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Binshalan T, Buckley E, Nair S, Mcneill A. Variability of Multiple Sclerosis Walking Scale and Multiple Sclerosis Impact Scale Scores in People Without Multiple Sclerosis. Cureus 2024; 16:e51811. [PMID: 38322083 PMCID: PMC10846872 DOI: 10.7759/cureus.51811] [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] [Accepted: 01/07/2024] [Indexed: 02/08/2024] Open
Abstract
Introduction Many people with multiple sclerosis (pwMS) experience problems with mobility at some point in their disease course. The Multiple Sclerosis Impact Scale (MSIS) and Multiple Sclerosis Walking Scale (MSWS) are validated patient-reported outcome measures of physical impairment in pwMS. The range of scores on MSIS and MSWS in people without MS (pwoMS) are not well understood. Methods People over the age of 16 who did not have a diagnosis of multiple sclerosis (MS) were invited to complete an online survey consisting of a general health questionnaire, MSIS and the MSWS. Scores for MSIS and MSWS from pwoMS were compared to those from a cohort of 35 pwMS from a previous study. Scores for MSIS and MSWS were correlated with age, sex and comorbidities in pwoMS. Results One hundred eighty-nine ambulant pwoMS were recruited (52.5% female), aged over 16 years of age. Ninety-nine percent reported no difficulty with walking, 89.4% were non-smokers, and 14% had a physical co-morbidity. None used a walking aid. For pwoMS, the MSIS score was a mean of 39.14±13.75 (range 29-127), compared to a mean of 77.2±24.94 (range 40-126) for pwMS. For pwoMS, the mean MSWS score was 8.46±16.2 (0-87) compared to a mean of 56.9±28.9 (4-100) for pwMS. There was no significant effect of sex or smoking on MSIS or MSWS scores in pwoMS. Presence of a physical co-morbidity was associated with significantly higher MSIS and MSWS scores in pwoMS. There was a significant correlation of increasing age with increasing MSWS score in pwoMS but no correlation of age with MSIS score. Conclusion There is a wide range of MSWS and MSIS scores in pwoMS. The age and presence of comorbidities influence both MSWS and MSIS scores. Our findings have implications for the selection of control groups for clinical studies in pwMS.
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Affiliation(s)
| | - Ellen Buckley
- Neuroscience, The University of Sheffield, Sheffield, GBR
| | - Siva Nair
- Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, GBR
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Chorschew A, Kesgin F, Bellmann-Strobl J, Flachenecker P, Schiffmann I, Rosenthal F, Althoff P, Drebinger D, Arsenova R, Rasche L, Dorsch EM, Heesen C, Paul F, Stellmann JP, Schmitz-Hübsch T. Translation and validation of the multiple sclerosis walking scale 12 for the German population - the MSWS-12/D. Health Qual Life Outcomes 2023; 21:110. [PMID: 37814258 PMCID: PMC10563229 DOI: 10.1186/s12955-023-02190-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 09/12/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Gait impairment is a relevant problem in persons with multiple sclerosis (pwMS). The Multiple Sclerosis Walking Scale 12 (MSWS-12) is a valid Patient Reported Outcome Measure (PROM) to evaluate walking ability in pwMS. The aim of this study was to provide a linguistically valid translation of MSWS-12 into German language (MSWS-12/D) and to evaluate its psychometric properties. METHODS The MSWS-12 was translated in a process modified from guidelines for the cross-cultural adaption of PROMs, and a pre-test was applied in a small sample of 20 pwMS to evaluate comprehensibility and acceptance. Psychometric properties (floor and ceiling effects, internal consistency, construct validity) were then assessed in 124 pwMS seen at academic MS centers. Construct validity was evaluated against Expanded Disability Status Scale (EDSS) and maximum gait speed in the Timed 25-Foot Walk (T25FW). RESULTS Although the sample covered a wide spectrum of symptom severity, the majority had rather low levels of disability (EDSS median 2.0) and 6.5% scored EDSS of 0. In this sample, MSWS-12/D showed floor effects (36% with score 0) and for internal consistency, a Cronbach's alpha of 0.98 was calculated. MSWS-12/D score showed a relevant correlation to EDSS (ρ = 0.73) and T25FW speed (r=-0.72). CONCLUSION We provide MSWS-12/D as a linguistically valid German version of MSWS-12. Psychometric properties (acceptance, floor and ceiling effects, internal consistency and construct validity) in pwMS were similar to those described for the original version. This indicates that MSWS-12/D can be applied as equivalent to the original version in German speaking pwMS. Results support the relevance of PROMs to capture patient perception of walking ability in addition to performance-based assessments such as maximum walking speed or maximum walking distance.
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Affiliation(s)
- Anna Chorschew
- Experimental and Clinical Research Center (ECRC), a cooperation between Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Lindenberger Weg 80, 13125, Berlin, Germany
- Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Firat Kesgin
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Judith Bellmann-Strobl
- Experimental and Clinical Research Center (ECRC), a cooperation between Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Lindenberger Weg 80, 13125, Berlin, Germany
- Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | | | - Insa Schiffmann
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Friederike Rosenthal
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Patrick Althoff
- Experimental and Clinical Research Center (ECRC), a cooperation between Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Lindenberger Weg 80, 13125, Berlin, Germany
- Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Daniel Drebinger
- Experimental and Clinical Research Center (ECRC), a cooperation between Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Lindenberger Weg 80, 13125, Berlin, Germany
- Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Department of Physical Medicine and Rehabilitation, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Radina Arsenova
- Experimental and Clinical Research Center (ECRC), a cooperation between Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Lindenberger Weg 80, 13125, Berlin, Germany
- Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Department of Pediatrics, St Joseph Krankenhaus Berlin-Tempelhof, Berlin, Germany
| | - Ludwig Rasche
- Department of Psychiatry, Schlosspark-Klinik Charlottenburg, Berlin, Germany
| | - Eva-Maria Dorsch
- Experimental and Clinical Research Center (ECRC), a cooperation between Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Lindenberger Weg 80, 13125, Berlin, Germany
- Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center (ECRC), a cooperation between Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Lindenberger Weg 80, 13125, Berlin, Germany
- Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Neuroscience Clinical Research Center, Charité - Universitätsmedizin Berlin, Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Jan-Patrick Stellmann
- Aix-Marseille Univ, CNRS, CRMBM, UMR 7339; APHM La Timone, CEMEREM, Marseille, France
- APHM, Hospital de la Timone, CEMEREM, Marseille, France
| | - Tanja Schmitz-Hübsch
- Experimental and Clinical Research Center (ECRC), a cooperation between Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Lindenberger Weg 80, 13125, Berlin, Germany.
- Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.
- Neuroscience Clinical Research Center, Charité - Universitätsmedizin Berlin, Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.
