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Girard-Côté L, Gallais B, Gagnon C, Roussel MP, Morin M, Hébert LJ, Monckton D, Leduc-Gaudet JP, Gouspillou G, Marcangeli V, Duchesne E. Resistance training in women with myotonic dystrophy type 1: a multisystemic therapeutic avenue. Neuromuscul Disord 2024; 40:38-51. [PMID: 38824906 DOI: 10.1016/j.nmd.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 05/08/2024] [Accepted: 05/13/2024] [Indexed: 06/04/2024]
Abstract
Myotonic dystrophy type 1 (DM1) is a hereditary disease characterized by muscular impairments. Fundamental and clinical positive effects of strength training have been reported in men with DM1, but its impact on women remains unknown. We evaluated the effects of a 12-week supervised strength training on physical and neuropsychiatric health. Women with DM1 performed a twice-weekly supervised resistance training program (3 series of 6-8 repetitions of squat, leg press, plantar flexion, knee extension, and hip abduction). Lower limb muscle strength, physical function, apathy, anxiety and depression, fatigue and excessive somnolence, pain, and patient-reported outcomes were assessed before and after the intervention, as well as three and six months after completion of the training program. Muscle biopsies of the vastus lateralis were also taken before and after the training program to assess muscle fiber growth. Eleven participants completed the program (attendance: 98.5 %). Maximal hip and knee extension strength (p < 0.006), all One-Repetition Maximum strength measures (p < 0.001), apathy (p = 0.0005), depression (p = 0.02), pain interference (p = 0.01) and perception of the lower limb function (p = 0.003) were significantly improved by training. Some of these gains were maintained up to six months after the training program. Strength training is a good therapeutic strategy for women with DM1.
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Affiliation(s)
- Laura Girard-Côté
- School of Rehabilitation Sciences, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada; Neuromuscular Diseases Interdisciplinary Research Group (GRIMN), Saguenay-Lac-St-Jean Integrated University Health and Social Services Center, Saguenay, Quebec, Canada
| | - Benjamin Gallais
- Neuromuscular Diseases Interdisciplinary Research Group (GRIMN), Saguenay-Lac-St-Jean Integrated University Health and Social Services Center, Saguenay, Quebec, Canada; ÉCOBES - Research and Transfer, Cegep de Jonquière, Jonquière, Quebec, Canada
| | - Cynthia Gagnon
- Neuromuscular Diseases Interdisciplinary Research Group (GRIMN), Saguenay-Lac-St-Jean Integrated University Health and Social Services Center, Saguenay, Quebec, Canada; CHU Sherbrooke Research Center, and Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marie-Pier Roussel
- Neuromuscular Diseases Interdisciplinary Research Group (GRIMN), Saguenay-Lac-St-Jean Integrated University Health and Social Services Center, Saguenay, Quebec, Canada; Department of Fundamental Sciences, University of Quebec at Chicoutimi, Saguenay, Quebec, Canada
| | - Marika Morin
- Neuromuscular Diseases Interdisciplinary Research Group (GRIMN), Saguenay-Lac-St-Jean Integrated University Health and Social Services Center, Saguenay, Quebec, Canada
| | - Luc J Hébert
- School of Rehabilitation Sciences, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Capitale-Nationale Integrated University Health and Social Services Center, Quebec, Quebec, Canada; Department of Radiology and Nuclear Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
| | - Darren Monckton
- Institute of Molecular, Cell and Systems Biology, University of Glasgow, Glasgow, UK
| | - Jean-Philippe Leduc-Gaudet
- Research Group in Cellular Signaling, Department of Medical Biology, University of Quebec at Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Gilles Gouspillou
- Département des sciences de l'activité physique, Faculté des sciences, University of Quebec at Montréal (UQAM), Montréal, Quebec, Canada
| | - Vincent Marcangeli
- Département des sciences de l'activité physique, Faculté des sciences, University of Quebec at Montréal (UQAM), Montréal, Quebec, Canada
| | - Elise Duchesne
- School of Rehabilitation Sciences, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada; Neuromuscular Diseases Interdisciplinary Research Group (GRIMN), Saguenay-Lac-St-Jean Integrated University Health and Social Services Center, Saguenay, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Capitale-Nationale Integrated University Health and Social Services Center, Quebec, Quebec, Canada; CHU de Québec - Université Laval Research Center, Québec, Québec, Canada.
