guide for practitioners in the field. It analyzes the most cited procedures currently in use for the management of a number of symptoms affecting the majority of patients with multiple sclerosis, from different training routines to cognitive rehabilitation and therapies using physical agents, such as electrostimulation, hydrotherapy, cryotherapy and electromagnetic fields. Furthermore, it investigates the quality of evidence for the aforementioned therapies and the different tests applied in practice to assess their utility. Lastly, the study looks at potential future candidates for the treatment and evaluation of patients with multiple sclerosis and the supposed benefits they could bring in clinical settings.
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Guffanti D, Brunete A, Hernando M, Gambao E, Alvarez D. ANN-Based Optimization of Human Gait Data Obtained From a Robot-Mounted 3D Camera: A Multiple Sclerosis Case Study. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2022.3189433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Diego Guffanti
- Department of Electrical, Electronic and Automation Engineering and Applied Physics, ETSIDI, Universidad Politécnica de Madrid, Madrid, Spain
| | - Alberto Brunete
- Centre for Automation and Robotics (CAR) UPM-CSIC, Madrid, Spain
| | - Miguel Hernando
- Centre for Automation and Robotics (CAR) UPM-CSIC, Madrid, Spain
| | - Ernesto Gambao
- Centre for Automation and Robotics (CAR) UPM-CSIC, Madrid, Spain
| | - David Alvarez
- Centre for Automation and Robotics (CAR) UPM-CSIC, Madrid, Spain
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9
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Short inertial sensor-based gait tests reflect perceived state fatigue in multiple sclerosis. Mult Scler Relat Disord 2022; 58:103519. [DOI: 10.1016/j.msard.2022.103519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/26/2021] [Accepted: 01/09/2022] [Indexed: 11/20/2022]
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10
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Monaghan AS, Huisinga JM, Peterson DS. The relationship between plantar sensation and muscle onset during automatic postural responses in people with multiple sclerosis and healthy controls. Mult Scler Relat Disord 2021; 56:103313. [PMID: 34644600 DOI: 10.1016/j.msard.2021.103313] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 09/09/2021] [Accepted: 10/02/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Plantar sensation is critical for balance control in people with multiple sclerosis (PwMS). While previous research has described its impact on standing balance, the influence of plantar sensation during automatic postural responses (APRs) is not well understood in PwMS. The purpose of this study was to characterize the relationship between plantar sensation and APRs in PwMS and controls. A secondary aim was to determine whether the relationship between plantar sensation and APRs is different across PwMS and control groups. METHODS 122 PwMS and 48 age-matched controls underwent forward and backward support-surface perturbations from stance. The onset of the tibialis anterior (TA) and medial gastrocnemius (MG) were the primary reactive balance outcome measures for backward and forward losses of balance, respectively. Plantar sensation was measured as the vibration sensation threshold (VT). RESULTS As expected, PwMS had significantly higher (i.e., worse) VT (p<0.001) and an increased MG and TA onset latency (TA: p<0.001, MG: p = 0.01) compared to the control group. A higher VT was related to increased MG (p<0.001) and TA latency (p<0.001) across all participants. However, no moderating effect of group (control or PwMS) was observed for the relationship between VT and muscle onset (MG: p = 0.14; TA: p = 0.34). CONCLUSION PwMS demonstrated poorer plantar sensation and delayed muscle onset during APRs compared to controls. Plantar sensation was also related to muscle onset after perturbations in all participants. Although this relationship was not moderated by group, this may be related to the lack of dynamic range of VT scores in controls. These results indicate that plantar sensation may be related to reactive balance and provides insight into a potential contributing factor of delayed automatic postural responses in people with MS.
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Affiliation(s)
- A S Monaghan
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - J M Huisinga
- University of Kansas Medical Center, Department of Physical Therapy and Rehabilitation Science
| | - D S Peterson
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA; Phoenix VA Health Care Center, Phoenix, AZ, USA.