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Jerković A, Nikolić Ivanišević M, Šimić N, Poljičanin A, Đogaš Z, Rogić Vidaković M. Psychometric properties of the Croatian version of the Multiple Sclerosis Walking Scale (MSWS-12). Disabil Rehabil 2023; 45:3373-3378. [PMID: 36222552 DOI: 10.1080/09638288.2022.2132301] [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: 01/27/2022] [Revised: 08/30/2022] [Accepted: 09/04/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Walking difficulties in people with multiple sclerosis (pwMS) are one of the most pronounced predictors affecting patients' quality of life. The study objective was to determine the psychometric properties of the Croatian version of the Multiple Sclerosis Walking Scale (MSWS-12) among pwMS in Croatia and to examine the association between MSWS-12 and Depression, Anxiety, and Stress Scale-21 (DASS-21), and Multiple Sclerosis Impact Scale-29 (MSIS-29). MATERIALS AND METHODS A cross-sectional study included a sample of pwMS (N = 148). Psychometric properties were examined by estimating the validity and reliability of the MSWS-12. The predictive validity of MSWS-12 and demographic and disease-related factors were assessed by a hierarchical regression model using MSIS-29 and DASS-21 as criterion variables. RESULTS Scale reliability was good for the MSWS-12 scale, expressed by Cronbach's alpha coefficient (α = 0.98). Correlations between MSWS-12 and DASS-21 (0.20-0.27) and between MSWS-12 and MSIS-29 subscales (0.47-0.83) provided initial support for the convergent validity. Factor analysis demonstrated the unidimensional structure of the MSWS-12. CONCLUSIONS The Croatian version of the MSWS-12 is a reliable, valid, and clinically useful tool for assessing walking impairments in pwMS.Implications for rehabilitationWalking difficulties in people with multiple sclerosis (pwMS) are one of the most pronounced predictors affecting patients' quality of life.Multiple Sclerosis Walking Scale (MSWS-12) is a measure of the disease's impact on walking abilities from the patient's perspective.MSWS-12 is a reliable scale for assessing walking speed, endurance, and gait quality in multiple sclerosis and is validated in several languages (Korean, Italian, Brazilian, and Persian).The Croatian version of the MSWS-12 is a reliable, predictive, and valid tool for screening walking impairments in pwMS.
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Affiliation(s)
- Ana Jerković
- Department of Neuroscience, School of Medicine, Laboratory for Human and Experimental Neurophysiology (LAHEN), University of Split, Split, Croatia
| | | | - Nataša Šimić
- Department of Psychology, University of Zadar, Zadar, Croatia
| | - Ana Poljičanin
- Institute of Physical Medicine and Rehabilitation with Rheumatology, University Hospital of Split, Split, Croatia
- Department of Health Studies, University of Split, Split, Croatia
| | - Zoran Đogaš
- Department of Neuroscience, School of Medicine, Laboratory for Human and Experimental Neurophysiology (LAHEN), University of Split, Split, Croatia
- Sleep Medical Centre, University Hospital of Split, Split, Croatia
| | - Maja Rogić Vidaković
- Department of Neuroscience, School of Medicine, Laboratory for Human and Experimental Neurophysiology (LAHEN), University of Split, Split, Croatia
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Naghdi S, Ansari NN, Haghparast A, Nakhostin-Ansari A, Khalifeloo M, Biglar M, Lotfi R, Hasson S. Responsiveness of Persian 12-Item multiple sclerosis walking scale: a replication study. BMC Res Notes 2023; 16:45. [PMID: 37016445 PMCID: PMC10071465 DOI: 10.1186/s13104-023-06316-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 03/20/2023] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVE To re-explore the responsiveness of the Persian version of Multiple Sclerosis Walking Scale-12 (MSWS-12p) to physiotherapy intervention and determine the minimally clinically important change (MCIC). This study followed a prospective cohort design. Patients with MS (PwMS) underwent physiotherapy treatment for 10 sessions. The outcome measures were the MSWS-12p and Timed 25-Foot Walk test (T25-FW). Data was collected before and after ten sessions of physiotherapy. The effect sizes and the area under receiver operating characteristics curve (AUC) and MCIC were calculated. RESULTS Thirty PwMS (16 female, mean age 43.07 years) participated in the study. The effect sizes for MSWS-12p were moderate (0.52, 0.64). The change scores of MSWS-12p showed excellent correlation with the dichotomized smallest detectable change (SDC) criterion (Eta coefficient test = 0.84). There was no correlation between the MSWS-12p total change scores and the T25-FW (r = - 0.14, p = 0.45). The AUC was perfect and the MCIC for the MSWS-12p was calculated 10.0 points. The MSWS-12p is responsive and demonstrates changes after physiotherapy. Changes > 10.0 points on MSWS-12p total score should be considered as true improvement after physiotherapy.
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Affiliation(s)
- Soofia Naghdi
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
- Research Center for War-affected People, Tehran University of Medical Sciences, #594, First floor, Taleghani Ave, Tehran, 14178, Iran.
| | - Afarin Haghparast
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Nakhostin-Ansari
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maede Khalifeloo
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Biglar
- Research Center for War-affected People, Tehran University of Medical Sciences, #594, First floor, Taleghani Ave, Tehran, 14178, Iran
- Drug Design and Development Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Roghie Lotfi
- Physiotherapy Clinic, Iran MS Society, Tehran, Iran
| | - Scott Hasson
- Department of Physical Therapy, Augusta University, Augusta, GA, USA
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Comparison of anchor-based methods for estimating thresholds of meaningful within-patient change using simulated PROMIS PF 20a data under various joint distribution characteristic conditions. Qual Life Res 2022; 32:1277-1293. [PMID: 36371770 DOI: 10.1007/s11136-022-03285-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE To compare the performance of anchor-based methods for estimating thresholds of meaningful within-patient change (i.e., individual change) of clinical outcome assessments in conditions reflecting data characteristics of small- to medium-sized clinical trials. METHODS Datasets were generated from the joint distributions of the PROMIS PF 20a T-score changes and a seven-point global change anchor measure. The 108 simulation conditions (1000 replications per condition) included combinations of three marginal distributions of T-score changes, three improvement percentages in the anchor measure, four levels of responsiveness correlations, and three sample sizes. Threshold estimation methods included mean change, median change, ROC curve, predictive modeling, half SD, and SEM. Relative bias, precision, accuracy, and measurement significance of the estimates were evaluated based on comparison with true thresholds and IRT-based individual reliable changes of PROMIS scores. Quantile regression models were applied to select and interpret effects of simulation conditions on estimation bias. RESULTS When PROMIS T-score changes were distributed normally, the predictive modeling method performed best with 50% or more responders identified by the anchor; the mean and median methods were preferred with 30% responders. For skewed distributions, the median method and ROC method gained more advantages. Among the evaluated study conditions, the improvement percentage condition had the most obvious effects on estimation bias. CONCLUSION To establish accurate and precise thresholds, clinical researchers are recommended to prioritize study designs with at least 50% anchor-defined responders and strongly responsive target endpoints with highly reliable scoring calibration and to select optimal anchor-based methods given the data characteristics.
