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Skjerbæk AG, Dalgas U, Stenager E, Boesen F, Hvid LG. The six spot step test is superior in detecting walking capacity impairments compared to short- and long-distance walk tests in persons with multiple sclerosis. Mult Scler J Exp Transl Clin 2023; 9:20552173231218127. [PMID: 38105806 PMCID: PMC10722939 DOI: 10.1177/20552173231218127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/15/2023] [Indexed: 12/19/2023] Open
Abstract
Background Walking capacity is important not only to persons with multiple sclerosis but also to clinical practice and research. The present study aims to compare the extent of impairments (relative to healthy controls) across three commonly used walking capacity outcomes in persons with multiple sclerosis. Methods In a two-hospital cross-sectional study, walking capacity was assessed using the timed-25-footwalk-test (timed 25-ft walk test; 'walking speed'), the six-minute-walk-test ('walking endurance') and the six-spot-step-test ('walking balance and coordination'). Data were compared to normative reference data in healthy controls. Results A total of 228 persons with multiple sclerosis (68% females) were involved in the study: age 53.7 ± 11.6 y (range 26-81 y); patient-determined-disease-steps 3 [IQR; 1; 4] (range 0-7); time since diagnosis 12.6 ± 9.9 y (range 0-49 y); MS-phenotype (relapse remitting MS, secondary progressive MS, primary progressive MS) 146/39/41; and co-morbidity n = 80 (35%). Compared to healthy controls, deficits were observed across all walking capacity outcomes (p < 0.001): timed 25-foot walk test -26 [-30; -23]%, 6 minute-walk-test -36 [-39; -32]% and six-spot-step-test -44 [-47; -40]%. Deficits differed across walking capacity outcomes (p < 0.001). Conclusion Altogether, persons with multiple sclerosis performed substantially worse than healthy controls across all three walking capacity outcomes. The results showed that the six-spot-step-test was superior to the timed 25-foot walk test and the 6 minute-walk-test in detecting walking capacity impairments in persons with multiple sclerosis.
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Affiliation(s)
- Anders G Skjerbæk
- The Danish MS Hospitals, Ry and Haslev, Denmark
- Exercise Biology, Department of Public Health, Aarhus University, Denmark
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Denmark
| | - Egon Stenager
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Finn Boesen
- The Danish MS Hospitals, Ry and Haslev, Denmark
| | - Lars G Hvid
- The Danish MS Hospitals, Ry and Haslev, Denmark
- Exercise Biology, Department of Public Health, Aarhus University, Denmark
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Daroudi R, Mousavi M, Shirazikhah M, Alizadeh Zarei M, Hendi H, Joghataei F, Darvishi A. Cost-utility analysis of multiple sclerosis rehabilitation in Iran. Expert Rev Pharmacoecon Outcomes Res 2023; 23:1129-1137. [PMID: 37614049 DOI: 10.1080/14737167.2023.2251689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/26/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Rehabilitation of Multiple Sclerosis (MS) is associated with various clinical, social and economic outcomes. We aimed to evaluate the cost-utility of MS multidisciplinary rehabilitation in Iran. RESEARCH DESIGN AND METHODS An economic evaluation was conducted using a Markov model designed to reflect the natural course of the disease and interventions. Parameters and variables were extracted from available evidence, and costs and outcomes were calculated from the social perspective. The base-case analysis considered a 5-year time horizon. Costs were estimated based on approved national standards for MS rehabilitation. Sensitivity analyses were also performed. RESULTS The average cost of the rehabilitation strategy was higher compared to the non-rehabilitation strategy, but it resulted in higher quality-adjusted life years (QALYs) values. The incremental cost-effectiveness ratio (ICER) was found to be $2,845.8 per QALY, indicating that the rehabilitation strategy is cost-effective. In the deterministic sensitivity analysis, extending the time horizon to 10 years made the rehabilitation strategy a dominant choice. Probabilistic sensitivity analysis results were consistent with the base-case findings. CONCLUSIONS The MS multidisciplinary rehabilitation proved to be a cost-effective strategy; however, the results were sensitive to the input values of the model. Increasing the time horizon increased the probability of rehabilitation being cost-effective.
