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Bartoš F, Martinková P. Assessing quality of selection procedures: Lower bound of false positive rate as a function of inter-rater reliability. THE BRITISH JOURNAL OF MATHEMATICAL AND STATISTICAL PSYCHOLOGY 2024. [PMID: 38623032 DOI: 10.1111/bmsp.12343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 03/06/2024] [Accepted: 03/18/2024] [Indexed: 04/17/2024]
Abstract
Inter-rater reliability (IRR) is one of the commonly used tools for assessing the quality of ratings from multiple raters. However, applicant selection procedures based on ratings from multiple raters usually result in a binary outcome; the applicant is either selected or not. This final outcome is not considered in IRR, which instead focuses on the ratings of the individual subjects or objects. We outline the connection between the ratings' measurement model (used for IRR) and a binary classification framework. We develop a simple way of approximating the probability of correctly selecting the best applicants which allows us to compute error probabilities of the selection procedure (i.e., false positive and false negative rate) or their lower bounds. We draw connections between the IRR and the binary classification metrics, showing that binary classification metrics depend solely on the IRR coefficient and proportion of selected applicants. We assess the performance of the approximation in a simulation study and apply it in an example comparing the reliability of multiple grant peer review selection procedures. We also discuss other possible uses of the explored connections in other contexts, such as educational testing, psychological assessment, and health-related measurement, and implement the computations in the R package IRR2FPR.
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Affiliation(s)
- František Bartoš
- Department of Statistical Modelling, Institute of Computer Science of the Czech Academy of Sciences, Prague, Czech Republic
- Department of Psychological Methods, University of Amsterdam, Amsterdam, The Netherlands
| | - Patrícia Martinková
- Department of Statistical Modelling, Institute of Computer Science of the Czech Academy of Sciences, Prague, Czech Republic
- Faculty of Education, Charles University, Prague, Czech Republic
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Woelfle T, Bourguignon L, Lorscheider J, Kappos L, Naegelin Y, Jutzeler CR. Wearable Sensor Technologies to Assess Motor Functions in People With Multiple Sclerosis: Systematic Scoping Review and Perspective. J Med Internet Res 2023; 25:e44428. [PMID: 37498655 PMCID: PMC10415952 DOI: 10.2196/44428] [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: 11/18/2022] [Revised: 12/19/2022] [Accepted: 05/04/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Wearable sensor technologies have the potential to improve monitoring in people with multiple sclerosis (MS) and inform timely disease management decisions. Evidence of the utility of wearable sensor technologies in people with MS is accumulating but is generally limited to specific subgroups of patients, clinical or laboratory settings, and functional domains. OBJECTIVE This review aims to provide a comprehensive overview of all studies that have used wearable sensors to assess, monitor, and quantify motor function in people with MS during daily activities or in a controlled laboratory setting and to shed light on the technological advances over the past decades. METHODS We systematically reviewed studies on wearable sensors to assess the motor performance of people with MS. We scanned PubMed, Scopus, Embase, and Web of Science databases until December 31, 2022, considering search terms "multiple sclerosis" and those associated with wearable technologies and included all studies assessing motor functions. The types of results from relevant studies were systematically mapped into 9 predefined categories (association with clinical scores or other measures; test-retest reliability; group differences, 3 types; responsiveness to change or intervention; and acceptability to study participants), and the reporting quality was determined through 9 questions. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. RESULTS Of the 1251 identified publications, 308 were included: 176 (57.1%) in a real-world context, 107 (34.7%) in a laboratory context, and 25 (8.1%) in a mixed context. Most publications studied physical activity (196/308, 63.6%), followed by gait (81/308, 26.3%), dexterity or tremor (38/308, 12.3%), and balance (34/308, 11%). In the laboratory setting, outcome measures included (in addition to clinical severity scores) 2- and 6-minute walking tests, timed 25-foot walking test, timed up and go, stair climbing, balance tests, and finger-to-nose test, among others. The most popular anatomical landmarks for wearable placement were the waist, wrist, and lower back. Triaxial accelerometers were most commonly used (229/308, 74.4%). A surge in the number of sensors embedded in smartphones and smartwatches has been observed. Overall, the reporting quality was good. CONCLUSIONS Continuous monitoring with wearable sensors could optimize the management of people with MS, but some hurdles still exist to full clinical adoption of digital monitoring. Despite a possible publication bias and vast heterogeneity in the outcomes reported, our review provides an overview of the current literature on wearable sensor technologies used for people with MS and highlights shortcomings, such as the lack of harmonization, transparency in reporting methods and results, and limited data availability for the research community. These limitations need to be addressed for the growing implementation of wearable sensor technologies in clinical routine and clinical trials, which is of utmost importance for further progress in clinical research and daily management of people with MS. TRIAL REGISTRATION PROSPERO CRD42021243249; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=243249.
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Affiliation(s)
- Tim Woelfle
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Lucie Bourguignon
- Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland
| | - Johannes Lorscheider
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Yvonne Naegelin
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
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Ingram LA, Butler AA, Brodie MA, Hoang P, Gandevia SC, Lord SR. Original articleQuantifying upper-limb motor impairment in people with multiple sclerosis: a physiological profiling approach. Ann Phys Rehabil Med 2021; 65:101625. [PMID: 34958919 DOI: 10.1016/j.rehab.2021.101625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 11/17/2021] [Accepted: 11/21/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND . Upper-limb sensory and motor impairments are common in people with multiple sclerosis (MS), yet the current gold standard criteria for documenting functional impairment largely focuses on mobility, balance and postural stability. OBJECTIVE . We aimed to determine the validity of the upper-limb Physiological Profile Assessment (PPA) in people with MS by investigating whether the included domains of muscle strength, dexterity, arm stability, position sense, skin sensation and bimanual coordination 1) are sensitive in differentiating people with MS from healthy controls and 2) correlate with a validated measure of upper-limb function and a scale for quantifying disability in MS. METHODS . In a cross-sectional study, 40 participants with MS and 80 healthy controls completed all 13 of the upper-limb PPA tests within a single session. RESULTS . People with MS were impaired across all physiological domains tested. Performance in 4 of the 13 tests was correlated with a validated measure of self-reported upper-limb function (Pearson's r or Spearman's rho -0.333-0.441), whereas 3 tests were associated with the degree of MS-specific disability (Spearman's rho -0.318; 0.456). CONCLUSIONS . The upper-limb PPA offers a valid and clinically suitable assessment of upper-limb function in people with MS. Clinicians should prioritise assessments of motor speed, fine motor control and functional tasks in their assessment of upper-limb function in people with MS because these domains are the most commonly and significantly impaired.