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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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Ozdogar AT, Baba C, Kahraman T, Sagici O, Dastan S, Ertekin O, Ozakbas S. Effects and safety of exergaming in persons with multiple sclerosis during corticosteroid treatment: a pilot study. Mult Scler Relat Disord 2022; 63:103823. [PMID: 35523062 DOI: 10.1016/j.msard.2022.103823] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/10/2022] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND There is no information about the effects and usability of rehabilitation during corticosteroid treatment. This randomized clinical trial was conducted to evaluate and compare the effects and safety of exergaming and conventional rehabilitation (CR) on persons with multiple sclerosis (MS, pwMS) during corticosteroid treatment. METHODS The participants were randomly divided into two groups: Exergaming (n=15) and CR (n=15). Rehabilitation was applied by a physiotherapist who has expertise in MS. Measurements were done at baseline (T1), immediately after discharge (T2), and 1 month after discharge (T3). The outcome measures included upper extremity functions, walking, balance, cognitive functions, quality of life, depression, and fatigue. RESULTS The Nine Hole Peg Test, California Verbal Learning Test, Symbol Digit Modalities Test, MS Walking Scale-12, Six Spot Step Test showed a significant difference between T1 to T2 and T1 to T3 in the exergaming and CR groups (p < 0.05). The Timed 25 Foot Walk and Multiple Sclerosis International Quality of Life Questionnaire were significantly different between T1 to T3 in the exergaming and CR groups (p < 0.05). Brief Visuospatial Memory Test-Revised was significantly different between T1 to T3 and T2 to T3 in the exergaming and CR groups (p < 0.05). The MFIS showed a significant difference between T1 to T2 and T1 to T3 in the exergaming group (p < 0.05). CONCLUSIONS This study suggests that exergaming and CR are effective and safe methods for improving upper extremity, cognitive functions, fatigue, quality of life, balance, and walking ability in pwMS during the hospitalization period.
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Affiliation(s)
| | - Cavid Baba
- Institute of Health Sciences, Dokuz Eylül University, Izmir, Turkey
| | - Turhan Kahraman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | - Ozge Sagici
- Institute of Health Sciences, Dokuz Eylül University, Izmir, Turkey
| | - Seda Dastan
- Institute of Health Sciences, Dokuz Eylül University, Izmir, Turkey
| | - Ozge Ertekin
- Department of Neurological Physiotherapy-Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
| | - Serkan Ozakbas
- Department of Neurology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
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Kamudoni P, Amtmann D, Johns J, Cook KF, Salem R, Salek S, Raab J, Middleton R, Repovic P, Alschuler KN, von Geldern G, Wundes A, Barrett A, Olayinka-Amao O, Henke C. The validity, responsiveness, and score interpretation of the PROMISnq Physical Function – Multiple Sclerosis 15a short form in multiple sclerosis. Mult Scler Relat Disord 2022; 62:103753. [DOI: 10.1016/j.msard.2022.103753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/16/2022] [Accepted: 03/18/2022] [Indexed: 10/18/2022]
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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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Block VJ, Pitsch EA, Gopal A, Zhao C, Pletcher MJ, Marcus GM, Olgin JE, Hollenbach J, Bove R, Cree BAC, Gelfand JM. Identifying falls remotely in people with multiple sclerosis. J Neurol 2022; 269:1889-1898. [PMID: 34405267 PMCID: PMC8370664 DOI: 10.1007/s00415-021-10743-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/27/2021] [Accepted: 08/03/2021] [Indexed: 10/29/2022]
Abstract
BACKGROUND Falling is common in people with multiple sclerosis (MS) but tends to be under-ascertained and under-treated. OBJECTIVE To evaluate fall risk in people with MS. METHODS Ninety-four people with MS, able to walk > 2 min with or without an assistive device (Expanded Disability Status Scale (EDSS ≤ 6.5) were recruited. Clinic-based measures were recorded at baseline and 1 year. Patient-reported outcomes (PROs), including a fall survey and the MS Walking Scale (MSWS-12), were completed at baseline, 1.5, 3, 6, 9, and 12 months. Average daily step counts (STEPS) were recorded using a wrist-worn accelerometer. RESULTS 50/94 participants (53.2%) reported falling at least once. Only 56% of participants who reported a fall on research questionnaires had medical-record documented falls. Fallers had greater disability [median EDSS 5.5 (IQR 4.0-6.0) versus 2.5 (IQR 1.5-4.0), p < 0.001], were more likely to have progressive MS (p = 0.003), and took fewer STEPS (mean difference - 1,979, p = 0.007) than Non-Fallers. Stepwise regression revealed MSWS-12 as a major predictor of future falls. CONCLUSIONS Falling is common in people with MS, under-reported, and under-ascertained by neurologists in clinic. Multimodal fall screening in clinic and remotely may help improve patient care by identifying those at greatest risk, allowing for timely intervention and referral to specialized physical rehabilitation.
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Affiliation(s)
- Valerie J. Block
- grid.266102.10000 0001 2297 6811Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, 1651 4th Street, Box 3126, San Francisco, CA 94143 USA
| | - Erica A. Pitsch
- grid.266102.10000 0001 2297 6811Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, USA
| | - Arpita Gopal
- grid.266102.10000 0001 2297 6811Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, USA
| | - Chao Zhao
- grid.266102.10000 0001 2297 6811Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, 1651 4th Street, Box 3126, San Francisco, CA 94143 USA
| | - Mark J. Pletcher
- grid.266102.10000 0001 2297 6811Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA ,grid.266102.10000 0001 2297 6811Department of Medicine, University of California San Francisco, San Francisco, USA
| | - Gregory M. Marcus
- grid.266102.10000 0001 2297 6811Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA
| | - Jeffrey E. Olgin
- grid.266102.10000 0001 2297 6811Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA
| | - Jill Hollenbach
- grid.266102.10000 0001 2297 6811Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, 1651 4th Street, Box 3126, San Francisco, CA 94143 USA
| | - Riley Bove
- grid.266102.10000 0001 2297 6811Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, 1651 4th Street, Box 3126, San Francisco, CA 94143 USA
| | - Bruce A. C. Cree
- grid.266102.10000 0001 2297 6811Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, 1651 4th Street, Box 3126, San Francisco, CA 94143 USA
| | - Jeffrey M. Gelfand
- grid.266102.10000 0001 2297 6811Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, 1651 4th Street, Box 3126, San Francisco, CA 94143 USA
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11
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Hsu WY, Anderson A, Rowles W, Peters KE, Li V, Stone KL, Ashbrook LH, Gelfand AA, Bove RM. Effects of melatonin on sleep disturbances in multiple sclerosis: A randomized, controlled pilot study. Mult Scler J Exp Transl Clin 2021; 7:20552173211048756. [PMID: 34777854 PMCID: PMC8573503 DOI: 10.1177/20552173211048756] [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: 07/14/2021] [Revised: 08/12/2021] [Accepted: 09/08/2021] [Indexed: 11/29/2022] Open
Abstract
Background Sleep disturbances are commonly reported by people with multiple sclerosis (PwMS). However, optimal management of sleep disturbances is uncertain, and objective studies of sleep quality in PwMS are scarce. Objectives To determine the effect of exogenous melatonin on sleep quality and sleep disturbances in PwMS. Methods Thirty adult PwMS reporting sleep difficulties were recruited in a randomized, controlled, double-blind cross-over study. They took either melatonin or placebo for 2 weeks, and the opposite for the following 2 weeks. During weeks 2 and 4, an actigraph was used to capture mean total sleep time and sleep efficiency. Patient-reported outcomes (PROs) were collected at weeks 0, 2 and 4. Results Melatonin use significantly improved mean total sleep time (p = 0.03), with a trend towards higher sleep efficiency (p = 0.06). No PROs were significantly different; there was a trend for melatonin use to decrease mean Insomnia Severity Index score (p = 0.07), improve Pittsburgh Sleep Quality Index sleep quality component (p = 0.07), and improve NeuroQoL-Fatigue (p = 0.06). No other PROs showed differences between melatonin and placebo; nor did step count measured by actigraphy (all p > 0.45). Conclusion These results provide preliminary evidence that melatonin, a low-cost, over-the-counter supplement, could improve objective measures of sleep quality in PwMS.