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Affiliation(s)
- Rajabali Daroudi
- National Center for Health Insurance Research, Tehran, Iran
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mirtaher Mousavi
- Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Marzieh Shirazikhah
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mehdi Alizadeh Zarei
- Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Hendi
- Department of social welfare management, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Faezeh Joghataei
- Department of social welfare management, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ali Darvishi
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iranan
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Ju Q, Gan Y, Rinn R, Duan Y, Lippke S. Health Status Stability of Patients in a Medical Rehabilitation Program: What Are the Roles of Time, Physical Fitness Level, and Self-efficacy? Int J Behav Med 2022; 29:624-637. [PMID: 34940949 PMCID: PMC9525393 DOI: 10.1007/s12529-021-10046-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 10/25/2022]
Abstract
BACKGROUND Individuals' physical and mental health, as well as their chances of returning to work after their ability to work is damaged, can be addressed by medical rehabilitation. AIM This study investigated the developmental trends of mental and physical health among patients in medical rehabilitation and the roles of self-efficacy and physical fitness in the development of mental and physical health. DESIGN A longitudinal design that included four time-point measurements across 15 months. SETTING A medical rehabilitation center in Germany. POPULATION Participants included 201 patients who were recruited from a medical rehabilitation center. METHODS To objectively measure physical fitness (lung functioning), oxygen reabsorption at anaerobic threshold (VO2AT) was used, along with several self-report scales. RESULTS We found a nonlinear change in mental health among medical rehabilitation patients. The results underscored the importance of medical rehabilitation for patients' mental health over time. In addition, patients' physical health was stable over time. The initial level of physical fitness (VO2AT) positively predicted their mental health and kept the trend more stable. Self-efficacy appeared to have a positive relationship with mental health after rehabilitation treatment. CONCLUSIONS This study revealed a nonlinear change in mental health among medical rehabilitation patients. Self-efficacy was positively related to mental health, and the initial level of physical fitness positively predicted the level of mental health after rehabilitation treatment. CLINICAL REHABILITATION More attention could be given to physical capacity and self-efficacy for improving and maintaining rehabilitants' mental health.
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Affiliation(s)
- Qianqian Ju
- School of Psychological and Cognitive Sciences, Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China
| | - Yiqun Gan
- School of Psychological and Cognitive Sciences, Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China.
| | - Robin Rinn
- University of Würzburg, Wurzburg, Germany
| | - Yanping Duan
- Hong Kong Baptist University, Kowloon, Hong Kong
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Hvid LG, Gaemelke T, Dalgas U, Slipsager MK, Rasmussen PV, Petersen T, Nørgaard M, Skjerbaek AG, Boesen F. Personalised inpatient multidisciplinary rehabilitation elicits clinically relevant improvements in physical function in patients with multiple sclerosis - The Danish MS Hospitals Rehabilitation Study. Mult Scler J Exp Transl Clin 2021; 7:2055217321989384. [PMID: 33643662 PMCID: PMC7894699 DOI: 10.1177/2055217321989384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/02/2020] [Accepted: 12/20/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose Evidence of the effects of inpatient multidisciplinary rehabilitation (MDR) on physical function in patients with multiple sclerosis (MS) is limited, particularly whether clinically relevant improvements can be achieved. The aim of this study, therefore, was to investigate the effects of personalised inpatient MDR on the physical function of MS patients. Methods Embedded in the Danish MS Hospitals Rehabilitation Study, a pragmatic study was performed in MS patients undergoing four weeks of inpatient MDR specifically targeting physical function. Outcomes were assessed at baseline (n = 142), at discharge (n = 137) and at six months follow-up (n = 126) using the six-minute walk test (6MWT), six-spot step test (SSST), five times sit to stand test (5STS), nine-hole peg test (NHPT), dynamic gait index (DGI) and 12-item MS walking scale (MSWS). Results From Baseline-to-Discharge, significant and clinically relevant improvements were found in all measures of walking capacity (6MWT, SSST, 5STS, DGI and MSWS; p < 0.05) along with significant (but not clinically relevant) improvements in upper extremity function (NHPT; p < 0.05). Whilst comparable improvements were observed within subgroups of MS phenotype (relapsing-remitting [RR] vs. secondary + primary progressive [SP + PP]), disease severity (moderate [EDSS2.5–5.5] vs. severe [EDSS6.0–7.5]) and age (young/middle-aged [Age24–59] vs. old [Age60–65]), an attenuated adaptation was nevertheless observed for 6MWT in the most affected and vulnerable subgroups (i.e. SP + PP, EDSS6.0–7.5 and Age60–65). The significant improvements in walking capacity and upper extremity function persisted at six months follow-up but did not exceed anymore the thresholds regarded as clinically relevant. Conclusion The results provide novel evidence that personalised inpatient MDR targeting physical function in MS patients elicits significant and clinically relevant improvements in physical function.