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Affiliation(s)
- Lewis A Ingram
- Neuroscience Research Australia, Sydney, New South Wales, Australia; University of South Australia, Adelaide, South Australia, Australia.
| | - Annie A Butler
- Neuroscience Research Australia, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew A Brodie
- Neuroscience Research Australia, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia
| | - Phu Hoang
- Neuroscience Research Australia, Sydney, New South Wales, Australia; Multiple Sclerosis Limited, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia
| | - Stephen R Lord
- Neuroscience Research Australia, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia
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Robot-Assisted Gait Training in Patients with Multiple Sclerosis: A Randomized Controlled Crossover Trial. ACTA ACUST UNITED AC 2021; 57:medicina57070713. [PMID: 34356994 PMCID: PMC8306232 DOI: 10.3390/medicina57070713] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 02/04/2023]
Abstract
Background and Objectives: Gait disorders represent one of the most disabling aspects in multiple sclerosis (MS) that strongly influence patient quality of life. The improvement of walking ability is a primary goal for rehabilitation treatment. The aim of this study is to evaluate the effectiveness of robot-assisted gait training (RAGT) in association with physiotherapy treatment in patients affected by MS in comparison with ground conventional gait training. Study design: Randomized controlled crossover trial. Materials and Methods: Twenty-seven participants affected by MS with EDSS scores between 3.5 and 7 were enrolled, of whom seventeen completed the study. They received five training sessions per week over five weeks of conventional gait training with (experimental group) or without (control group) the inclusion of RAGT. The patients were prospectively evaluated before and after the first treatment session and, after the crossover phase, before and after the second treatment session. The evaluation was based on the 25-foot walk test (25FW, main outcome), 6 min walk test (6MWT), Tinetti Test, Modified Ashworth Scale, and modified Motricity Index for lower limbs. We also measured disability parameters using Functional Independence Measure and Quality of Life Index, and instrumental kinematic and gait parameters: knee extensor strength, double-time support, step length ratio; 17 patients reached the final evaluation. Results: Both groups significantly improved on gait parameters, motor abilities, and autonomy recovery in daily living activities with generally better results of RAGT over control treatment. In particular, the RAGT group improved more than control group in the 25FW (p = 0.004) and the 6MWT (p = 0.022). Conclusions: RAGT is a valid treatment option that in association with physiotherapy could induce positive effects in MS-correlated gait disorders. Our results showed greater effectiveness in recovering gait speed and resistance than conventional gait training.
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Ayvat F, Özçakar L, Ayvat E, Aksu Yıldırım S, Kılınç M. Effects of low vs. high frequency local vibration on mild-moderate muscle spasticity: Ultrasonographical and functional evaluation in patients with multiple sclerosis. Mult Scler Relat Disord 2021; 51:102930. [PMID: 33836458 DOI: 10.1016/j.msard.2021.102930] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/16/2021] [Accepted: 03/26/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Local vibration (LV) is a physiotherapy application that aims to reduce spasticity. The study aimed to compare the effects of 50 Hz vs. 100 Hz LV on mild-moderate spasticity, functional performance and muscle architecture. METHODS Thirty-three patients were randomly divided into three groups: 50 Hz LV group, 100 Hz LV group and the control group. Physical therapy was applied for one hour a day, three days a week, for a total of eight weeks. LV was applied to the right and left medial gastrocnemius muscles for five minutes. Clinical (spasticity, ankle joint position sense, balance, gait) and ultrasonographic (gastrocnemius fascicle length and pennation angle) measurements were performed before and after treatment. RESULTS The study was completed with 27 patients. The decrease in spasticity and the increase in fascicle length were found to be statistically significant in the 50 Hz group (both p<0.05). Ankle joint position sense, single-leg stance time, limits of stability/postural sway range in the medio-lateral direction significantly improved in the vibration treatment groups (all p<0.05). The antero-posterior limits of stability and postural sway showed significant improvement in all groups (all p<0.05). While the 50 Hz group showed significant improvement for all walking parameters; velocity, step length and base of support values improved in the 100 Hz group (all p<0.05). The exercise group showed significant improvement only for single support and stance phase percentages of the gait cycle (both p<0.05). According to between group comparisons, significant difference was found only in medio-lateral limits of stabillity (p<0.05). Medio-lateral limits of stabillity scores were better for the 50 Hz group than the 100 Hz and exercise group. CONCLUSION Our findings show that LV does not have any substantial effect except for medio-lateral limits of stability. CLINICAL TRIAL NUMBER NCT04192786.
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Affiliation(s)
- Fatma Ayvat
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, 06100 Samanpazarı/Altındag, Ankara, Turkey.
| | - Levent Özçakar
- Hacettepe University Medical School, Department of Physical and Rehabilitation Medicine, Ankara, Turkey.
| | - Ender Ayvat
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, 06100 Samanpazarı/Altındag, Ankara, Turkey.
| | - Sibel Aksu Yıldırım
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, 06100 Samanpazarı/Altındag, Ankara, Turkey.
| | - Muhammed Kılınç
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, 06100 Samanpazarı/Altındag, Ankara, Turkey.
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Prochazkova M, Tintera J, Spanhelova S, Prokopiusova T, Rydlo J, Pavlikova M, Prochazka A, Rasova K. Brain activity changes following neuroproprioceptive "facilitation, inhibition" physiotherapy in multiple sclerosis: a parallel group randomized comparison of two approaches. Eur J Phys Rehabil Med 2020; 57:356-365. [PMID: 32935954 DOI: 10.23736/s1973-9087.20.06336-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Imaging methods bring new possibilities for describing the brain plasticity processes that underly the improvement of clinical function after physiotherapy in people with multiple sclerosis (pwMS). Although these processes have been described mainly in connection with task-oriented physiotherapy and aerobic training, they have not been properly verified in neuroproprioceptive "facilitation, inhibition" (facilitation) approaches. AIM The study determined whether facilitation physiotherapy could enhance brain plasticity, compared two facilitation methods and looked for any relation to clinical improvement in pwMS. DESIGN The study was designed as parallel group randomized comparison of two kinds of physiotherapeutic interventions referred to healthy controls. SETTING Thirty-eight outpatients were involved in the study. POPULATION The study had 80 participants (38 pwMS and 42 healthy controls). METHODS PwMS were divided into two groups and underwent a two-month physiotherapy program: Vojta reflex locomotion (VRL) or Motor program activating therapy (MPAT), (1 hour, twice a week). Functional magnetic resonance imaging (fMRI) and clinical examination was performed before and after therapy. Healthy controls underwent one fMRI examination. RESULTS Physiotherapy in pwMS leads to extension of brain activity in specific brain areas (cerebellum, supplementary motor areas and premotor areas) in connection with the improvement of the clinical status of individual patients after therapy (P=0.05). Greater changes (P=0.001) were registered after MPAT than after VRL. The extension of activation was a shift to the examined activation of healthy controls, whose activation was higher in the cerebellum and secondary visual area (P=0.01). CONCLUSIONS Neuroproprioceptive "facilitation, inhibition" physiotherapy may enhance brain activity and could involve processes connected with the processing of motion activation. CLINICAL REHABILITATION IMPACT The study showed that facilitation approach can modulate brain activity. This could be useful for developing of effective physiotherapeutic treatment in MS.