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Trentzsch K, Weidemann ML, Torp C, Inojosa H, Scholz M, Haase R, Schriefer D, Akgün K, Ziemssen T. The Dresden Protocol for Multidimensional Walking Assessment (DMWA) in Clinical Practice. Front Neurosci 2020; 14:582046. [PMID: 33192268 PMCID: PMC7649388 DOI: 10.3389/fnins.2020.582046] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/06/2020] [Indexed: 12/14/2022] Open
Abstract
Walking impairments represent one of the most debilitating symptom areas for people with multiple sclerosis (MS). It is important to detect even slightest walking impairments in order to start and optimize necessary interventions in time to counteract further progression of the disability. For this reason, a regular monitoring through gait analysis is highly necessary. At advanced stages of MS with significant walking impairment, this assessment is also necessary to optimize symptomatic treatment, choose the most suitable walking aid and plan individualized rehabilitation. In clinical practice, walking impairment is only assessed at higher levels of the disease using e.g., the Expanded Disability Status Scale (EDSS). In contrast to the EDSS, standardized functional tests such as walking speed, walking endurance and balance as well as walking quality and gait-related patient-reported outcomes allow a more holistic and sensitive assessment of walking impairment. In recent years, the MS Center Dresden has established a standardized monitoring procedure for the routine multidimensional assessment of gait and balance disorders. In the following protocol, we present the techniques and procedures for the analysis of gait and balance of people with MS at the MS Center Dresden. Patients are assessed with a multidimensional gait analysis at least once a year. This enables long-term monitoring of walking impairment, which allows early active intervention regarding further progression of disease and improves the current standard clinical practice.
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Affiliation(s)
- Katrin Trentzsch
- Department of Neurology, MS Center Dresden, Center of Clinical Neuroscience, Neurological Clinic, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Marie Luise Weidemann
- Department of Neurology, MS Center Dresden, Center of Clinical Neuroscience, Neurological Clinic, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Charlotte Torp
- Department of Neurology, MS Center Dresden, Center of Clinical Neuroscience, Neurological Clinic, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Hernan Inojosa
- Department of Neurology, MS Center Dresden, Center of Clinical Neuroscience, Neurological Clinic, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Maria Scholz
- Department of Neurology, MS Center Dresden, Center of Clinical Neuroscience, Neurological Clinic, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Rocco Haase
- Department of Neurology, MS Center Dresden, Center of Clinical Neuroscience, Neurological Clinic, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Dirk Schriefer
- Department of Neurology, MS Center Dresden, Center of Clinical Neuroscience, Neurological Clinic, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Katja Akgün
- Department of Neurology, MS Center Dresden, Center of Clinical Neuroscience, Neurological Clinic, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Tjalf Ziemssen
- Department of Neurology, MS Center Dresden, Center of Clinical Neuroscience, Neurological Clinic, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
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12
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Simmatis LE, Jin AY, Taylor SW, Bisson EJ, Scott SH, Baharnoori M. The feasibility of assessing cognitive and motor function in multiple sclerosis patients using robotics. Mult Scler J Exp Transl Clin 2020; 6:2055217320964940. [PMID: 33149931 PMCID: PMC7580159 DOI: 10.1177/2055217320964940] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/18/2020] [Indexed: 12/12/2022] Open
Abstract
Background Multiple sclerosis (MS) causes pervasive motor, sensory and cognitive dysfunction. The Expanded Disability Status Scale (EDSS) is the gold standard for assessing MS disability. The EDSS is biased towards mobility and may not accurately measure MS-related disabilities in the upper limb or in cognitive functions (e.g. executive function). Objective Our objectives were to determine the feasibility of using the Kinarm robotic system to quantify neurological deficits related to arm function and cognition in MS patients, and examine relationships between traditional clinical assessments and Kinarm variables. Methods Individuals with MS performed 8 robotic tasks assessing motor, cognitive, and sensory ability. We additionally collected traditional clinical assessments and compared these to the results of the robotic assessment. Results Forty-three people with MS were assessed. Most participants could complete the robotic assessment. Twenty-six (60%) were impaired on at least one cognitive task and twenty-six (60%) were impaired on at least one upper-limb motor task. Cognitive domain task performance correlated most strongly with the EDSS. Conclusions Kinarm robotic assessment of people with MS is feasible, can identify a broad range of upper-limb motor and sensory, as well as cognitive, impairments, and complements current clinical rating scales in the assessment of MS-related disability.
