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Helmlinger B, Pinter D, Hechenberger S, Bachmaier G, Khalil M, Heschl B, Damulina A, Pichler A, Enzinger C. Evaluation of the T25FW in minimally disabled people with multiple sclerosis. J Neurol Sci 2024; 462:123073. [PMID: 38852261 DOI: 10.1016/j.jns.2024.123073] [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: 01/15/2024] [Revised: 05/29/2024] [Accepted: 05/29/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Walking impairment is one of the most prevalent symptoms in people with multiple sclerosis (pwMS). In this study, we aimed to explore the usefulness of a simple walking test, the Timed 25 Foot Walk (T25FW), in detecting subtle differences in "fully ambulatory" pwMS compared to HC. METHODS We therefore investigated retrospective data from a clinical real-life cohort of 650 pwMS. We first analyzed the amount of patients showing clinically relevant impairment in the T25FW (T25FW > 6 s) within different levels of disability according to the Expanded Disability Status Scale (EDSS). For detailed analysis in "fully ambulatory" pwMS, we formed four groups according to the respective levels of disability (EDSS 0, EDSS 1, EDSS 1.5-2, EDSS 2.5-3), and compared their walking speed to age- and sex-matched healthy controls (HC). RESULTS In our cohort, the number of patients showing clinically relevant slowing in the T25FW ranged from 15% in "fully ambulatory" patients (EDSS 0-3) to 69% in patients with moderate (EDSS 3.5-5.5) and 100% in patients with severe impairment (EDSS ≥6). Further analyses in "fully ambulatory" patients revealed that all EDSS-subgroups showed significant slowing compared to HC. The mean difference to walking speed of HC became gradually more pronounced from 0.15 m/s in asymptomatic patients (EDSS 0) to 0.5 m/s in patients with EDSS 2.5-3. CONCLUSION These findings underline the ability of the T25FW to detect slowing even in patients with minimal disability. While the difference to HC was slightly below clinical relevance in asymptomatic patients (EDSS 0), slowing gradually worsened from EDSS 1 onwards and exceeded published thresholds for clinical meaningfulness.
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Affiliation(s)
- Birgit Helmlinger
- Medical University of Graz, Department of Neurology, Research Unit for Neuronal Plasticity and Repair, Graz, Austria; Medical University of Graz, Department of Neurology, Graz, Austria
| | - Daniela Pinter
- Medical University of Graz, Department of Neurology, Research Unit for Neuronal Plasticity and Repair, Graz, Austria; Medical University of Graz, Department of Neurology, Graz, Austria.
| | - Stefanie Hechenberger
- Medical University of Graz, Department of Neurology, Research Unit for Neuronal Plasticity and Repair, Graz, Austria; Medical University of Graz, Department of Neurology, Graz, Austria
| | - Gerhard Bachmaier
- Medical University of Graz, Institute for Medical Informatics, Statistics and Documentation, Graz, Austria
| | - Michael Khalil
- Medical University of Graz, Department of Neurology, Graz, Austria; Medical University of Graz, Neurology Biomarker Research Unit, Graz, Austria
| | - Bettina Heschl
- Medical University of Graz, Department of Neurology, Graz, Austria
| | - Anna Damulina
- Medical University of Graz, Department of Neurology, Graz, Austria
| | | | - Christian Enzinger
- Medical University of Graz, Department of Neurology, Research Unit for Neuronal Plasticity and Repair, Graz, Austria; Medical University of Graz, Department of Neurology, Graz, Austria
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Gaemelke T, Laustsen C, Feys P, Folkestad L, Andersen MS, Jørgensen NR, Jørgensen ML, Jespersen SN, Ringgaard S, Eskildsen SF, Dalgas U, Hvid LG. Effects of power training in older patients with multiple sclerosis on neurodegeneration, neuromuscular function, and physical function. A study protocol for the "power training in older multiple sclerosis patients (PoTOMS) randomized control trial. Contemp Clin Trials Commun 2024; 38:101279. [PMID: 38444875 PMCID: PMC10912361 DOI: 10.1016/j.conctc.2024.101279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/24/2024] [Accepted: 02/17/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction Approximately one-third of all persons with multiple sclerosis (pwMS) are older, i.e., having an age ≥60 years. Whilst ageing and MS separately elicit deteriorating effects on brain morphology, neuromuscular function, and physical function, the combination of ageing and MS may pose a particular challenge. To counteract such detrimental changes, power training (i.e., a type of resistance exercise focusing on moderate-to-high loading at maximal intended movement velocity) presents itself as a viable and highly effective solution. Power training is known to positively impact physical function, neuromuscular function, as well as brain morphology. Existing evidence is promising but limited to young and middle-aged pwMS, with the effects of power training remaining to be elucidated in older pwMS. Methods The presented 'Power Training in Older MS patients (PoTOMS)' trial is a national, multi-center, parallel-group, randomized controlled trial. The trial compares 24 weeks of usual care(n = 30) to 24 weeks of usual care and power training (n = 30). The primary outcome is whole brain atrophy rate. The secondary outcomes include changes in brain micro and macro structures, neuromuscular function, physical function, cognitive function, bone health, and patient-reported outcomes. Ethics and dissemination The presented study is approved by The Regional Ethics Committee (reference number 1-10-72-222-20) and registered at the Danish Data Protection Agency (reference number 2016-051-000001). All study findings will be published in scientific peer-reviewed journals and presented at relevant scientific conferences independent of the results. The www.clinicaltrials.gov identifier is NCT04762342.