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Affiliation(s)
- Marie Prochazkova
- Department of Rehabilitation Medicine, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jaroslav Tintera
- MR Unit, Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Sarka Spanhelova
- Department of Rehabilitation, Motol Faculty Hospital, Prague, Czech Republic
| | - Terezie Prokopiusova
- Department of Rehabilitation Medicine, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Rydlo
- MR Unit, Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Marketa Pavlikova
- Department of Rehabilitation Medicine, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Antonin Prochazka
- Institute of Biophysics and Informatics, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Kamila Rasova
- Department of Rehabilitation Medicine, Third Faculty of Medicine, Charles University, Prague, Czech Republic -
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Řasová K, Martinková P, Soler B, Freeman J, Cattaneo D, Jonsdottir J, Smedal T, Romberg A, Henze T, Santoyo-Medina C, Feys P. Real-World Goal Setting and Use of Outcome Measures According to the International Classification of Functioning, Disability and Health: A European Survey of Physical Therapy Practice in Multiple Sclerosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134774. [PMID: 32630765 PMCID: PMC7369767 DOI: 10.3390/ijerph17134774] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/27/2020] [Accepted: 06/30/2020] [Indexed: 01/29/2023]
Abstract
Goal setting is a core component of physical therapy in multiple sclerosis (MS). It is unknown whether and to what extent goals are set at different levels of the International Classification of Functioning, Disability and Health (ICF), and whether, and to which, standardized outcome measures are used in real life for evaluation at the different ICF levels. Our aim was to describe the real-world use of goal setting and outcome measures in Europe. An online cross-sectional survey, completed by 212 physical therapists (PTs) specialized in MS from 26 European countries, was conducted. Differences between European regions and relationships between goals and assessments were analyzed. PTs regularly set goals, but did not always apply the Specific, Measurable, Achievable, Realistic, Timed (SMART) criteria. Regions did not differ in the range of activities assessed, but in goals set (e.g., Western and Northern regions set significantly more goals regarding leisure and work) and outcome measures used (e.g., the Berg Balance Scale was more frequently used in Northern regions). Quality of life was not routinely assessed, despite being viewed as an important therapy goal. Discrepancies existed both in goal setting and assessment across European regions. ICF assists in understanding these discrepancies and in guiding improved health-care for the future.
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Affiliation(s)
- Kamila Řasová
- Department of Rehabilitation, Third Faculty of Medicine, Charles University, Prague 108 00, Czech Republic
- Correspondence: ; Tel.: +420-60-4511-416
| | - Patrícia Martinková
- Department of Statistical Modelling, Institute of Computer Science of the Czech Academy of Sciences, Prague 182 07, Czech Republic;
| | - Bernadita Soler
- Neurology, Pontificia Universidad Católica de Chile, Santiago 3580000, Chile;
- Neurology, Hospital Doctor Sótero del Rio, Santiago 8320000, Chile
- REVAL, Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt 3500, Belgium;
| | - Jenny Freeman
- Faculty of Health, University of Plymouth, Devon PL6 8BH, UK;
| | - Davide Cattaneo
- IRCCS Fondazione Don Carlo Gnocchi, Larice Lab, 20148 Milan, Italy; (D.C.); (J.J.)
| | - Johanna Jonsdottir
- IRCCS Fondazione Don Carlo Gnocchi, Larice Lab, 20148 Milan, Italy; (D.C.); (J.J.)
| | - Tori Smedal
- Norwegian Multiple Sclerosis Competence Centre, Department of Neurology and Department of Physiotherapy, Haukeland University Hospital, 5021 Bergen, Norway;
| | - Anders Romberg
- Physiotherapy, Masku Neurological Rehabilitation Centre, 21250 Masku, Finland;
| | - Thomas Henze
- Specialist Practice in Neurology, 93059 Regensburg, Germany;
| | - Carme Santoyo-Medina
- Neurology-Neuroimmunology Department, Neurorehabilitation Unit, Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d’Hebron University Hospital, 08035 Barcelona, Spain;
| | - Peter Feys
- REVAL, Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt 3500, Belgium;
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Meseguer-Henarejos AB, Rubio-Aparicio M, López-Pina JA, Carles-Hernández R, Gómez-Conesa A. Characteristics that affect score reliability in the Berg Balance Scale: a meta-analytic reliability generalization study. Eur J Phys Rehabil Med 2019; 55:570-584. [DOI: 10.23736/s1973-9087.19.05363-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Macaron G, Ontaneda D. Diagnosis and Management of Progressive Multiple Sclerosis. Biomedicines 2019; 7:E56. [PMID: 31362384 PMCID: PMC6784028 DOI: 10.3390/biomedicines7030056] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 07/23/2019] [Accepted: 07/26/2019] [Indexed: 12/13/2022] Open
Abstract
Multiple sclerosis is a chronic autoimmune disease of the central nervous system that results in varying degrees of disability. Progressive multiple sclerosis, characterized by a steady increase in neurological disability independently of relapses, can occur from onset (primary progressive) or after a relapsing-remitting course (secondary progressive). As opposed to active inflammation seen in the relapsing-remitting phases of the disease, the gradual worsening of disability in progressive multiple sclerosis results from complex immune mechanisms and neurodegeneration. A few anti-inflammatory disease-modifying therapies with a modest but significant effect on measures of disease progression have been approved for the treatment of progressive multiple sclerosis. The treatment effect of anti-inflammatory agents is particularly observed in the subgroup of patients with younger age and evidence of disease activity. For this reason, a significant effort is underway to develop molecules with the potential to induce myelin repair or halt the degenerative process. Appropriate trial methodology and the development of clinically meaningful disability outcome measures along with imaging and biological biomarkers of progression have a significant impact on the ability to measure the efficacy of potential medications that may reverse disease progression. In this issue, we will review current evidence on the physiopathology, diagnosis, measurement of disability, and treatment of progressive multiple sclerosis.