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Affiliation(s)
- Wan-Yu Hsu
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | | | - William Rowles
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | | | | | - Katie L Stone
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Liza H Ashbrook
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Amy A Gelfand
- Child & Adolescent Headache Program, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Riley M Bove
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
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12
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Cohen ET, Huser S, Barone K, Barone DA. Trekking Poles to Aid Multiple Sclerosis Walking Impairment: An Exploratory Comparison of the Effects of Assistive Devices on Psychosocial Impact and Walking. Int J MS Care 2021; 23:135-141. [PMID: 34177386 DOI: 10.7224/1537-2073.2020-064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Walking dysfunction is reported by two-thirds of persons with multiple sclerosis (MS). Assistive devices are frequently recommended to improve walking; however, it is uncommon to consider their psychosocial impact, although many users abandon their assistive devices. The psychosocial impact, walking, balance, and fatigue associated with three assistive devices were compared to guide clinical decision making. Methods Twenty-five persons with MS (median Expanded Disability Status Scale score, 4.0; range, 2.5-6.0) who reported walking difficulty were trained in the use of three assistive devices-a single-point cane (SPC), a four-point cane (FPC), and a trekking pole (TP)-at 1- to 2-week intervals, then used the assistive device for their usual activities. Outcome measures included the Psychosocial Impact of Assistive Devices Scale (PIADS), the 6-Minute Walk Test (6MWT), walking speed, cadence, stride length, stride time, the 12-item Multiple Sclerosis Walking Scale (MSWS-12), the Activities-specific Balance Confidence (ABC) scale, the 5-item Modified Fatigue Impact Scale (MFIS-5), and a visual analogue scale of fatigue (VAS-F). Results The SPC and TP were more positive in the PIADS adaptability, competence, and self-esteem subscales. The SPC and TP resulted in higher 6MWT, walking speed, cadence, stride length, stride time, and MSWS-12 scores compared with the FPC. No differences were found in ABC scale, MFIS-5, or VAS-F scores. Conclusions Participants reported more positive psychosocial impact, and walked faster and with higher quality, with the SPC and TP than with the FPC. Clinicians should consider suggesting an SPC or TP to patients who may benefit from assistive device use and for whom psychosocial impact is an important consideration.
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13
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ŘasovÁ K, BuČkovÁ B, ProkopiusovÁ T, ProchÁzkovÁ M, Angel G, MarkovÁ M, HruŠkovÁ N, ŠtĚtkÁŘovÁ I, ŠpaŇhelovÁ Š, MareŠ J, TintĚra J, Zach P, Musil V, Hlinka J. A Three-Arm Parallel-Group Exploratory Trial documents balance improvement without much evidence of white matter integrity changes in people with multiple sclerosis following two months ambulatory neuroproprioceptive "facilitation and inhibition" physical therapy. Eur J Phys Rehabil Med 2021; 57:889-899. [PMID: 33565742 DOI: 10.23736/s1973-9087.21.06701-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Changes of white matter integrity in people with multiple sclerosis (MS) were documented following mainly motor/skill acquisitions physical therapy, while following neuroproprioceptive "facilitation, inhibition" (neurofacilitation) only by two pilot studies. Neurofacilitation has potential to induce white matter changes due to possibility to interfere with the neuronal tactility threshold, but stronger evidence is missing. AIM This study investigates whether neurofacilitation (three physical therapy types) induce white matter changes and if they relate to clinical improvement. DESIGN The Three-Arm Parallel-Group Exploratory Trial (NCT04355663). SETTING Each group underwent different kind of two months ambulatory therapy (Motor Program Activating Therapy, Vojta's reflex locomotion, and Functional Electric Stimulation in Posturally Corrected Position). POPULATION MS people with moderate disability. METHODS At baseline and after the program, participants underwent magnetic resonance diffusion tensor imaging (DTI) and clinical assessment. Fractional anisotropy maps obtained from DTI were further analyzed using tract-based spatial statistic exploring the mean values in the whole statistic skeleton. Moreover, additional exploratory analysis in 48 regions of white matter was done. RESULTS 92 people were recruited. DTI data from 61 were analysed. The neurofacilitation (irrespective type of therapy) resulted in significant improvement on the Berg Balance Scale (p=0.0089), mainly driven by the Motor Program Activating Therapy. No statistically significant change in the whole statistic skeleton was observed (only a trend for decrement of fractional anisotropy after Vojta's reflex locomotion). Additional exploratory analysis confirmed significant decrement of fractional anisotropy in the right anterior corona radiata. CONCLUSIONS Neurofacilitation improved balance without much evidence of white matter integrity changes in people with MS. CLINICAL REHABILITATION IMPACT The study results point to the importance of neuroproprioceptive "facilitation and inhibition" physical therapy in management of balance in people with multiple sclerosis and the potential to induce white matter changes due to possibility to interfere with the neuronal tactility threshold.