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Affiliation(s)
- Tobias Gaemelke
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Christoffer Laustsen
- The MR Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Peter Feys
- REVAL, Rehabilitation Research Center, BIOMED, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Lars Folkestad
- Department of Endocrinology, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | | | - Niklas Rye Jørgensen
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Sune Nørhøj Jespersen
- Department of Physics and Astronomy, Aarhus University, Aarhus, Denmark
- Center of Functionally Integrative Neuroscience and MINDLab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Steffen Ringgaard
- The MR Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Simon F. Eskildsen
- Center of Functionally Integrative Neuroscience and MINDLab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Lars G. Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
- The Danish MS Hospitals, Ry and Haslev, Denmark
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Boková I, Gaemelke T, Novotná K, Hvid LG, Dalgas U. Effects of walking interventions in persons with multiple sclerosis-A systematic review. Mult Scler Relat Disord 2024; 84:105511. [PMID: 38412757 DOI: 10.1016/j.msard.2024.105511] [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: 06/02/2023] [Revised: 09/10/2023] [Accepted: 02/19/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE The aim of the present systematic review was to investigate the effects of voluntary walking interventions in persons with multiple sclerosis (pwMS). For this purpose, we developed a framework to describe the components of walking interventions. DATA SOURCES Two databases (MEDLINE/PubMed and EMBASE) were searched in January 2023. STUDY SELECTION Included studies enrolled pwMS and evaluated walking interventions with a duration of 2 weeks or longer. Further, they evaluated at least one walking-related outcome. Both RCTs and non-controlled studies were enrolled. DATA EXTRACTION Data were extracted using a customized spreadsheet, which included detailed information on patient characteristics, interventions, outcomes, and results. Based on the extracted results, the effect sizes (ES, Hedge's g) of the walking interventions were calculated if possible. The methodological quality of the included studies and their reporting was determined using the TESTEX evaluation tool. DATA SYNTHESIS Data from a total of n = 200 pwMS was included from N = 7 RCT´s (from 3 we used within-group data) and N = 5 single-group studies. On average 91.7 ± 9.9 % of the planned walking sessions were attended, 8.7 ± 10.5 % of the participants dropped out, and very few adverse events occurred. Walking interventions improved walking performance during short distance walk tests (ES ranging from -0.21 to -0.72, "walking time") and long distance walk tests (ES ranging from 0.27 to 0.72, "walking distance"). CONCLUSIONS Voluntary walking interventions appear to be safe and effective at improving walking performance in pwMS. However, well-powered walking intervention studies are needed to confirm these promising effects. The simplicity of walking interventions makes them highly relevant for ambulatory pwMS.
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Affiliation(s)
- Ivana Boková
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic; Department of Rehabilitation and Sports Medicine, 2nd Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czech Republic.
| | - Tobias Gaemelke
- Exercise Biology, Department of Public Health, Aarhus University, Denmark
| | - Klara Novotná
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic; Department of Rehabilitation Medicine, First Faculty of Medicine and General University Hospital in Prague, Czech Republic
| | - Lars G Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Denmark; The Danish MS Hospitals, Ry and Haslev, Denmark
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Denmark
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Huynh TLT, Feasel CD, Jeng B, Motl RW. Cross-sectional, comparative study of health-related quality of life across the adult lifespan in multiple sclerosis. Int J Neurosci 2024:1-8. [PMID: 38441501 DOI: 10.1080/00207454.2024.2327404] [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: 07/19/2023] [Accepted: 03/02/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE This study examines the independent and interactive effects of age and multiple sclerosis (MS) on health-related quality of life (HRQOL). MATERIALS AND METHODS The sample included persons with MS (n = 207) and healthy controls (HCs; n = 99) divided into three age groups (young, middle-aged, and older adults) who completed a battery of questionnaires, including the 36-item Short-Form Health Survey (SF-36) as a measure of HRQOL. The SF-36 yielded scores for the Physical Component Summary (PCS) (i.e. physical HRQOL) and Mental Component Summary (MCS) (i.e. mental HRQOL). The data were analyzed using two-way MANOVA. RESULTS There was no interaction between age and disease status on HRQOL, but there were significant main effects of age and disease status on HRQOL. HRQOL was significantly lower in participants with MS than HCs, regardless of age. Physical HRQOL was lower, whereas mental HRQOL was higher across age groups. CONCLUSION The findings suggest that future research should develop behavioral and rehabilitation approaches that are applicable for improving HRQOL across the lifespan in persons with MS, particularly for physical HRQOL in older adults with MS.