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Affiliation(s)
- Gabrielle Macaron
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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Norbye AD, Midgard R, Thrane G. Spasticity, gait, and balance in patients with multiple sclerosis: A cross-sectional study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 25:e1799. [PMID: 31287210 DOI: 10.1002/pri.1799] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 04/10/2019] [Accepted: 05/17/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVE More than 80% of people with multiple sclerosis (MS) are affected by spasticity. Spasticity is known to reduce quality of life and contribute to additional symptoms, such as pain and reduced mobility, but the association between spasticity, balance, and mobility has not yet been established. Our aim was to examine whether a relationship exists between spasticity in the lower limbs, balance, and gait, as well as to explore the involvement of different muscle groups. METHODS This study employed a cross-sectional design. Thirty patients with MS were included. The Modified Ashworth Scale (MAS) was used to examine spasticity in the ankle plantar flexors, knee extensors, and hip adductors. Balance was measured using the Mini-Balance Evaluation Systems Test, and gait with the 2-Minute Walk Test. The participants were tested once with no additional follow-up. Spearman's correlation, recursive partitioning, and linear regression analyses were used to explore the association. RESULTS A significant correlation between gait distance and spasticity in the ankle plantar flexors (ρ = -.69, p < .001) and knee extensors (ρ = -.45, p = .012) was observed. Balance significantly correlated with spasticity in ankle plantar flexors (ρ = -.69, p < .001), knee extensors (ρ = -.52, p = .003), and hip adductors (ρ = -.5, p = .005). The relationship between spasticity in ankle plantar flexors and hip adductors was significant, even from low levels of spasticity, whereas MAS score ≥ 2 was clinically correlated with a decrease in gait and balance function. Adjustments for sex, age, or years since diagnosis had only minor impact on the results. CONCLUSIONS This study indicates that spasticity in the lower limbs is clinically significantly associated with mobility in people with MS.
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Affiliation(s)
- Anja Davis Norbye
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Neurology, Molde Hospital, Møre and Romsdal Health Trust, Molde, Norway.,Department of Physiotherapy, University Hospital of North Norway, Tromsø, Norway
| | - Rune Midgard
- Department of Neurology, Molde Hospital, Møre and Romsdal Health Trust, Molde, Norway.,Unit for Applied Clinical Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Gyrd Thrane
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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Lamers I, Raats J, Spaas J, Meuleman M, Kerkhofs L, Schouteden S, Feys P. Intensity-dependent clinical effects of an individualized technology-supported task-oriented upper limb training program in Multiple Sclerosis: A pilot randomized controlled trial. Mult Scler Relat Disord 2019; 34:119-127. [PMID: 31255988 DOI: 10.1016/j.msard.2019.06.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 05/08/2019] [Accepted: 06/15/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Task-oriented training promotes functional recovery in Multiple Sclerosis (MS). Know-how to determine an individualized training intensity and intensity-dependent effects are, however, unknown. The objective of the study was to investigate the feasibility and the clinical effects of a task-oriented upper limb training program at different individualized training intensities with conventional occupational therapy. METHODS People with MS (n = 20, EDSS range 4-8) were divided into three groups, receiving task-oriented training at 100% (n = 7) or 50% (n = 8) of their individual maximal number of repetitions, or conventional occupational therapy (n = 5). Effects were evaluated using different upper limb capacity and perceived performance measures on activity level, and measures on body functions and structures level. RESULTS Mixed model analyses revealed significant improvements (p < 0.05) over time on the Box and block test (BBT), Action Research Arm Test and the Manual Ability Measure-36. Significant interaction effects (group*time) in favor of the task-oriented group training at the highest intensity were found for BBT and static fatigue index during a maximal sustained handgrip strength test. CONCLUSION All participants were able to perform the task-oriented training at their individualized intensity without any adverse effects. Several improvements over time were found for all intervention groups, however the results suggest a superiority of task-oriented training at 100%. CLINICAL TRIAL REGISTRATION NUMBER ON CLINICALTRIALS.GOV: = NCT02688231.
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Affiliation(s)
- Ilse Lamers
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Martelarenlaan 42, Hasselt 3500, Belgium; Rehabilitation and MS center, Boemerangstraat 2, Overpelt 3900, Belgium.
| | - Joke Raats
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Martelarenlaan 42, Hasselt 3500, Belgium
| | - Jan Spaas
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Martelarenlaan 42, Hasselt 3500, Belgium
| | - Michaël Meuleman
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Martelarenlaan 42, Hasselt 3500, Belgium
| | - Lore Kerkhofs
- Rehabilitation and MS center, Boemerangstraat 2, Overpelt 3900, Belgium
| | - Sofie Schouteden
- Rehabilitation and MS center, Boemerangstraat 2, Overpelt 3900, Belgium
| | - Peter Feys
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Martelarenlaan 42, Hasselt 3500, Belgium
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Horn KK, Allen DD, Gibson-Horn C, Widener GL. Effects of Torso-Weighting on Standing Balance and Falls During the Sensory Organization Test in People with Multiple Sclerosis. Int J MS Care 2018; 20:68-75. [PMID: 29681777 DOI: 10.7224/1537-2073.2015-090] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background In people with multiple sclerosis (MS), common gait and balance impairments can lead to falls, fear of falling, activity restriction, and social isolation. Sensory augmentation in the form of torso-weighting has resulted in improvement in gait and balance, but research on its effect on falls in MS is lacking. Methods 60 people with MS and 10 bin-matched controls completed the Sensory Organization Test (SOT) while nonweighted and again while weighted using the Balance-Based Torso-Weighting assessment method. This was a quasi-experimental pre-post intervention study. The SOT composite scores, equilibrium scores, and number of falls occurring across six SOT conditions were compared between and within groups using 2-way analysis of variance, α = .05 with planned t test analyses of weighting effects. Results A significant increase in composite score of 9.14 points nonweighted to weighted occurred in the MS group (P < .001) but not in controls (P = .626). Equilibrium scores were significantly higher with weights in the MS group (P < .001) but not in controls (P = .5). Falls during the SOT were reduced by 35% with weights in the MS group versus without weights (P < .001), with the greatest number of falls occurring in the most challenging SOT conditions. Conclusions During a single testing session, torso-weighting produced significant improvements in postural stability and fall reduction during the SOT for people with MS but no change in controls. Further research is needed to determine whether torso-weighting has the potential to reduce falls in MS during real-world activities.