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Affiliation(s)
- Kamila ŘasovÁ
- Department of Rehabilitation, Third Faculty of Medicine, Charles University, Prague, Czech Republic -
| | - Barbora BuČkovÁ
- Department of Complex Systems, Institute of Computer Science of the Czech Academy of Sciences, Prague, Czech Republic.,Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Terezie ProkopiusovÁ
- Department of Rehabilitation, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marie ProchÁzkovÁ
- Department of Rehabilitation, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Gabriela Angel
- Department of Rehabilitation, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Magdaléna MarkovÁ
- Department of Rehabilitation, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Natália HruŠkovÁ
- Department of Rehabilitation, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ivana ŠtĚtkÁŘovÁ
- Department of Neurology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Šárka ŠpaŇhelovÁ
- Department of Rehabilitation and Sport Medicine, Motol University Hospital, Prague, Czech Republic
| | - Jan MareŠ
- Applied Neurosciences and Brain Imaging, National Institute of Mental Health, Klecany, Czech Republic
| | - Jaroslav TintĚra
- Radiodiagnostic and Interventional Radiology Department, Institute for Clinical and Experimental Medicine, Praha, Czech Republic
| | - Petr Zach
- Department of Anatomy, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Vladimír Musil
- Centre of Scientific Information, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jaroslav Hlinka
- Department of Complex Systems, Institute of Computer Science of the Czech Academy of Sciences, Prague, Czech Republic.,Applied Neurosciences and Brain Imaging, National Institute of Mental Health, Klecany, Czech Republic
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14
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Gunn H, Stevens KN, Creanor S, Andrade J, Paul L, Miller L, Green C, Ewings P, Barton A, Berrow M, Vickery J, Marshall B, Zajicek J, Freeman JA. Balance Right in Multiple Sclerosis (BRiMS): a feasibility randomised controlled trial of a falls prevention programme. Pilot Feasibility Stud 2021; 7:2. [PMID: 33390184 PMCID: PMC7780657 DOI: 10.1186/s40814-020-00732-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 11/23/2020] [Indexed: 11/24/2022] Open
Abstract
Background Balance, mobility impairments and falls are problematic for people with multiple sclerosis (MS). The “Balance Right in MS (BRiMS)” intervention, a 13-week home and group-based exercise and education programme, aims to improve balance and minimise falls. This study aimed to evaluate the feasibility of undertaking a multi-centre randomised controlled trial and to collect the necessary data to design a definitive trial. Methods This randomised controlled feasibility study recruited from four United Kingdom NHS clinical neurology services. Patients ≥ 18 years with secondary progressive MS (Expanded Disability Status Scale 4 to 7) reporting more than two falls in the preceding 6 months were recruited. Participants were block-randomised to either a manualised 13-week education and exercise programme (BRiMS) plus usual care, or usual care alone. Feasibility assessment evaluated recruitment and retention rates, adherence to group assignment and data completeness. Proposed outcomes for the definitive trial (including impact of MS, mobility, quality of life and falls) and economic data were collected at baseline, 13 and 27 weeks, and participants completed daily paper falls diaries. Results Fifty-six participants (mean age 59.7 years, 66% female, median EDSS 6.0) were recruited in 5 months; 30 randomised to the intervention group. Ten (18%) participants withdrew, 7 from the intervention group. Two additional participants were lost to follow up at the final assessment point. Completion rates were > 98% for all outcomes apart from the falls diary (return rate 62%). After adjusting for baseline score, mean intervention—usual care between-group differences for the potential primary outcomes at week 27 were MS Walking Scale-12v2: − 7.7 (95% confidence interval [CI] − 17.2 to 1.8) and MS Impact Scale-29v2: physical 0.6 (CI − 7.8 to 9), psychological − 0.4 (CI − 9.9 to 9). In total, 715 falls were reported, rate ratio (intervention:usual care) for falls 0.81 (0.41 to 2.26) and injurious falls 0.44 (0.41 to 2.23). Conclusions Procedures were practical, and retention, programme engagement and outcome completion rates satisfied a priori progression criteria. Challenges were experienced in completion and return of daily falls diaries. Refinement of methods for reporting falls is therefore required, but we consider a full trial to be feasible. Trial registration ISRCTN13587999 Date of registration: 29 September 2016
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Affiliation(s)
- H Gunn
- Faculty of Health, School of Health Professions, Peninsula Allied Health Centre, University of Plymouth, Derriford Road, Plymouth, PL6 8BH, England.
| | - K N Stevens
- Faculty of Health, Medical Statistics Group, Room N15, Plymouth Science Park, Plymouth, PL6 8BX, England.,Peninsula Clinical Trials Unit, University of Plymouth, Room N16, Plymouth Science Park, Plymouth, PL6 8BX, England
| | - S Creanor
- Faculty of Health, Medical Statistics Group, Room N15, Plymouth Science Park, Plymouth, PL6 8BX, England.,University of Exeter Medical School, College of Medicine & Health, University of Exeter, Exeter, England
| | - J Andrade
- Faculty of Health, School of Psychology, University of Plymouth, Portland Square Building, Drake Circus Campus, Plymouth, PL4 8AA, England
| | - L Paul
- School of Health & Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, Scotland
| | - L Miller
- Douglas Grant Rehabilitation Unit, Ayrshire Central Hospital, Kilwinning Road, Irvine, KA12 8SS, Scotland
| | - C Green
- University of Exeter Medical School, Health Economics Group, University of Exeter, St. Luke's Campus, Exeter, EX1 2LU, England
| | - P Ewings
- NIHR Research Design Service (South West), Musgrove Park Hospital, Taunton, TA1 5DA, England
| | - A Barton
- Faculty of Medicine and Dentistry, NIHR Research Design Service South West, ITTC Building, Plymouth Science Park, Plymouth, PL6 8BX, England
| | - M Berrow
- Faculty of Health, Medical Statistics Group, Room N15, Plymouth Science Park, Plymouth, PL6 8BX, England
| | - J Vickery
- Faculty of Health, Medical Statistics Group, Room N15, Plymouth Science Park, Plymouth, PL6 8BX, England
| | - B Marshall
- Faculty of Health, School of Health Professions, Peninsula Allied Health Centre, University of Plymouth, Derriford Road, Plymouth, PL6 8BH, England
| | - J Zajicek
- School of Medicine, Medical and Biological Sciences, University of St. Andrews, North Haugh, St. Andrews, KY16 9TF, Scotland
| | - J A Freeman
- Faculty of Health, School of Health Professions, Peninsula Allied Health Centre, University of Plymouth, Derriford Road, Plymouth, PL6 8BH, England
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15
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Acosta C, Gianinazzi M, Dort T, Armstrong N, Ryder S, Lundqvist T, Ekelund M, Lycke J. Modeling the cost-effectiveness of prolonged-release fampridine for the treatment of walking impairment in patients with multiple sclerosis in Sweden. J Med Econ 2021; 24:770-780. [PMID: 33966549 DOI: 10.1080/13696998.2021.1927746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Aims: To evaluate the cost-effectiveness of adding prolonged-release (PR)-fampridine to best supportive care (BSC) versus BSC alone for the improvement of walking ability in patients with MS.Methods: A cost-utility analysis based on a Markov model was developed to model responders and timed 25-foot walk (T25FW) scores, accumulated costs, and quality-adjusted life-years (QALY) in adults with MS and Expanded Disability Status Scale (EDSS) scores between 4 and 7. The analysis was conducted from a Swedish societal perspective.Results: In the base-case analysis, PR-fampridine plus BSC led to a higher QALY gain than BSC alone. The largest direct cost was professional care provision followed by hospital inpatient stays while the indirect cost was the loss of earnings due to days off work. The incremental cost-effectiveness ratio (ICER) for PR-fampridine plus BSC compared with BSC alone was 57,109 Swedish Kronor (kr)/QALY (€5,607/QALY [1 kr = €0.0981762 on 8 April 2021] and $6,675/QALY [1 kr = $0.116890 on 8 April 2021]). All sensitivity analyses performed resulted in ICERs below 500,000 kr (€49,088 and $58,445).Limitations: Resource use data were not specific to the Swedish market.Conclusions: PR-fampridine represents a cost-effective treatment for MS-related walking impairment in Sweden, due to improvements in patients' quality of life and reduced healthcare resource utilization.