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Affiliation(s)
- Trinh L T Huynh
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Corey D Feasel
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brenda Jeng
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Robert W Motl
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA
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Jeng B, Huynh TLT, Motl RW. Comorbid Conditions and Physical Function in Adults With Multiple Sclerosis. Arch Phys Med Rehabil 2024; 105:251-257. [PMID: 37442217 DOI: 10.1016/j.apmr.2023.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/12/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE We examined the total number of comorbid conditions as a correlate of physical function in persons with multiple sclerosis (MS). We further identified the presence of common comorbid conditions and examined physical function outcomes based on presence or absence of the comorbid conditions in persons with MS. DESIGN Cross-sectional, comparative study. SETTING University-based laboratory. PARTICIPANTS Two hundred seven persons with MS (N=207) completed the study. MAIN OUTCOME MEASURES Participants provided demographic, clinical, and comorbidity information. Participants then completed the 6-minute walk (6MW), timed 25-foot walk (T25FW), timed Up and Go (TUG), and short physical performance battery (SPPB). INTERVENTIONS Not applicable. RESULTS The number of comorbid conditions was associated with 6MW, T25FW, TUG, and SPPB scores (all P≤.001). Persons with MS who had hypertension performed worse on the 6MW, T25FW, TUG, and SPPB than persons without hypertension. Persons who had osteoarthritis performed worse on the 6MW, T25FW, and SPPB than persons without osteoarthritis. CONCLUSIONS The results demonstrate that persons who report more comorbid conditions have worse physical function, and this may largely be associated with hypertension or osteoarthritis. There are opportunities for the design of behavioral interventions that target physical activity and/or diet for improving physical function via comorbid conditions in persons with MS.
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Affiliation(s)
- Brenda Jeng
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL; Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL.
| | - Trinh L T Huynh
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL; Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL
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Schlagheck ML, Bansi J, Langeskov-Christensen M, Zimmer P, Hvid LG. Cardiorespiratory fitness (V̇O 2peak) across the adult lifespan in persons with multiple sclerosis and matched healthy controls. J Sci Med Sport 2024; 27:10-15. [PMID: 37951825 DOI: 10.1016/j.jsams.2023.10.009] [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: 07/16/2023] [Revised: 09/26/2023] [Accepted: 10/13/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES Cardiorespiratory fitness (measured as peak oxygen uptake; V̇O2peak) is a well-established health predictor in the general population and in persons with multiple sclerosis (pwMS). We aimed to investigate differences in V̇O2peak between age groups and the prevalence of V̇O2peak impairments across the adult lifespan in pwMS compared to age- and sex-matched healthy controls (HC). DESIGN Cross-sectional study. METHODS Data from 469 pwMS (EDSS range 1.0-7.0), who carried out graded cardiopulmonary exercise testing during their rehabilitation stay at the Valens clinic from 07/2010 to 10/2022, were retrospectively analyzed. Data from 21,063 HC were extracted from previously published studies containing normative reference values. RESULTS With advanced age (i.e., across age groups), a continuous deterioration of V̇O2peak was observed in both pwMS and HC. Within all age groups, V̇O2peak was reduced in pwMS compared to HC with deficits ranging from 29 % to 40 % for females (p < .05), and from 30 % to 41 % for males (p < .05). However, no age ∗ group interaction was observed in neither males (p = .626) nor females (p = .557). With V̇O2peak impairments defined as values below the 5th percentile of HC, a high prevalence was observed in pwMS, with values ranging from 48 % to 100 % across age groups. CONCLUSIONS The present data provide evidence for a parallel deterioration of V̇O2peak in pwMS and matched controls with advancing age, coinciding with a high prevalence of impairments in V̇O2peak already present in young adulthood in pwMS. Understanding the extent of impairments as well as the age trajectories of cardiorespiratory fitness in pwMS is crucial for designing optimal rehabilitative and preventive interventions.