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Hadouiri N, Fournel I, Thauvin-Robinet C, Jacquin-Piques A, Ornetti P, Gueugnon M. Walking test outcomes in adults with genetic neuromuscular diseases: a systematic literature review of their measurement properties. Eur J Phys Rehabil Med 2024; 60:257-269. [PMID: 38300152 PMCID: PMC11114158 DOI: 10.23736/s1973-9087.24.08095-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 12/11/2023] [Accepted: 01/19/2024] [Indexed: 02/02/2024]
Abstract
INTRODUCTION Neuromuscular diseases (NMDs) include a large group of heterogeneous diseases. NMDs frequently involve gait disorders, which affect quality of life. Several walking tests and tools have been described in the literature, but there is no consensus regarding the use of walking tests and tools in NMDs or of their measurement properties for walking outcomes. The aim of this review is to present an overview of walking tests, including their measurement properties when used in adults with inherited or genetic NMDs. The aim is to help clinicians and researchers choose the most appropriate test for their objective. EVIDENCE ACQUISITION A systematic review was conducted after consulting MEDLINE (via PubMed), EMBASE, Science direct, Google Scholar and Cochrane Central Register of Controlled Trials databases for published studies in which walking outcome measurement properties were assessed. The validity, reliability, measurement error and responsiveness properties were evaluated in terms of statistical methods and methodological design qualities using the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines. EVIDENCE SYNTHESIS We included 46 studies in NMDs. These studies included 15 different walking tests and a wide variety of walking outcomes, assessed with six types of walking tools. Overall, the 6MWT was the most studied test in terms of measurement properties. The methodological design and statistical methods of most studies evaluating construct validity, reliability and measurement error were "very good." The majority of outcome measurements were valid and reliable. However, studies on responsiveness as minimal important difference or minimal important change were lacking or were found to have inadequate methodological and statistical methods according to the COSMIN guidelines. CONCLUSIONS Most walking outcomes were found to be valid and reliable in NMDs. However, in view of the growing number of clinical trials, further studies are needed to clarify additional measurement properties.
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Affiliation(s)
- Nawale Hadouiri
- Department of Physical Medicine and Rehabilitation, Dijon-Bourgogne University Hospital, Dijon, France -
- UMR-Inserm 1231, Génétique des Anomalies du Développement (GAD), Bourgogne Franche-Comté University, Dijon, France -
- INSERM, CIC 1432, Clinical Investigation Center, Plurithematic Module, Technological Investigation Platform, Dijon-Bourgogne University Hospital, Dijon, France -
| | - Isabelle Fournel
- Clinical Investigation Center, CHU Dijon, Dijon, France
- INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France
| | - Christel Thauvin-Robinet
- UMR-Inserm 1231, Génétique des Anomalies du Développement (GAD), Bourgogne Franche-Comté University, Dijon, France
- Fédération Hospitalo-Universitaire Médecine Translationnelle et Anomalies du Développement (TRANSLAD), CHU Dijon Bourgogne, Dijon, France
- Centre de Référence Maladies Rares "Maladies neurogénétiques", CHU Dijon Bourgogne, Dijon, France
| | - Agnès Jacquin-Piques
- Centre de Compétences Maladies Rares "Maladies neuromusculaires", Department of Neurology, Dijon University Hospital, Dijon, France
| | - Paul Ornetti
- Department of Rheumatology, Dijon-Bourgogne University Hospital, Dijon, France
- INSERM, UMR1093-CAPS, Bourgogne Franche-Comté University, Dijon, France
| | - Mathieu Gueugnon
- INSERM, CIC 1432, Clinical Investigation Center, Plurithematic Module, Technological Investigation Platform, Dijon-Bourgogne University Hospital, Dijon, France
- INSERM, UMR1093-CAPS, Bourgogne Franche-Comté University, Dijon, France