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Balcer LJ, Raynowska J, Nolan R, Galetta SL, Kapoor R, Benedict R, Phillips G, LaRocca N, Hudson L, Rudick R. Validity of low-contrast letter acuity as a visual performance outcome measure for multiple sclerosis. Mult Scler 2017; 23:734-747. [PMID: 28206829 PMCID: PMC5407511 DOI: 10.1177/1352458517690822] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Low-contrast letter acuity (LCLA) has emerged as the leading outcome measure to assess visual disability in multiple sclerosis (MS) research. As visual dysfunction is one of the most common manifestations of MS, sensitive visual outcome measures are important in examining the effect of treatment. Low-contrast acuity captures visual loss not seen in high-contrast visual acuity (HCVA) measurements. These issues are addressed by the MS Outcome Assessments Consortium (MSOAC), including representatives from advocacy organizations, Food and Drug Administration (FDA), European Medicines Agency (EMA), National Institute of Neurological Disorders and Stroke (NINDS), academic institutions, and industry partners along with persons living with MS. MSOAC goals are acceptance and qualification by regulators of performance outcomes that are highly reliable and valid, practical, cost-effective, and meaningful to persons with MS. A critical step is elucidation of clinically relevant benchmarks, well-defined degrees of disability, and gradients of change that are clinically meaningful. This review shows that MS and disease-free controls have similar median HCVA, while MS patients have significantly lower LCLA. Deficits in LCLA and vision-specific quality of life are found many years after an episode of acute optic neuritis, even when HCVA has recovered. Studies reveal correlations between LCLA and the Expanded Disability Status Score (EDSS), Multiple Sclerosis Functional Composite (MSFC), retinal nerve fiber layer (RNFL) and ganglion cell layer plus inner plexiform layer (GCL + IPL) thickness on optical coherence tomography (OCT), brain magnetic resonance imaging (MRI), visual evoked potential (VEP), electroretinogram (ERG), pupillary function, and King-Devick testing. This review also concludes that a 7-point change in LCLA is clinically meaningful. The overall goal of this review is to describe and characterize the LCLA metric for research and clinical use among persons with MS.
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Affiliation(s)
- Laura J Balcer
- Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Jenelle Raynowska
- Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Rachel Nolan
- Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Steven L Galetta
- Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Raju Kapoor
- National Hospital for Neurology and Neurosurgery, London, UK
| | - Ralph Benedict
- Department of Neurology, University at Buffalo, Buffalo, NY, USA
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- Multiple Sclerosis Outcome Assessments Consortium (MSOAC), Critical Path Institute, Tucson, AZ, USA
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Motor programme activating therapy influences adaptive brain functions in multiple sclerosis: clinical and MRI study. Int J Rehabil Res 2015; 38:49-54. [PMID: 25325167 DOI: 10.1097/mrr.0000000000000090] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There is still little scientific evidence for the efficacy of neurofacilitation approaches and their possible influence on brain plasticity and adaptability. In this study, the outcome of a new kind of neurofacilitation approach, motor programme activating therapy (MPAT), was evaluated on the basis of a set of clinical functions and with MRI. Eighteen patients were examined four times with standardized clinical tests and diffusion tensor imaging to monitor changes without therapy, immediately after therapy and 1 month after therapy. Moreover, the strength of effective connectivity was analysed before and after therapy. Patients underwent a 1-h session of MPAT twice a week for 2 months. The data were analysed by nonparametric tests of association and were subsequently statistically evaluated. The therapy led to significant improvement in clinical functions, significant increment of fractional anisotropy and significant decrement of mean diffusivity, and decrement of effective connectivity at supplementary motor areas was observed immediately after the therapy. Changes in clinical functions and diffusion tensor images persisted 1 month after completing the programme. No statistically significant changes in clinical functions and no differences in MRI-diffusion tensor images were observed without physiotherapy. Positive immediate and long-term effects of MPAT on clinical and brain functions, as well as brain microstructure, were confirmed.
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Karabudak R, Dahdaleh M, Aljumah M, Alroughani R, Alsharoqi IA, AlTahan AM, Bohlega SA, Daif A, Deleu D, Amous A, Inshasi JS, Rieckmann P, Sahraian MA, Yamout BI. Functional clinical outcomes in multiple sclerosis: Current status and future prospects. Mult Scler Relat Disord 2015; 4:192-201. [PMID: 26008936 DOI: 10.1016/j.msard.2015.03.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 02/23/2015] [Accepted: 03/14/2015] [Indexed: 11/29/2022]
Abstract
For decades, the Expanded Disability Status Scale (EDSS) has been the principal measure of disability in clinical trials in patients with multiple sclerosis (MS) and in clinical practice. However, this test is dominated by effects on ambulation. Composite endpoints may provide a more sensitive measure of MS-related disability through the measurement of additional neurological functions. The MS Functional Composite (MSFC) includes a walking test (25-ft walk) plus tests of upper extremity dexterity (9-hole peg test) and cognitive function (Paced Auditory serial Addition test [PASAT]). Replacing PASAT with the Symbol Digit Modality test, a more sensitive test preferred by patients, may improve the clinical utility of the MSFC. In addition, disease-specific measures of QoL may be used alongside the MSFC (which does not include measurement of QoL). Clinical data suggest that disease-modifying therapies may delay or prevent relapse, and better composite measures will be valuable in the assessment of disease activity-free status in people with MS.