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Affiliation(s)
| | | | | | - Mette K Slipsager
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Peter V Rasmussen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Thor Petersen
- Department of Regional Health Research, University Hospital of Southern Denmark, Odense, Denmark
| | | | | | - Finn Boesen
- MS Hospitals in Ry and Haslev, Haslev, Denmark
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Johansson S, Skjerbæk AG, Nørgaard M, Boesen F, Hvid LG, Dalgas U. Associations between fatigue impact and lifestyle factors in people with multiple sclerosis - The Danish MS hospitals rehabilitation study. Mult Scler Relat Disord 2021; 50:102799. [PMID: 33582566 DOI: 10.1016/j.msard.2021.102799] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The lack of medical treatment options to reduce fatigue in patients with multiple sclerosis (MS) emphasize the importance of identifying potential non-pharmacological modifiable factors, as this may help advance current treatment strategies. The aim of this study was to identify potential modifiable lifestyle factors as well as patient- and disease-related characteristics, that are associated with fatigue in a large sample of clinically well-characterized patients with MS. METHODS This study was a secondary analysis of a pragmatic randomized controlled trial of inpatient multidisciplinary rehabilitation in Denmark. MS patients aged 18 to 65 years and with a disease severity score ≤ 7.5 according to the Expanded Disability Status Scale participated. Data on patient- and disease-related characteristics, fatigue impact (Modified Fatigue Impact Scale (MFIS)), and on lifestyle factors (tobacco smoking, alcohol intake, and physical activity), were collected at baseline. A linear mixed model was used to compare MFIS total, physical, cognitive, and psychosocial scores across subgroups of selected characteristics. Regression analyses were used to examine associations between lifestyle factors and MFIS total, physical, cognitive, and psychosocial scores. RESULTS In the sample of 417 MS patients, median age was 51 years, 69% were female, median time since diagnosis was 8 years, with 41% having relapsing remitting MS. Higher MFIS total scores were observed in MS patients with shorter time since diagnosis, being a tobacco smoker, and not undertaking regular physical activity. Somewhat similar findings were observed for MFIS subscores (physical, cognitive, psychosocial), especially MFIS physical scores. In the multivariate analyses, physical activity was significantly associated with fatigue impact on total, physical and psychosocial functioning. Tobacco smoking was significantly associated with fatigue impact on psychosocial functioning. Alcohol intake was not associated with fatigue impact. None of the lifestyle factors were associated with fatigue impact on cognitive functioning. In the adjusted models time since diagnosis was significantly associated with fatigue impact on total, physical and cognitive functioning, as was disease severity with fatigue impact on physical and cognitive functioning. CONCLUSION Physical activity showed the most pronounced associations with fatigue impact on physical and psychosocial functioning, while the impact on cognitive functioning showed a trend. Tobacco smoking contributed significantly to impact on psychosocial functioning, while alcohol intake did not contribute to fatigue impact. Introducing or supporting maintenance of physical activity/exercise and cessation of tobacco smoking seems to be a useful approach for rehabilitation services to help patients with MS manage fatigue.
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Affiliation(s)
- Sverker Johansson
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Allied Health Professionals Function, Medical Unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.
| | | | | | - Finn Boesen
- MS Hospitals in Denmark, Ry and Haslev, Denmark
| | - Lars G Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
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Wade DT. What is rehabilitation? An empirical investigation leading to an evidence-based description. Clin Rehabil 2020; 34:571-583. [PMID: 32037876 PMCID: PMC7350200 DOI: 10.1177/0269215520905112] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 01/18/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND There is no agreement about or understanding of what rehabilitation is; those who pay for it, those who provide it, and those who receive it all have different interpretations. Furthermore, within each group, there will be a variety of opinions. Definitions based on authority or on theory also vary and do not give a clear description of what someone buying, providing, or receiving rehabilitation can actually expect. METHOD This editorial extracts information from systematic reviews that find rehabilitation to be effective, to discover the key features and to develop an empirical definition. FINDINGS The evidence shows that rehabilitation may benefit any person with a long-lasting disability, arising from any cause, may do so at any stage of the illness, at any age, and may be delivered in any setting. Effective rehabilitation depends on an expert multidisciplinary team, working within the biopsychosocial model of illness and working collaboratively towards agreed goals. The effective general interventions include exercise, practice of tasks, education of and self-management by the patient, and psychosocial support. In addition, a huge range of other interventions may be needed, making rehabilitation an extremely complex process; specific actions must be tailored to the needs, goals, and wishes of the individual patient, but the consequences of any action are unpredictable and may not even be those anticipated. CONCLUSION Effective rehabilitation is a person-centred process, with treatment tailored to the individual patient's needs and, importantly, personalized monitoring of changes associated with intervention, with further changes in goals and actions if needed.
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Affiliation(s)
- Derick T Wade
- Oxford Institute of Nursing, Midwifery and Allied Health Research (OxINMAHR) and Movement Science Group, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
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