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Affiliation(s)
- Carlos Acosta
- Value & Market Access, Biogen International GmbH, Baar, Switzerland
| | | | - Thibaut Dort
- Value & Market Access, Biogen International GmbH, Baar, Switzerland
| | | | | | | | - Mats Ekelund
- Market Access, Biogen Sweden AB, Upplands Väsby, Sweden
| | - Jan Lycke
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
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16
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Gunn H, Andrade J, Paul L, Miller L, Creanor S, Stevens K, Green C, Ewings P, Barton A, Berrow M, Vickery J, Marshall B, Zajicek J, Freeman J. A self-management programme to reduce falls and improve safe mobility in people with secondary progressive MS: the BRiMS feasibility RCT. Health Technol Assess 2020; 23:1-166. [PMID: 31217069 DOI: 10.3310/hta23270] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Balance, mobility impairments and falls are common problems for people with multiple sclerosis (MS). Our ongoing research has led to the development of Balance Right in MS (BRiMS), a 13-week home- and group-based exercise and education programme intended to improve balance and encourage safer mobility. OBJECTIVE This feasibility trial aimed to obtain the necessary data and operational experience to finalise the planning of a future definitive multicentre randomised controlled trial. DESIGN Randomised controlled feasibility trial. Participants were block randomised 1 : 1. Researcher-blinded assessments were scheduled at baseline and at 15 and 27 weeks post randomisation. As is appropriate in a feasibility trial, statistical analyses were descriptive rather than involving formal/inferential comparisons. The qualitative elements utilised template analysis as the chosen analytical framework. SETTING Four sites across the UK. PARTICIPANTS Eligibility criteria included having a diagnosis of secondary progressive MS, an Expanded Disability Status Scale (EDSS) score of between ≥ 4.0 and ≤ 7.0 points and a self-report of two or more falls in the preceding 6 months. INTERVENTIONS Intervention - manualised 13-week education and exercise programme (BRiMS) plus usual care. Comparator - usual care alone. MAIN OUTCOME MEASURES Trial feasibility, proposed outcomes for the definitive trial (including impact of MS, mobility, quality of life and falls), feasibility of the BRiMS programme (via process evaluation) and economic data. RESULTS A total of 56 participants (mean age 59.7 years, standard deviation 9.7 years; 66% female; median EDSS score of 6.0 points, interquartile range 6.0-6.5 points) were recruited in 5 months; 30 were block randomised to the intervention group. The demographic and clinical data were broadly comparable at baseline; however, the intervention group scored worse on the majority of baseline outcome measures. Eleven participants (19.6%) withdrew or were lost to follow-up. Worsening of MS-related symptoms unrelated to the trial was the most common reason (n = 5) for withdrawal. Potential primary and secondary outcomes and economic data had completion rates of > 98% for all those assessed. However, the overall return rate for the patient-reported falls diary was 62%. After adjusting for baseline score, the differences between the groups (intervention compared with usual care) at week 27 for the potential primary outcomes were MS Walking Scale (12-item) version 2 -7.7 [95% confidence interval (CI) -17.2 to 1.8], MS Impact Scale (29-item) version 2 (MSIS-29vs2) physical 0.6 (95% CI -7.8 to 9) and MSIS-29vs2 psychological -0.4 (95% CI -9.9 to 9) (negative score indicates improvement). After the removal of one outlier, a total of 715 falls were self-reported over the 27-week trial period, with substantial variation between individuals (range 0-93 falls). Of these 715 falls, 101 (14%) were reported as injurious. Qualitative feedback indicated that trial processes and participant burden were acceptable, and participants highlighted physical and behavioural changes that they perceived to result from undertaking BRiMS. Engagement varied, influenced by a range of condition- and context-related factors. Suggestions to improve the utility and accessibility of BRiMS were highlighted. CONCLUSIONS The results suggest that the trial procedures are feasible and acceptable, and retention, programme engagement and outcome completion rates were sufficient to satisfy the a priori progression criteria. Challenges were experienced in some areas of data collection, such as completion of daily diaries. FUTURE WORK Further development of BRiMS is required to address logistical issues and enhance user-satisfaction and adherence. Following this, a definitive trial to assess the clinical effectiveness and cost-effectiveness of the BRiMS intervention is warranted. TRIAL REGISTRATION Current Controlled Trials ISRCTN13587999. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 27. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Hilary Gunn
- School of Health Professions, Faculty of Health and Human Sciences, Peninsula Allied Health Centre, University of Plymouth, Plymouth, UK
| | - Jackie Andrade
- School of Psychology, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK
| | - Lorna Paul
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Linda Miller
- Douglas Grant Rehabilitation Unit, Ayrshire Central Hospital, Irvine, UK
| | - Siobhan Creanor
- Peninsula Clinical Trials Unit at Plymouth University (PenCTU), Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK.,Medical Statistics Group, Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Kara Stevens
- Medical Statistics Group, Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Colin Green
- University of Exeter Medical School, Health Economics Group, University of Exeter, Exeter, UK
| | - Paul Ewings
- National Institute for Health Research (NIHR) Research Design Service (South West), Musgrove Park Hospital, Taunton, UK
| | - Andrew Barton
- National Institute for Health Research (NIHR) Research Design Service, Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Margie Berrow
- Peninsula Clinical Trials Unit at Plymouth University (PenCTU), Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Jane Vickery
- Peninsula Clinical Trials Unit at Plymouth University (PenCTU), Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | | | - John Zajicek
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Jennifer Freeman
- School of Health Professions, Faculty of Health and Human Sciences, Peninsula Allied Health Centre, University of Plymouth, Plymouth, UK
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das Nair R, de Groot V, Freeman J. Beyond current research practice: Methodological considerations in MS rehabilitation research (is designing the perfect rehabilitation trial the Holy Grail or a Gordian knot?). Mult Scler 2020; 25:1337-1347. [PMID: 31469355 DOI: 10.1177/1352458519858271] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Rehabilitation is an essential aspect of symptomatic and supportive treatment for people with multiple sclerosis (MS). The number of randomised controlled trials (RCTs) for rehabilitation interventions in MS has increased over the last two decades. The design, conduct and reporting quality of some of these trials could be improved. There are, however, some specific challenges that researchers face in conducting RCTs of rehabilitation interventions, which are often 'complex interventions'. This paper explores some of the challenges of undertaking robust clinical trials in rehabilitation. We focus on issues related to (1) participant selection and sample size, (2) interventions - the 'dose', content, active ingredients, targeting, fidelity of delivery and treatment adherence, (3) control groups and (4) outcomes - choosing the right type, number, timing of outcomes, and the importance of defining a primary outcome and clinically important difference between groups. We believe that by following internationally accepted RCT guidelines, by developing a critical mass of MS rehabilitation 'trialists' through international collaboration and by continuing to critique, challenge, and develop RCT designs, we can exploit the potential of RCTs to answer important questions related to the effectiveness of rehabilitation interventions.