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Affiliation(s)
- Rana Karabudak
- Hacettepe University Hospitals, Dept. of Neurology, Neuroimmunology Unit, Ankara, Turkey.
| | - Maurice Dahdaleh
- Department of Internal Medicine, Neurology Section, Arab Medical Center and Khalidi Hospital, Amman, Jordan
| | - Mohammed Aljumah
- King Abdullah International Medical Research Center, King Saud Ben Abdulaziz University for Health Sciences, NGHA, Riyadh, Saudi Arabia; Prince Mohammed bin Abdul-Aziz Hospital, Ministry of Health, Riyadh, Saudi Arabia
| | - Raed Alroughani
- Division of Neurology, Amiri Hospital, Kuwait; Division of Neurology, Dasman Diabetes Institute, Kuwait
| | - I Ahmed Alsharoqi
- Clinical Neurosciences Department, Salmaniya Medical Complex, Manama, Bahrain
| | - Abdulrahman M AlTahan
- Neurology Section, King Khalid University Hospital, King Saud University and Dallah Hospital, Saudi Arabia
| | - Saeed A Bohlega
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Abdulkader Daif
- Neurology Section, King Khalid University Hospital, King Saud University and Dallah Hospital, Saudi Arabia
| | - Dirk Deleu
- Department of Neurology (Medicine), Hamad Medical Corporation, Doha, Qatar
| | - Amer Amous
- Merck Serono Intercontinental Region, Dubai, United Arab Emirates
| | - Jihad S Inshasi
- Neurology Department, Rashid Hospital and Dubai Medical College, Dubai Health Authority, United Arab Emirates
| | | | - Mohammed A Sahraian
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Iran
| | - Bassem I Yamout
- Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
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Mayer L, Warring T, Agrella S, Rogers HL, Fox EJ. Effects of functional electrical stimulation on gait function and quality of life for people with multiple sclerosis taking dalfampridine. Int J MS Care 2015; 17:35-41. [PMID: 25741225 DOI: 10.7224/1537-2073.2013-033] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) can adversely affect gait, causing gait slowing, loss of balance, decreased functional mobility, and gait deficits, such as footdrop. Current treatments for gait dysfunction due to MS are pharmacologic, using dalfampridine, or orthotic, using an ankle-foot orthosis. Functional electrical stimulation (FES) to the fibular nerve stimulates active dorsiflexion and provides an alternative treatment for gait dysfunction caused by footdrop. The objective of this study was to determine the effect of FES on gait function and the impact of MS on walking and quality of life for people with MS taking a stable dalfampridine dose. METHODS Participants demonstrating gait slowing and footdrop completed the Timed 25-Foot Walk (T25FW) test, 6-Minute Walk (6MW) test, GaitRite Functional Ambulation Profile, 12-item Multiple Sclerosis Walking Scale (MSWS-12), and 36-item Short Form Health Status Survey (SF-36) at screening without FES; the measures were repeated with FES at baseline, 1 month, and 3 months. RESULTS Twenty participants (8 men and 12 women) completed this unblinded case series study. The mean age, duration of MS, and time taking dalfampridine were 51.7, 15.8, and 1.4 years, respectively. Changes from screening to baseline and screening to 3 months were analyzed. Significant improvement was noted from screening to baseline for the MSWS-12 (P = .024) and SF-36 Physical Function domain (P = .028) and from screening to 3 months for the T25FW (P = .015), MSWS-12 (P = .003), and SF-36 Physical Function (P = .032) and Role Limitation-Physical Health (P = .012) domains. CONCLUSIONS Improvements above those induced pharmacologically suggest that FES can augment pharmacologic intervention and significantly improve gait function, decrease the impact of MS on walking, and improve quality of life for people with MS.
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Affiliation(s)
- Lori Mayer
- Multiple Sclerosis Clinic of Central Texas, Central Texas Neurology Consultants, Round Rock, TX, USA (LM, TW, SA, EJF); and Innovative Neurotronics, Austin, TX, USA (HLR)
| | - Tina Warring
- Multiple Sclerosis Clinic of Central Texas, Central Texas Neurology Consultants, Round Rock, TX, USA (LM, TW, SA, EJF); and Innovative Neurotronics, Austin, TX, USA (HLR)
| | - Stephanie Agrella
- Multiple Sclerosis Clinic of Central Texas, Central Texas Neurology Consultants, Round Rock, TX, USA (LM, TW, SA, EJF); and Innovative Neurotronics, Austin, TX, USA (HLR)
| | - Helen L Rogers
- Multiple Sclerosis Clinic of Central Texas, Central Texas Neurology Consultants, Round Rock, TX, USA (LM, TW, SA, EJF); and Innovative Neurotronics, Austin, TX, USA (HLR)
| | - Edward J Fox
- Multiple Sclerosis Clinic of Central Texas, Central Texas Neurology Consultants, Round Rock, TX, USA (LM, TW, SA, EJF); and Innovative Neurotronics, Austin, TX, USA (HLR)
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Abstract
BACKGROUND Impaired manual dexterity is frequent and disabling in people with multiple sclerosis (MS). Therefore, convenient, quick, and validated tests for manual dexterity in people with MS are needed. OBJECTIVE The aim of this study was to validate the Coin Rotation Task (CRT) for examining manual dexterity in people with MS. DESIGN This was a cross-sectional study. METHODS A total of 101 outpatients with MS were assessed with the CRT, the Expanded Disability Status Scale (EDSS), the Scale for the Assessment and Rating of Ataxia (SARA), and the Modified Ashworth Scale (MAS); muscle strength and sensory deficits of the hands were noted. The concurrent validity and diagnostic accuracy of the CRT were determined by comparison with the 9-Hole Peg Test (9HPT). Construct validity was determined by comparison with a valid dexterity questionnaire. Multiple regression analyses were done to explore correlations of the CRT with the EDSS, SARA, MAS, muscle strength, and sensory deficits. RESULTS The CRT correlated significantly with the 9HPT (r=.73, P<.0001), indicating good concurrent validity. The cutoff values for the CRT relative to the 9HPT were 18.75 seconds for the dominant hand (sensitivity=81.5%, specificity=80.0%) and 19.25 seconds for the nondominant hand (sensitivity=90.3%, specificity=81.8%); these values indicated good diagnostic accuracy. Furthermore, the CRT correlated significantly with the dexterity questionnaire (r=-.49, P<.0001), indicating moderate construct validity. Multiple regression analyses revealed that the EDSS was the strongest predictor for impaired dexterity. LIMITATIONS Most of the people examined had relapsing-remitting MS and EDSS scores of up to 7. CONCLUSIONS This study validated the CRT as a test that can be used easily and quickly to evaluate manual dexterity in people with MS.