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Savcun Demirci C, Sütçü G, Ayvat F, Onursal Kılınç Ö, Doğan M, Ayvat E, Bekircan-Kurt CE, Erdem-Özdamar S, Yıldırım SA, Kılınç M, Tan E. Identifying A Cut-Off Point for Timed Up and Go Test in Neuromuscular Diseases. TURKISH JOURNAL OF NEUROLOGY 2022. [DOI: 10.4274/tnd.2021.84553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Hammarén E, Kollén L. What Happened with Muscle Force, Dynamic Stability And Falls? A 10-Year Longitudinal Follow-Up in Adults with Myotonic Dystrophy Type 1. J Neuromuscul Dis 2021; 8:1007-1016. [PMID: 34151851 PMCID: PMC8673550 DOI: 10.3233/jnd-200521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Individuals with myotonic dystrophy type 1 (DM1) are known to stumble and fall, but knowledge is scarce regarding dynamic stability in this disorder. OBJECTIVE To describe disease progress regarding muscle force, dynamic stability and patient reported unintentional falls during a ten-year period, in individuals with DM1. METHODS Quantification of isometric muscle force in four leg muscle groups and assessment of Timed 10-meter-walk in maximum speed (T10max), Timed Up&Go (TUG) and Step test (STEP) were performed at three occasions in a DM1 cohort, together with self-reported falls. RESULTS Thirty-four people (m/f:11/23, age:50.2 + /-9.4) participated. The muscle force loss after ten years was large in the distal ankle muscles. A steeper force decrease was seen in most muscles between year five and ten compared to the former five-year period. Males reported more falls than females, 91%vs 35%had fallen last year. A positive correlation, ρ= 0.633, p < 0.001, was shown between walking time (T10max) and number of falls. Frequent fallers were only seen among those with slower walk (T10max > 10seconds), and fewer steps in the STEP test (STEP≤5 steps). CONCLUSIONS A diminishing leg muscle strength and worse dynamic stability were seen in the group, with a steeper decrease in the latter five years. Weak ankle dorsiflexors, a slower walk and difficulties to lift the forefoot were related to frequent falls.
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Affiliation(s)
- Elisabet Hammarén
- Occupational and Physiotherapy Department, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Sahlgrenska Academy at the University of Gothenburg, Sweden
| | - Lena Kollén
- Occupational and Physiotherapy Department, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Sahlgrenska Academy at the University of Gothenburg, Sweden
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Roussel MP, Fiset MM, Gauthier L, Lavoie C, McNicoll É, Pouliot L, Gagnon C, Duchesne E. Assessment of muscular strength and functional capacity in the juvenile and adult myotonic dystrophy type 1 population: a 3-year follow-up study. J Neurol 2021; 268:4221-4237. [PMID: 33907889 DOI: 10.1007/s00415-021-10533-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Myotonic dystrophy type 1 (DM1) is a progressive, multisystemic, and autosomal dominant disease. Muscle wasting and weakness have been associated with impaired functional capacity and restricted social participation in affected individuals. The disease's presentation is very heterogenous and its progression is still under-documented. OBJECTIVE The aim of the study was to document the progression of muscular strength and functional capacity in the DM1 population over a 3-year period. METHODS Twenty-three individuals with juvenile or adult phenotypes of DM1 were recruited to complete clinical assessments in 2016 and 2019. Maximal isometric muscle strength (MIMS) was evaluated with quantified muscle testing and functional capacity was evaluated with the Mini-BESTest, the 10-m walk test at comfortable and maximal speeds, the Timed Up and Go and the 6-min walk test. Participants also completed three questionnaires: DM1-Activ, Upper Extremity Functional Index and Lower Extremity Functional Scale (LEFS). Subgroup analyses were evaluated for sex, phenotype, and type of physical activity practiced during the 3-year period. RESULTS For the whole group, there was a significant decline in the scores of the Mini-BESTest and the LEFS. Also, MIMS significantly declined for prehension, lateral pinch as well as for hip abductors, knee extensors and ankle dorsiflexors muscle groups. Subgroups analyses revealed that men lost more MIMS than women, and that adult phenotype lost more MIMS than juvenile phenotype. CONCLUSION Quantified muscle testing is a better indicator of disease progression over a 3-year period than functional tests. Phenotype and sex are important factors that influence the progression of DM1.