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Affiliation(s)
- Leif Er Simmatis
- Centre for Neuroscience Studies, Queen's University, Kingston, Canada
| | | | - Sean W Taylor
- Centre for Neuroscience Studies, Queen's University, Kingston, Canada
| | - Etienne J Bisson
- Centre for Neuroscience Studies, Queen's University, Kingston, Canada
| | - Stephen H Scott
- Centre for Neuroscience Studies, Queen's University, Kingston, Canada
| | - Moogeh Baharnoori
- Centre for Neuroscience Studies, Queen's University, Kingston, Canada
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13
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Alonso RN, Eizaguirre MB, Cohen L, Quarracino C, Silva B, Pita MC, Yastremiz C, Vanotti S, Garcea O. Upper Limb Dexterity in Patients with Multiple Sclerosis: An Important and Underrated Morbidity. Int J MS Care 2020; 23:79-84. [PMID: 33880084 DOI: 10.7224/1537-2073.2019-083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Scales to assess disability in multiple sclerosis (MS) rarely provide reliable data on actual global impairment. Upper limb dysfunction is usually overlooked, which has a negative effect on patient well-being. We sought to analyze associations among upper limb dexterity, lower limb speed, and Expanded Disability Status Scale (EDSS) score; the difference in upper limb dexterity between patients with EDSS scores less than 5 and 5 or greater; and the associations that upper limb dexterity, lower limb speed, and EDSS score have with health-related quality of life measurements and depression. Methods A total of 140 adults with MS were evaluated using the Nine-Hole Peg Test, Timed 25-Foot Walk test, EDSS, Multiple Sclerosis International Quality of Life (MusiQoL) questionnaire, and Beck Depression Inventory. Thorough descriptive-analytical research was conducted using the Spearman correlation, multiple linear regression, and structural equation modeling. Results Upper limb dexterity was more closely related to EDSS score than lower limb speed (r = 0.43 vs 0.29, R 2 = 0.38) and was greatest in patients with EDSS scores less than 5 (P < .01). Moreover, upper limb dexterity was negatively associated with EDSS score and the MusiQoL questionnaire (rS = -0.557 to -0.321, P < .05). The correlation that depression has with upper limb dexterity loss was higher than the one it has with lower limb speed (0.098 vs 0.066, t > 1.96). Conclusions Upper limb dexterity is associated with global disability, depression, and health-related quality of life. We advocate for the assessment of upper limb dexterity in patients with MS to adopt a better approach to their functional impairment.
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Bethoux F, Varsanik JS, Chevalier TW, Halpern EF, Stough D, Kimmel ZM. Walking speed measurement with an Ambient Measurement System (AMS) in patients with multiple sclerosis and walking impairment. Gait Posture 2018; 61:393-397. [PMID: 29454289 DOI: 10.1016/j.gaitpost.2018.01.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 12/30/2017] [Accepted: 01/28/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Walking speed is an important measure of gait impairment in multiple sclerosis (MS). The clinical assessment of walking speed requires dedicated time, space, and personnel, and may not accurately gauge real-world performance. The term "Ambient Measurement System" (AMS) refers to a new class of device that passively measures walking speed at home, without the need for dedicated space or specialized setup. This study compared an AMS, Echo5D, versus in-clinic standard measures of walking speed on a straight path. METHODS Twenty participants with MS and walking impairment were recruited from the Cleveland Clinic Mellen Center for MS. Each participant traversed an electronic GAITRite CIRFace (GC) sensor mat four times (two at comfortable pace, two at fast pace). Each participant then performed the Timed 25-Foot Walk (T25FW) twice, measured by a manual stopwatch (SW). All traversals were simultaneously measured by an array of Echo5D devices. Echo5D speeds were correlated with the Patient-Determined Disease Steps and the MS Walking Scale-12 patient-reported outcomes. RESULTS Pearson correlations between Echo5D and clinical tests ranged from 0.89 to 0.98 (p < 0.0001). No statistically significant bias was found between Echo5D and GC. A small statistically significant bias was found between Echo5D and SW, with Echo5D reporting approximately 5% faster walking speeds in aggregate. CONCLUSIONS Among MS patients with walking impairments, the Echo5D AMS acquired walking speeds which were closely correlated with the standard measures of GC and SW. The strong agreement supports the use of Echo5D to assess in-home, real-world walking performance in MS.
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Affiliation(s)
- Francois Bethoux
- Mellen Center for MS Treatment and Research, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | | | | | - Elkan F Halpern
- Institute for Technology Assessment, 101 Merrimac St., Boston, MA 02114, USA.
| | - Darlene Stough
- Mellen Center for MS Treatment and Research, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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15
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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.
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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
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- Multiple Sclerosis Outcome Assessments Consortium (MSOAC), Critical Path Institute, Tucson, AZ, USA
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