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Affiliation(s)
- Marit L Schlagheck
- Division of Performance and Health, Institute for Sport and Sport Science, Technical University Dortmund, Germany.
| | - Jens Bansi
- Department of Research and Development, Kliniken Valens, Switzerland; OST - Eastern Swiss University of Applied Sciences, Department of Health, Switzerland
| | - Martin Langeskov-Christensen
- Exercise Biology, Department of Public Health, Aarhus University, Denmark; Department of Neurology, Viborg Regional Hospital, Denmark. https://twitter.com/LangekovMartin
| | - Philipp Zimmer
- Division of Performance and Health, Institute for Sport and Sport Science, Technical University Dortmund, Germany. https://twitter.com/P_Zimmer
| | - Lars G Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Denmark; The Danish MS Hospitals, Ry and Haslev, Denmark. https://twitter.com/HvidLars
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Dalgas U, Riemenschneider M, Gold SM, Kalron A, Beckerman H, de Groot V, Dennett R, Edwards T, Pilutti LA, Freeman J. The MoXFo initiative - study design: Considerations related to study design and methodology in exercise research for people with multiple sclerosis. Mult Scler 2023; 29:1561-1568. [PMID: 37880962 DOI: 10.1177/13524585231204456] [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] [Indexed: 10/27/2023]
Abstract
BACKGROUND Exercise as a subset of physical activity is a cornerstone in the management of multiple sclerosis (MS) based on its pleiotropic effects, but continued progression of the field requires better future designs and methodologies. OBJECTIVES This paper outlines the work of the 'Study design and methodology' group of the MoXFo (moving exercise research forward) initiative, and addresses critical aspects and future directions when defining the research question of interest, and subsequently, designing the study and exercise intervention in MS patients. METHODS The work is based on the formation of an international expert panel formed within the MoXFo initiative. We provide a structured and concise synthesis of exercise-specific MS research challenges and considerations when designing randomized controlled trials (RCTs). RESULTS Challenges and considerations are presented using the Patient population, Intervention, Comparator, Outcomes, Timing, Setting (PICOTS) framework, thereby forming a new and specific MS exercise PICOTS framework. CONCLUSION We propose that researchers should carefully consider and align all elements of this MS exercise PICOTS framework when developing future research questions and study designs, ultimately improving the quality of new exercise studies in people with MS.
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Affiliation(s)
- Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus C, Denmark
| | | | - Stefan M Gold
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Section of Psychosomatic Medicine, Medical Department, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Alon Kalron
- Department of Physical Therapy, The Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neurosciences, Tel Aviv University, Tel Aviv, Israel
- Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Israel
| | - Heleen Beckerman
- Amsterdam UMC location Vrije Universiteit, Department of Rehabilitation Medicine, MS Center Amsterdam, Amsterdam, The Netherlands
- Societal Participation & Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Vincent de Groot
- Amsterdam UMC location Vrije Universiteit, Department of Rehabilitation Medicine, MS Center Amsterdam, Amsterdam, The Netherlands
- Societal Participation & Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Rachel Dennett
- School of Health Professions, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Thomas Edwards
- School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
| | - Lara A Pilutti
- Interdisciplinary School of Health Sciences, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Jenny Freeman
- School of Health Professions, Faculty of Health, University of Plymouth, Plymouth, UK
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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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Byrnes-Blanco L, Reed K, Dubey R, Carey SL. A systematic literature review of ankle-foot orthosis and functional electrical stimulation foot-drop treatments for persons with multiple sclerosis. Prosthet Orthot Int 2023; 47:358-367. [PMID: 36701192 DOI: 10.1097/pxr.0000000000000190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 08/17/2022] [Indexed: 01/27/2023]
Abstract
Foot-drop is one of the most diagnosed and physically limiting symptoms persons with multiple sclerosis (pwMS) experience. Clinicians prescribe ankle-foot orthosis (AFO) and functional electrical stimulation (FES) devices to help alleviate the effects of foot drop, but it is unclear how their clinical and functional gait improvements compare given the user's level of disability, type of multiple sclerosis, walking environment, or desired physical activity. The research questions explored were what is the current state of AFO and FES research for pwMS? What are the prevailing research trends? What definitive clinical and functional device comparisons exist for pwMS? eight databases were systematically searched for relevant literature published between 2009 and 2021. The American Association of Orthotists and Prosthetists and Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines for systematic literature reviews were followed. A team of 3 researchers critically evaluated 17 articles that passed eligibility criteria. This review discusses the current state and trends of research, provides evidence statements on device effects, and recommends improvements for future studies. A meta-analysis would be informative, but study variability across the literature makes directly comparing AFO and FES device effects unreliable. This review contributes new and useful information to multiple sclerosis literature that can be used by both clinicians and researchers. Clinicians can use the provided insights to prescribe more effective, customized treatments, and other researchers can use them to evaluate and design future studies.