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Affiliation(s)
- Roshan das Nair
- Clinical Psychology and Neuropsychology, Institute of Mental Health, University of Nottingham, Jubilee Campus, Nottingham, UK
| | - Vincent de Groot
- Department of Rehabilitation Medicine, MS Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jennifer Freeman
- Physiotherapy and Rehabilitation, School of Health Professions, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK
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18
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Arntzen EC, Straume B, Odeh F, Feys P, Normann B. Group‐based, individualized, comprehensive core stability and balance intervention provides immediate and long‐term improvements in walking in individuals with multiple sclerosis: A randomized controlled trial. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 25:e1798. [DOI: 10.1002/pri.1798] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 03/12/2019] [Accepted: 05/17/2019] [Indexed: 01/22/2023]
Affiliation(s)
| | - Bjørn Straume
- Department of Community Medicine, Faculty of Health SciencesUiT, The Arctic University of Norway Tromsø Norway
| | - Francis Odeh
- Institute for Clinical Medicine, Faculty of Health ScienceUiT, The Arctic University of Norway Tromsø Norway
- Department of NeurologyNordland Hospital Trust Bodø Norway
| | - Peter Feys
- BIOMED/REVALUniversity of Hasselt Diepenbeek Belgium
| | - Britt Normann
- Department of PhysiotherapyNordland Hospital Trust Bodø Norway
- Department of Health and Care SciencesUiT, The Arctic University of Norway Tromsø Norway
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19
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Hobart J, Ziemssen T, Feys P, Linnebank M, Goodman AD, Farrell R, Hupperts R, Blight AR, Englishby V, McNeill M, Chang I, Lima G, Elkins J. Assessment of Clinically Meaningful Improvements in Self-Reported Walking Ability in Participants with Multiple Sclerosis: Results from the Randomized, Double-Blind, Phase III ENHANCE Trial of Prolonged-Release Fampridine. CNS Drugs 2019; 33:61-79. [PMID: 30535670 PMCID: PMC6328522 DOI: 10.1007/s40263-018-0586-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Walking impairment is a hallmark of multiple sclerosis (MS). It affects > 90% of individuals over time, reducing independence and negatively impacting health-related quality of life, productivity, and daily activities. Walking impairment is consistently reported as one of the most distressing impairments by individuals with MS. Prolonged-release (PR)-fampridine previously has been shown to improve objectively measured walking speed in walking-impaired adults with MS. The impact of PR-fampridine from the perspective of the individual with MS warrants full and detailed examination. OBJECTIVE The objective of this study was to evaluate whether PR-fampridine has a clinically meaningful effect on self-reported walking ability in walking-impaired participants with MS. METHODS ENHANCE was a phase III, randomized, double-blind, placebo-controlled study of PR-fampridine 10 mg twice daily in walking-impaired individuals age 18-70 years with either relapsing or progressive forms of MS and an Expanded Disability Status Scale (EDSS) score of 4.0-7.0 at screening. Participants were stratified by EDSS score (≤ 6.0 or 6.5-7.0) at randomization to ensure a balanced level of disability in the treatment groups. The primary endpoint was the proportion of participants with a mean improvement in the 12-item Multiple Sclerosis Walking Scale (MSWS-12) score exceeding the predefined threshold for clinically meaningful improvement (≥ 8 points) over 24 weeks. Secondary endpoints included the proportion with ≥ 15% improvement in Timed Up and Go (TUG) speed, and mean changes in Multiple Sclerosis Impact Scale physical impact subscale (MSIS-29 PHYS), Berg Balance Scale (BBS), and ABILHAND scores over 24 weeks. RESULTS In total, 636 participants with MS were randomized (PR-fampridine, n = 317; placebo, n = 319; modified intention-to-treat sample: PR-fampridine, n = 315; placebo, n = 318). At baseline in the PR-fampridine and placebo groups, 46% and 51% had a progressive form of MS, median [range] EDSS scores were 6.0 [4.0-7.0] and 5.5 [4.0-7.0], mean [range] MSWS-12 scores were 63.6 [0-100] and 65.4 [0-100], and mean [range] TUG speed was 0.38 [0.0-1.0] and 0.38 [0.0-1.2] feet/s, respectively. A significantly higher percentage of PR-fampridine-treated participants (136/315 [43.2%]) had clinically meaningful improvement in MSWS-12 score over 24 weeks versus placebo (107/318 [33.6%]; odds ratio 1.61 [95% confidence interval 1.15-2.26]; p = 0.006). For PR-fampridine versus placebo, significantly more participants had a ≥ 15% improvement in TUG speed, and there was significantly greater mean improvement in MSIS-29 PHYS score (p < 0.05); numerical improvements that were not statistically significant were observed in BBS/ABILHAND. Adverse events that were more common in the PR-fampridine group than placebo group (difference ≥ 3%) by Medical Dictionary for Regulatory Activities (MedDRA®) Preferred Term were urinary tract infection and insomnia. There were no seizures reported. CONCLUSIONS PR-fampridine treatment resulted in sustained, clinically meaningful improvements over 24 weeks in self-reported walking and functional ability in walking-disabled participants with MS. CLINICALTRIALS. GOV IDENTIFIER NCT02219932.
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Affiliation(s)
- Jeremy Hobart
- Plymouth University Peninsula Schools of Medicine and Dentistry, University Hospitals Plymouth NHS Trust, N13 ITTC Building, Plymouth Science Park, Plymouth, Devon, PL6 8BX, UK.