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Downing A, Van Ryn D, Fecko A, Aiken C, McGowan S, Sawers S, McInerny T, Moore K, Passariello L, Rogers H. Effect of a 2-week trial of functional electrical stimulation on gait function and quality of life in people with multiple sclerosis. Int J MS Care 2014; 16:146-52. [PMID: 25337057 DOI: 10.7224/1537-2073.2013-032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Footdrop is a common gait deviation in people with multiple sclerosis (MS) leading to impaired gait and balance as well as decreased functional mobility. Functional electrical stimulation (FES) provides an alternative to the current standard of care for footdrop, an ankle-foot orthosis (AFO). FES stimulates the peroneal nerve and activates the dorsiflexor muscles, producing an active toe clearance and a more normal gait. This study was undertaken to determine the effects of a 2-week FES Home Assessment Program on gait speed, perceived walking ability, and quality of life (QOL) among people with MS-related footdrop. METHODS Participants completed the Timed 25-Foot Walk test (T25FW) and two self-report measures: 12-item Multiple Sclerosis Walking Scale (MSWS-12) and 29-item Multiple Sclerosis Impact Scale (MSIS-29). Measures were taken without FES before and with FES after 2 weeks of full-time FES wear. RESULTS A total of 19 participants (10 female, 9 male) completed the study; mean age and duration of disease were 51.77 ± 10.16 and 9.01 ± 7.90 years, respectively. Use of FES for 2 weeks resulted in a significant decrease in time to complete the T25FW (P < .0001), the MSWS-12 standardized score (P < .0001), and the MSIS-29 total (P < .0001), Physical subscale (P < .0001), and Psychological subscale (P = .0006) scores. CONCLUSIONS These results suggest that use of FES can significantly improve gait speed, decrease the impact of MS on walking ability, and improve QOL in people with MS-related footdrop even over a short period of time.
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Affiliation(s)
- Abbey Downing
- Hanger Prosthetics and Orthotic Clinic, Torrington, CT, USA (AD); Wethersfield, CT, USA (DVR); Woburn, MA, USA (AF); Somersworth, NH, USA (CA); Greenville, NC, USA (SM); Seattle, WA, USA (SS); Albany, NY, USA (TM); Columbia, SC, USA (KM); and New London, CT, USA (LP); and Innovative Neurotronics, Galveston, TX, USA (HR)
| | - David Van Ryn
- Hanger Prosthetics and Orthotic Clinic, Torrington, CT, USA (AD); Wethersfield, CT, USA (DVR); Woburn, MA, USA (AF); Somersworth, NH, USA (CA); Greenville, NC, USA (SM); Seattle, WA, USA (SS); Albany, NY, USA (TM); Columbia, SC, USA (KM); and New London, CT, USA (LP); and Innovative Neurotronics, Galveston, TX, USA (HR)
| | - Anne Fecko
- Hanger Prosthetics and Orthotic Clinic, Torrington, CT, USA (AD); Wethersfield, CT, USA (DVR); Woburn, MA, USA (AF); Somersworth, NH, USA (CA); Greenville, NC, USA (SM); Seattle, WA, USA (SS); Albany, NY, USA (TM); Columbia, SC, USA (KM); and New London, CT, USA (LP); and Innovative Neurotronics, Galveston, TX, USA (HR)
| | - Christopher Aiken
- Hanger Prosthetics and Orthotic Clinic, Torrington, CT, USA (AD); Wethersfield, CT, USA (DVR); Woburn, MA, USA (AF); Somersworth, NH, USA (CA); Greenville, NC, USA (SM); Seattle, WA, USA (SS); Albany, NY, USA (TM); Columbia, SC, USA (KM); and New London, CT, USA (LP); and Innovative Neurotronics, Galveston, TX, USA (HR)
| | - Sean McGowan
- Hanger Prosthetics and Orthotic Clinic, Torrington, CT, USA (AD); Wethersfield, CT, USA (DVR); Woburn, MA, USA (AF); Somersworth, NH, USA (CA); Greenville, NC, USA (SM); Seattle, WA, USA (SS); Albany, NY, USA (TM); Columbia, SC, USA (KM); and New London, CT, USA (LP); and Innovative Neurotronics, Galveston, TX, USA (HR)
| | - Sarah Sawers
- Hanger Prosthetics and Orthotic Clinic, Torrington, CT, USA (AD); Wethersfield, CT, USA (DVR); Woburn, MA, USA (AF); Somersworth, NH, USA (CA); Greenville, NC, USA (SM); Seattle, WA, USA (SS); Albany, NY, USA (TM); Columbia, SC, USA (KM); and New London, CT, USA (LP); and Innovative Neurotronics, Galveston, TX, USA (HR)
| | - Thomas McInerny
- Hanger Prosthetics and Orthotic Clinic, Torrington, CT, USA (AD); Wethersfield, CT, USA (DVR); Woburn, MA, USA (AF); Somersworth, NH, USA (CA); Greenville, NC, USA (SM); Seattle, WA, USA (SS); Albany, NY, USA (TM); Columbia, SC, USA (KM); and New London, CT, USA (LP); and Innovative Neurotronics, Galveston, TX, USA (HR)
| | - Katie Moore
- Hanger Prosthetics and Orthotic Clinic, Torrington, CT, USA (AD); Wethersfield, CT, USA (DVR); Woburn, MA, USA (AF); Somersworth, NH, USA (CA); Greenville, NC, USA (SM); Seattle, WA, USA (SS); Albany, NY, USA (TM); Columbia, SC, USA (KM); and New London, CT, USA (LP); and Innovative Neurotronics, Galveston, TX, USA (HR)
| | - Louis Passariello
- Hanger Prosthetics and Orthotic Clinic, Torrington, CT, USA (AD); Wethersfield, CT, USA (DVR); Woburn, MA, USA (AF); Somersworth, NH, USA (CA); Greenville, NC, USA (SM); Seattle, WA, USA (SS); Albany, NY, USA (TM); Columbia, SC, USA (KM); and New London, CT, USA (LP); and Innovative Neurotronics, Galveston, TX, USA (HR)
| | - Helen Rogers
- Hanger Prosthetics and Orthotic Clinic, Torrington, CT, USA (AD); Wethersfield, CT, USA (DVR); Woburn, MA, USA (AF); Somersworth, NH, USA (CA); Greenville, NC, USA (SM); Seattle, WA, USA (SS); Albany, NY, USA (TM); Columbia, SC, USA (KM); and New London, CT, USA (LP); and Innovative Neurotronics, Galveston, TX, USA (HR)
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Paltamaa J. Adequate outcome measures for assessing ICF categories are needed. PHYSICAL THERAPY REVIEWS 2014. [DOI: 10.1179/1743288x13y.0000000127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Lamers I, Feys P. Assessing upper limb function in multiple sclerosis. Mult Scler 2014; 20:775-84. [DOI: 10.1177/1352458514525677] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 02/04/2014] [Indexed: 11/17/2022]
Abstract
The need to fully assess upper limb function in multiple sclerosis (MS) has become increasingly clear with recent studies revealing a high prevalence of upper limb dysfunction in persons with MS leading to increased dependency and reduced quality of life. It is important that clinicians and researchers use tailored outcome measures to systematically describe upper limb (dys)function and evaluate potential deterioration or improvement on treatment. This topical review provides a comprehensive summary of currently used upper limb outcome measures in MS, classified according to the levels of the International Classification of Functioning (ICF). The clinical utility, strengths, weaknesses and psychometric properties of common upper limb outcome measures are discussed. Based on this information, recommendations for selecting appropriate upper limb outcome measures are given. The current shortcomings in assessment which need to be addressed are identified.