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Jeng B, Šilić P, Bollaert RE, Sandroff BM, Motl RW. Physical function across the lifespan in adults with multiple sclerosis: An application of the Short Physical Performance Battery. Mult Scler Relat Disord 2023; 73:104624. [PMID: 37004273 DOI: 10.1016/j.msard.2023.104624] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 03/08/2023] [Accepted: 03/17/2023] [Indexed: 03/22/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) typically has its onset in early and middle adulthood, but the population is steadily becoming more dominated by older adults. One of the primary consequences of both MS and aging involves declines of lower extremity physical function and mobility. This cross-sectional study compared physical function status based on Short Physical Performance Battery (SPPB) summary and component scores between persons with MS and healthy controls across 6 age groups. We further examined associations between SPPB summary scores and component scores as well as associations between summary scores and measures of physical and cognitive function for identifying the strongest correlates of SPPB summary scores. METHODS The study involved secondary analysis of cross-sectional data from multiple studies. Ambulatory adults with MS who were relapse-free for the last 30 days were recruited, and controls were recruited based on similar criteria to adults with MS except without the diagnosis of MS or relapses. The sample of 345 persons with MS and 174 controls completed questionnaires regarding demographic and clinical information and underwent assessments of physical and cognitive function including the SPPB, 6-Minute Walk, Timed 25-Foot Walk, Symbol Digit Modalities Test, California Verbal Learning Test-Second Edition, and Brief Visuospatial Memory Test-Revised. RESULTS The two-way ANOVA indicated a main effect of MS status (F(5,500)=34.74, p<.01, η2=0.065), a main effect of age (F(1,500)=3.88, p<.01, η2=0.037), and no MS status by age interaction (F(5,500)=1.20, p=.31, η2=0.012) on SPPB scores. The bivariate correlation analysis indicated that summary SPPB scores were associated with component SPPB scores in the overall samples of persons with MS (rs=0.71 to 0.83) and controls (rs=0.42 to 0.91) as well as within most age groups of MS (rs=0.63 to 0.91) and controls (rs=0.34 to 1.00). The associations between SPPB scores and physical function outcomes were larger in the sample of persons with MS (rs=-0.72 to 0.76) than controls (rs=-0.47 to 0.48). SPPB scores were further significantly associated with scores on cognitive outcomes in persons with MS (rs=0.31 to 0.43), whereas these associations were weaker in controls (rs=0.09 to 0.32). Overall, the associations between SPPB scores and physical function outcomes were stronger than the associations between SPPB scores and cognitive function outcomes. CONCLUSION Overall, MS status and aging have additive effects on physical function, and the summary SPPB score may be driven by a specific component within each age group. SPPB scores may be driven more by mobility rather than cognition, and are consistent with cognitive-motor coupling in MS. The novelty of this study provides evidence of worsening physical function based on the application of the SPPB and its scores across the lifespan in persons with MS and controls, and this has important implications particularly given the increasing prevalence of older adults with MS.
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Affiliation(s)
- Brenda Jeng
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, United States.
| | - Petra Šilić
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, United States.
| | - Rachel E Bollaert
- Program in Exercise Science, Department of Physical Therapy, Marquette University, Milwaukee, WI, United States.
| | - Brian M Sandroff
- Center for Neuropsychology and Neuroscience Research, Kessler Foundation, West Orange, NJ, United States; Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States.
| | - Robert W Motl
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, United States.