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Carl Gustav Carus University Clinic, Technical University of Dresden, Dresden, Germany
| | - Peter Feys
- BIOMED-REVAL, University of Hasselt, Diepenbeek, Belgium
| | - Michael Linnebank
- HELIOS Klinik Hagen-Ambrock, University Witten/Herdecke, Hagen, Germany
| | - Andrew D. Goodman
- School of Medicine and Dentistry, University of Rochester, Rochester, NY USA
| | - Rachel Farrell
- National Hospital for Neurology and Neurosurgery, University College London Hospitals and University College London Institute of Neurology, London, UK
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20
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Sola-Valls N, Blanco Y, Sepúlveda M, Llufriu S, Martínez-Lapiscina EH, Zubizarreta I, Pulido-Valdeolivas I, Montejo C, Villoslada P, Saiz A. Combined walking outcome measures identify clinically meaningful response to prolonged-release fampridine. Ther Adv Neurol Disord 2018; 11:1756286418780007. [PMID: 29977342 PMCID: PMC6024337 DOI: 10.1177/1756286418780007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 02/15/2018] [Indexed: 11/17/2022] Open
Abstract
Background Gait impairment is common in multiple sclerosis (MS) and negatively impacts patients' health-related quality of life (HRQoL). Prolonged-release fampridine (PR-fam) improves walking speed, but it is unclear which walking measures are the most suitable for identifying treatment response. Our aim was to assess the effect of PR-fam and the outcome measures that best identify short- and long-term clinically meaningful response. Methods We conducted a prospective study in 32 MS patients treated with PR-fam for a year. The assessments at 2 weeks, 3, 6 and 12 months included: timed 25-foot walk (T25FW), 6-minute walk test (6MWT), MS Walking Scale-12 (MSWS-12), a five-level version of the EuroQoL-5 dimensions, and accelerometry. PR-fam response was defined as an improvement in T25FW ⩾20%. Results Twenty-five (78%) patients were considered responders after 2 weeks of PR-fam and improved significantly in all measures. Responders to T25FW and MSWS-12 (n = 19) showed a significant improvement in HRQoL and accelerometer data compared with responders only to T25FW (n = 6). At 1 year, 15/20 (75%) patients remained responders, but only those with permanent response to T25FW and MSWS-12 (n = 8; 53%) showed a significant improvement in 6MWT and HRQoL. Conclusion The combination of T25FW and MSWS-12 identify better those patients with a clinically significant benefit of PR-fam.
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Affiliation(s)
- Núria Sola-Valls
- Service of Neurology, Hospital Clinic, University of Barcelona, Spain Neuroimmunology Program, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Yolanda Blanco
- Service of Neurology, Hospital Clinic, University of Barcelona, Spain Neuroimmunology Program, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - María Sepúlveda
- Service of Neurology, Hospital Clinic, University of Barcelona, Spain Neuroimmunology Program, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Sara Llufriu
- Service of Neurology, Hospital Clinic, University of Barcelona, Spain Neuroimmunology Program, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Elena H Martínez-Lapiscina
- Service of Neurology, Hospital Clinic, University of Barcelona, Spain Neuroimmunology Program, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Irati Zubizarreta
- Service of Neurology, Hospital Clinic, University of Barcelona, Spain Neuroimmunology Program, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Irene Pulido-Valdeolivas
- Service of Neurology, Hospital Clinic, University of Barcelona, Spain Neuroimmunology Program, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Carmen Montejo
- Service of Neurology, Hospital Clinic, University of Barcelona, Spain Neuroimmunology Program, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Pablo Villoslada
- Service of Neurology, Hospital Clinic, University of Barcelona, Spain Neuroimmunology Program, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Albert Saiz
- Service of Neurology, Hospital Clinic, University of Barcelona, Spain Neuroimmunology Program, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Almuklass AM, Davis L, Hamilton LD, Hebert JR, Alvarez E, Enoka RM. Pulse Width Does Not Influence the Gains Achieved With Neuromuscular Electrical Stimulation in People With Multiple Sclerosis: Double-Blind, Randomized Trial. Neurorehabil Neural Repair 2018; 32:84-93. [PMID: 29366377 DOI: 10.1177/1545968317753681] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) eventually compromises the walking ability of most individuals burdened with the disease. Treatment with neuromuscular electrical stimulation (NMES) can restore some functional abilities in persons with MS, but its effectiveness may depend on stimulus-pulse duration. OBJECTIVE To compare the effects of a 6-week intervention with narrow- or wide-pulse NMES on walking performance, neuromuscular function, and disability status of persons with relapsing-remitting MS. METHODS Individuals with MS (52.6 ± 7.4 years) were randomly assigned to either the narrow-pulse (n = 13) or wide-pulse (n = 14) group. The NMES intervention was performed on the dorsiflexor and plantar flexor muscles of both legs (10 minutes each muscle, 4 s on and 12 s off) at a tolerable level for 18 sessions across 6 weeks. Outcomes were obtained before (week 0) and after (week 7) the intervention and 4 weeks later (week 11). RESULTS There was no influence of stimulus-pulse duration on the outcomes ( P > .05); thus, the data were collapsed across groups. The NMES intervention improved ( P < .05) gait speed and walking endurance, dorsiflexor strength in the more-affected leg, plantar flexor strength in the less-affected leg, force control for plantar flexors in the less-affected leg, and self-reported levels of fatigue and walking limitations. CONCLUSION There was no influence of stimulus-pulse duration on the primary outcomes (gait speed and walking endurance). The 6-week NMES intervention applied to the lower leg muscles of persons with mild to moderate levels of disability can improve their walking performance and provide some symptom relief.
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Affiliation(s)
- Awad M Almuklass
- 1 University of Colorado, Boulder, CO, USA.,2 King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Leah Davis
- 1 University of Colorado, Boulder, CO, USA
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Seebacher B, Kuisma R, Glynn A, Berger T. The effect of rhythmic-cued motor imagery on walking, fatigue and quality of life in people with multiple sclerosis: A randomised controlled trial. Mult Scler 2016; 23:286-296. [PMID: 27055804 DOI: 10.1177/1352458516644058] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Motor imagery and rhythmic auditory stimulation are physiotherapy strategies for walking rehabilitation. OBJECTIVES To investigate the effect of motor imagery combined with rhythmic cueing on walking, fatigue and quality of life (QoL) in people with multiple sclerosis (MS). METHODS Individuals with MS and Expanded Disability Status Scale scores of 1.5-4.5 were randomised into one of three groups: 17 minutes of motor imagery, six times per week, for 4 weeks, with music (A) or metronome cues (B), both with verbal cueing, and (C) controls. Primary outcomes were walking speed (Timed 25-Foot Walk) and distance (6-Minute Walk Test). Secondary outcomes were walking perception (Multiple Sclerosis Walking Scale-12), fatigue (Modified Fatigue Impact Scale) and QoL (Short Form-36 Health Survey, Multiple Sclerosis Impact Scale-29, Euroquol-5D-3L Questionnaire). RESULTS Of the 112 participants randomised, 101 completed the study. Compared to controls, both interventions significantly improved walking speed, distance and perception. Significant improvements in cognitive but not psychosocial fatigue were seen in the intervention groups, and physical fatigue improved only in the music-based group. Both interventions improved QoL; however, music-cued motor imagery was superior at improving health-related QoL. CONCLUSION Rhythmic-cued motor imagery improves walking, fatigue and QoL in people with MS, with music-cued motor imagery being more effective.
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Affiliation(s)
| | - Raija Kuisma
- School of Health Sciences, University of Brighton, Eastbourne, UK
| | - Angela Glynn
- School of Health Sciences, University of Brighton, Eastbourne, UK
| | - Thomas Berger
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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