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Affiliation(s)
- Ilse Lamers
- REVAL – Rehabilitation Research Institute, BIOMED – Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Belgium
| | - Peter Feys
- REVAL – Rehabilitation Research Institute, BIOMED – Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Belgium
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Lamers I, Kelchtermans S, Baert I, Feys P. Upper limb assessment in multiple sclerosis: a systematic review of outcome measures and their psychometric properties. Arch Phys Med Rehabil 2014; 95:1184-200. [PMID: 24631802 DOI: 10.1016/j.apmr.2014.02.023] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 01/30/2014] [Accepted: 02/25/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To provide an overview of applied upper limb outcome measures in multiple sclerosis (MS) according to the International Classification of Functioning, Disability and Health (ICF) levels and to review their psychometric properties in MS. DATA SOURCES PubMed and Web of Knowledge. STUDY SELECTION Articles published until June 2013 were selected when written in English, published in the last 25 years, peer reviewed, including >5 persons with MS, and including standardized clinical upper limb outcome measures. Included articles were screened based on title/abstract and full text by 2 independent reviewers. In case of doubt, feedback from a third independent reviewer was obtained. Additionally, references lists were checked for relevant articles. Of the articles, 109 met the selection criteria and were included for data extraction. DATA EXTRACTION All reported clinical upper limb outcome measures were extracted from the included studies and classified according to the ICF levels by 2 independent reviewers. In addition, available psychometric properties (reliability, validity, responsiveness) in MS were summarized and discussed. DATA SYNTHESIS A diversity of outcome measures assessing impairments on the body functions and structures level (n=33), upper limb capacity (n=11), and performance (n=8) on the activity level were extracted from 109 articles. Hand grip strength and the nine-hole peg test (NHPT) were the most frequently used outcome measures. However, multiple outcome measures are necessary to encapsulate the multidimensional character of the upper limb function. The psychometric properties were insufficiently documented for most of the outcome measures, except for the NHPT. CONCLUSIONS The results of this review may help with the selection of appropriate outcome measures and may guide future research regarding the psychometric properties in MS.
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Affiliation(s)
- Ilse Lamers
- Rehabilitation Research Institute, BIOMED-Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.
| | - Silke Kelchtermans
- Rehabilitation Research Institute, BIOMED-Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Ilse Baert
- Rehabilitation Research Institute, BIOMED-Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Peter Feys
- Rehabilitation Research Institute, BIOMED-Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
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Osborne LA, Gareth Noble J, Maramba IDC, Jones KH, Middleton RM, Lyons RA, Ford DV, Reed P. Outcome measures for multiple sclerosis. PHYSICAL THERAPY REVIEWS 2014. [DOI: 10.1179/1743288x13y.0000000094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Paoloni M, Giovannelli M, Mangone M, Leonardi L, Tavernese E, Di Pangrazio E, Bernetti A, Santilli V, Pozzilli C. Does giving segmental muscle vibration alter the response to botulinum toxin injections in the treatment of spasticity in people with multiple sclerosis? A single-blind randomized controlled trial. Clin Rehabil 2013; 27:803-12. [DOI: 10.1177/0269215513480956] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To determine if segmental muscle vibration and botulinum toxin-A injection, either alone or in combination, reduces spasticity in a sample of patients with multiple sclerosis. Design: Single-blind, randomized controlled trial. Setting: Physical medicine and rehabilitation outpatients service. Subjects: Forty-two patients affected by the secondary progressive form of multiple sclerosis randomized to group A (30 minutes of 120 Hz segmental muscle vibration over the rectus femoris and gastrocnemius medial and lateral, three per week, over a period of four weeks), group B (botulinum toxin in the rectus femoris, gastrocnemius medial and lateral and soleus, and segmental muscle vibration) and group C (botulinum toxin). Main measures: Modified Ashworth Scale at knee and ankle, and Fatigue Severity Scale. All the measurements were performed at baseline (T0), 10 weeks (T1) and 22 weeks (T2) postallocation. Results: Modified Ashworth Scale at knee and ankle significantly decreased over time ( p < 0.001) in all groups. Patients in group C displayed a significant increase of knee and ankle spasticity at T2 when compared with T1 ( p < 0.05). Fatigue Severity Scale values in groups A and C were significantly higher at T0 [A: 53.6 (2.31); C: 48.5 (2.77)] than at either T1 [A: 48.6 (2.21); p = 0.03; C: 43.5 (3.22); p = 0.03] or T2 [A: 46.7 (2.75); p = 0.02; 42.5 (2.17); p = 0.02], while no differences were detected in group B [T0: 43.4 (3.10); T1: 37.3 (3.15); T2: 39.7 (2.97)]. Conclusion: Segmental muscle vibration and botulinum toxin-A reduces spasticity and improves fatigue in the medium-term follow-up in patients with multiple sclerosis.
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Affiliation(s)
- Marco Paoloni
- Physical Medicine and Rehabilitation, Sapienza – University of Rome, Rome, Italy
| | | | - Massimiliano Mangone
- Physical Medicine and Rehabilitation, Sapienza – University of Rome, Rome, Italy
| | - Laura Leonardi
- MS Center S.Andrea Hospital, Sapienza University, Rome, Italy
| | - Emanuela Tavernese
- Physical Medicine and Rehabilitation, Sapienza – University of Rome, Rome, Italy
| | | | - Andrea Bernetti
- Physical Medicine and Rehabilitation, Sapienza – University of Rome, Rome, Italy
| | - Valter Santilli
- Physical Medicine and Rehabilitation, Sapienza – University of Rome, Rome, Italy
| | - Carlo Pozzilli
- MS Center S.Andrea Hospital, Sapienza University, Rome, Italy
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