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Hortobágyi T, Ács P, Baumann P, Borbély G, Áfra G, Reichardt-Varga E, Sántha G, Tollár J. Comparative effectiveness of four exercise interventions followed by two years of exercise maintenance in multiple sclerosis: A randomized control trial. Arch Phys Med Rehabil 2022; 103:1908-1916. [PMID: 35584738 DOI: 10.1016/j.apmr.2022.04.012] [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: 12/11/2021] [Revised: 03/25/2022] [Accepted: 04/20/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To determine the effects of Exergaming on quality of life (QoL), motor, and clinical symptoms in Multiple Sclerosis. We compared the effects of exergaming (EXE), balance (BAL), cycling (CYC), proprioceptive neuromuscular facilitation (PNF), and a standard care wait-listed control group (CON) on clinical and motor symptoms and quality of life (QoL) in people with MS (PwMS) and determined the effects of subsequent maintenance programs for 2 years in a hospital setting. DESIGN A randomized clinical trial, using before-after test design. SETTINGS University Hospital Setting PARTICIPANTS: Of 82 multiple sclerosis outpatients, 70 were randomized, and 68 completed the study. INTERVENTIONS The initial high-intensity and -frequency interventions consisted of 25, 1-h sessions over 5 weeks. After the 5-wk-long initial intervention, the 2-year-long maintenance programs followed, consisting of 3 sessions per week, each for 1h. MAIN OUTCOME MEASURES The primary outcome: Multiple Sclerosis Impact Scale (MSIS-29). SECONDARY OUTCOMES Measures five aspects of health-related QoL (EQ-5D index), Beck Depression Inventory, six-minute walk test (6MWT), Berg Balance Scale (BBS), Tinetti Assessment Tool (TAT) and static balance (center of pressure, COP). RESULTS MSIS-29 improved most in EXE (11 points), BAL (6), and CYC (6, all p<0.05). QoL improved most in EXE (3 points) and CYC and BAL (2, all p<0.05). TAT and BBS improved significantly (p<0.05) but similarly (p>0.05) in EXE, BAL, and CYC. 6MWT improved most in EXE (57m), BAL (32m), and CYC (19m all p<0.001). Standing sway did not change. Maintenance programs further increased the initial exercise-induced gains, robustly in EXE. CONCLUSION 25 sessions of EXE, BAL, CYC, and PNF, in this order, improved clinical and motor symptoms and QoL and subsequent, 2-y-long thrice weekly maintenance programs further slowed symptom-worsening and improved QoL. EXE was the most and PNF was the least effective to improve clinical symptoms, motor function, and QoL in PwMS.
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Affiliation(s)
- Tibor Hortobágyi
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, The Netherlands; Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary; Department of Sport Biology, Institute of Sport Sciences and Physical Education, University of Pécs, Hungary; Departments of Epidemiology and Neurosurgery, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Pongrác Ács
- University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences, Pécs, Hungary
| | - Petra Baumann
- University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences, Pécs, Hungary; Department of Dentistry, Oral and Maxillofacial Surgery, Pécs
| | - Gábor Borbély
- University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences, Pécs, Hungary
| | - György Áfra
- University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences, Pécs, Hungary
| | - Emese Reichardt-Varga
- University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences, Pécs, Hungary
| | - Gergely Sántha
- University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences, Pécs, Hungary
| | - József Tollár
- Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary; University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences, Pécs, Hungary; Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Hungary; Széchényi István University, Digital Development Center, Győr, Hungary.
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Objectively assessed physiological, physical, and cognitive function along with patient-reported outcomes during the first 2 years of Alemtuzumab treatment in multiple sclerosis: a prospective observational study. J Neurol 2022; 269:4895-4908. [PMID: 35482080 DOI: 10.1007/s00415-022-11134-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION In persons with multiple sclerosis (pwMS), little evidence exist on the effects of Alemtuzumab on physiological, physical, and cognitive function along with patient-reported outcomes, despite these domains are being rated as highly important. Therefore, our purpose was to perform a prospective observational study to examine these outlined outcomes during the first two years of Alemtuzumab treatment in pwMS. METHODS In n = 17 relapsing-remitting pwMS, physiological function [body composition; bone mineral content; muscle strength; aerobic capacity], physical function [6-min walk test (6MWT, primary outcome); timed 25 ft walk test (T25FWT); six spot step test (SSST); 9-step stair ascend (9SSA); timed up and go test (TUG); 5 × sit to stand test (5STS)], cognitive function [selective reminding test (SRT); symbol digit modalities test (SDMT)], and patient-reported outcomes [multiple sclerosis impact scale-29 (MSIS29); 12-item multiple sclerosis walking scale (MSWS12); modified fatigue impact scale (MFIS); hospital anxiety and depression scale (HADS)] were assessed prior to Alemtuzumab treatment initiation as well as 3, 6, 12, and 24 months into the treatment. RESULTS Improvements were observed at 24-month follow-up in T25FWT (+ 8%), SSST (+ 10%), SDMT (+ 5.2 points, 53% improved more than the clinical cut-off score) and SRT, whereas the primary outcome 6MWT, and all other remaining outcomes, remained stable throughout the Alemtuzumab treatment period. CONCLUSION The present findings suggest that Alemtuzumab treatment in relapsing-remitting pwMS can improve certain domains of physical function (short distance walking) and cognitive function (processing speed, memory), and furthermore stabilize physiological and physical function along with patient-reported outcomes. TRIAL REGISTRATION Registered at clinicaltrials.gov: NCT03806387.
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Langeskov‐Christensen M, Hvid LG, Jensen HB, Nielsen HH, Petersen T, Stenager E, Dalgas U. Efficacy of high-intensity aerobic exercise on common multiple sclerosis symptoms. Acta Neurol Scand 2022; 145:229-238. [PMID: 34687036 DOI: 10.1111/ane.13540] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/21/2021] [Accepted: 10/07/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Fatigue and walking impairment are disabling symptoms of multiple sclerosis (MS). We investigated the effects of progressive aerobic exercise (PAE) on fatigue, walking, cardiorespiratory fitness (VO2 max), and quality of life in people with MS (pwMS). MATERIALS & METHODS Randomized controlled trial (1:1 ratio, stratified by sex) with a 24-week crossover follow-up and intention-to-treat analysis. Allocation to an exercise (24 weeks of PAE followed by self-guided physical activity) and a waitlist (24 weeks of habitual lifestyle followed by PAE) group. PAE comprised two supervised sessions per week; 30-60 min, 65-95% of maximum heart rate. Fatigue impact (Modified Fatigue Impact Scale; MFIS) and severity (Fatigue Severity Scale; FSS), walking ability (12-item MS Walking Scale; MSWS-12) and capacity (Six-Minute Walk Test; 6MWT, Six Spot Step Test; SSST), quality of life (Short Form 36 health survey; SF-36), and VO2 max were measured at baseline, 24 weeks, and 48 weeks. RESULTS Eighty-six pwMS were enrolled. Following PAE between-group differences showed reductions in MFIStotal (-5.3 [95% CI: -10.9;0.4], point estimate >clinical relevance), MFISphysical subscore (-2.8 [-5.6;-0.1]), and MFISpsychosocial subscore (-0.9 [-1.6;-0.2]), and an increase in VO2 max (+3.5 ml O2 /min/kg [2.0;5.1]). MSWS-12 (-5.9 [-11.9; 0.2]) and 6MWT (+14 m [-5;33]) differences suggested potential small walking improvements. No changes observed in FSS, SSST, or SF-36. CONCLUSIONS In a representative sample of pwMS, PAE induced a clinically relevant reduction in fatigue impact, whereas small and no effects were seen for walking and quality of life, respectively. The results need confirmation in a future trial due to the study limitations.
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Affiliation(s)
| | - Lars Grøndahl Hvid
- Exercise Biology Department of Public Health Aarhus University Aarhus Denmark
| | - Henrik Boye Jensen
- Brain and Nerve Diseases Lillebaelt Hospital Kolding Denmark
- Department of Regional Health Research University of Southern Denmark Odense Denmark
| | - Helle Hvilsted Nielsen
- Department of Neurobiology Research Institute of Molecular Medicine University of Southern Denmark Odense Denmark
- Department of Neurology Odense University Hospital Odense Denmark
- BRIDGE ‐ Brain Research ‐ Inter‐Disciplinary Guided Excellence Department of Clinical Research University of Southern Denmark Odense Denmark
| | - Thor Petersen
- The Multiple Sclerosis Clinic Department of Neurology Aarhus University Hospital Aarhus Denmark
| | - Egon Stenager
- Department of Regional Health Research University of Southern Denmark Odense Denmark
| | - Ulrik Dalgas
- Exercise Biology Department of Public Health Aarhus University Aarhus Denmark
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Baird JF, Cutter GR, Motl RW. Do Physical Activity, Cardiorespiratory Fitness, and Subcortical Brain Structures Explain Reduced Walking Performance in Older Adults with Multiple Sclerosis? Mult Scler Relat Disord 2022; 60:103702. [DOI: 10.1016/j.msard.2022.103702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 01/04/2022] [Accepted: 02/19/2022] [Indexed: 10/19/2022]
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Is Aerobic or Resistance Training the Most Effective Exercise Modality for Improving Lower Extremity Physical Function and Perceived Fatigue in People With Multiple Sclerosis? A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2021; 102:2032-2048. [PMID: 33901439 DOI: 10.1016/j.apmr.2021.03.026] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/10/2021] [Accepted: 03/25/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of this systematic review was to investigate whether aerobic training (AT) or resistance training (RT) is most effective in terms of improving lower limb physical function and perceived fatigue in persons with multiple sclerosis (PwMS). DATA SOURCES Nine databases (MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health, Allied and Complementary Medicine Database, Physiotherapy Evidence Database, SPORTDiscus, PsycINFO, Web of Science, and Scopus) were electronically searched in April 2020. STUDY SELECTION Included studies were randomized controlled trials (RCTs) involving PwMS attending 1 of 2 exercise interventions: AT or RT. Studies had to include at least 1 objective or self-reported outcome of lower extremity physical function and/or perceived fatigue. DATA EXTRACTION Data were extracted using a customized spreadsheet, which included detailed information on patient characteristics, interventions, and outcomes. The methodological quality of the included studies was independently assessed by 2 reviewers using the Tool for Assessment of Study Quality for Reporting on Exercise rating scale. DATA SYNTHESIS Twenty-seven articles reporting data from 22 RCTS (AT=14, RT=8) including 966 PwMS. The 2 modalities were found to be equally effective in terms of improving short walk test (AT: effect size [ES]=0.33 [95% confidence interval (CI), -1.49 to 2.06]; RT: ES=0.27 [95% CI, 0.07-0.47]) and long walk test performance (AT: ES=0.37 [95% CI, -0.04 to 0.78]; RT: ES=0.36 [95% CI, -0.35 to 1.08]), as well as in reducing perceived fatigue (AT: ES=-0.61 [95% CI, -1.10 to -0.11]; RT: ES=-0.41 [95% CI, -0.80 to -0.02]). Findings on other functional mobility tests along with self-reported walking performance were sparse and inconclusive. CONCLUSIONS AT and RT appear equally highly effective in terms of improving lower extremity physical function and perceived fatigue in PwMS. Clinicians can thus use either modality to target impairments in these outcomes. In a future perspective, head-to-head exercise modality studies are warranted. Future MS exercise studies are further encouraged to adapt a consensus "core battery" of physical function tests to facilitate a detailed comparison of results across modalities.
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Lower extremity muscle power - A critical determinant of physical function in aging and multiple sclerosis. Exp Gerontol 2021; 150:111347. [PMID: 33872737 DOI: 10.1016/j.exger.2021.111347] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND PURPOSE In aging, lower extremity muscle power is undoubtedly one of the most important parameters of neuromuscular function implicating lower extremity physical function (e.g. walking capacity). However, no previous studies have examined the combined effects of aging and multiple sclerosis (MS) on lower extremity muscle power concomitant with lower extremity physical function. The aim of this cross-sectional study was to examine potential decrements in pwMS vs. healthy controls (HC) across the adult lifespan in these outcomes. METHODS In the present explorative cross-sectional study, n = 42 pwMS (females n = 29 (69%); age = 53 ± 12 years (mean ± SD), range 31-78; patient determined disease steps score = 3.7 ± 1.7, range 0-7) and n = 49 age-matched HC (females n = 34 (69%); age = 56 ± 16 years, range 24-78) were enrolled, and divided into groups of young (≤ 44 years), middle-aged (45-59 years), and old (≥ 60 years). Muscle power was obtained from bilateral leg press (PowerLegPressPeak) and maximal chair rise (PowerChairRise) using a linear encoder. Associations were assessed between muscle power and measurements of lower extremity physical function (5 x sit-to-stand (5STS); timed 25-foot-walk-test (T25FWT)). RESULTS Muscle power was reduced in pwMS vs. HC (PowerLegPressPeak -23[-34:-12]% (mean[95%CI]); PowerChairRise -26[-35:-17]%) and was negatively associated with advanced age in both pwMS (decline per decade -0.40 W.kg-1 and -2.53 W.kg-1, respectively) and HC (decline per decade -0.42 W.kg-1 and -2.03 W.kg-1, respectively). Muscle power was strongly associated with physical function in pwMS (r2range = 0.45-0.61, p < 0.01) yet only moderately associated in HC (r2range = 0.18-0.39, p < 0.01). CONCLUSION The combined effects of MS and aging reveal substantial decrements in lower extremity muscle power that is accompanied by (and strongly associated with) decrements in lower extremity physical function. Consequently, lower extremity muscle power should be viewed as a clinically important factor (i.e. a critical determinant of lower extremity physical function) in pwMS. We propose that lower extremity muscle power should be specifically targeted by preventive and rehabilitative exercise strategies, especially in older pwMS.
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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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Sieljacks PS, Søberg CA, Michelsen AS, Dalgas U, Hvid LG. Lower extremity muscle strength across the adult lifespan in multiple sclerosis: Implications for walking and stair climbing capacity. Exp Gerontol 2020; 139:111025. [DOI: 10.1016/j.exger.2020.111025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/03/2020] [Accepted: 07/16/2020] [Indexed: 01/22/2023]
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