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Affiliation(s)
- Marie-Pier Roussel
- Département des sciences fondamentales, Université du Québec à Chicoutimi, Québec, Canada
- Groupe de Recherche Interdisciplinaire sur les Maladies Neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Hôpital de Jonquière, Québec, Canada
- Centre de recherche Charles-Le Moyne-Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Université de Sherbrooke, Québec, Canada
- Centre Intersectoriel en Santé Durable (CISD), Université du Québec à Chicoutimi, Québec, Canada
| | - Marie-Michèle Fiset
- Unité d'enseignement en physiothérapie, Département des sciences de la santé, Université du Québec à Chicoutimi, 555, boul. de l'Université, Chicoutimi, Québec, G7H 2B1, Canada
| | - Laurie Gauthier
- Unité d'enseignement en physiothérapie, Département des sciences de la santé, Université du Québec à Chicoutimi, 555, boul. de l'Université, Chicoutimi, Québec, G7H 2B1, Canada
| | - Claudia Lavoie
- Unité d'enseignement en physiothérapie, Département des sciences de la santé, Université du Québec à Chicoutimi, 555, boul. de l'Université, Chicoutimi, Québec, G7H 2B1, Canada
| | - Émilie McNicoll
- Unité d'enseignement en physiothérapie, Département des sciences de la santé, Université du Québec à Chicoutimi, 555, boul. de l'Université, Chicoutimi, Québec, G7H 2B1, Canada
| | - Laurie Pouliot
- Unité d'enseignement en physiothérapie, Département des sciences de la santé, Université du Québec à Chicoutimi, 555, boul. de l'Université, Chicoutimi, Québec, G7H 2B1, Canada
| | - Cynthia Gagnon
- Groupe de Recherche Interdisciplinaire sur les Maladies Neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Hôpital de Jonquière, Québec, Canada
- Centre de recherche Charles-Le Moyne-Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Université de Sherbrooke, Québec, Canada
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Québec, Canada
| | - Elise Duchesne
- Groupe de Recherche Interdisciplinaire sur les Maladies Neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Hôpital de Jonquière, Québec, Canada.
- Centre de recherche Charles-Le Moyne-Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Université de Sherbrooke, Québec, Canada.
- Centre Intersectoriel en Santé Durable (CISD), Université du Québec à Chicoutimi, Québec, Canada.
- Unité d'enseignement en physiothérapie, Département des sciences de la santé, Université du Québec à Chicoutimi, 555, boul. de l'Université, Chicoutimi, Québec, G7H 2B1, Canada.
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Knak KL, Sheikh AM, Witting N, Vissing J. Responsiveness of outcome measures in myotonic dystrophy type 1. Ann Clin Transl Neurol 2020; 7:1382-1391. [PMID: 32672404 PMCID: PMC7448158 DOI: 10.1002/acn3.51129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/07/2020] [Accepted: 06/18/2020] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE As myotonic dystrophy type 1(DM1) evolves slowly and interventional trials often have a short duration, responsive outcomes in DM1 are needed. The objective of this study was to determine the responsiveness of muscle strength, balance, and functional mobility measurements after a 1-year follow-up period in individuals with DM1. METHODS Sixty-three adults with noncongenital DM1 completed the following assessments at baseline and at 1-year follow-up: Handheld dynamometry (lower limbs), stationary dynamometry (lower limbs), step test, timed-up-and-go test (TUG), modified clinical test of sensory integration and balance (mCTSIB), feet-together stance, tandem stance, one-leg stance, 10-meter walk test, and sit-to-stand test. RESULTS Change was captured by stationary dynamometry (proximal flexor and extensor muscles), handheld dynamometry (proximal flexor and distal extensor muscles), TUG, and mCTSIB (P ≤ 0.04). Ceiling or floor effects were shown for most static balance tests. INTERPRETATION Overall, adequate responsiveness was shown for both muscle strength dynamometers, TUG and mCTSIB. These outcomes are therefore likely candidate endpoints for clinical trials lasting 1 year. Most static balance tests are not responsive and not recommended in a heterogeneous DM1 population.
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Affiliation(s)
- Kirsten L Knak
- Rigshospitalet, Department of Neurology, Juliane Maries Vej 28, Copenhagen, DK-2100, Denmark
| | - Aisha M Sheikh
- Rigshospitalet, Department of Neurology, Juliane Maries Vej 28, Copenhagen, DK-2100, Denmark
| | - Nanna Witting
- Rigshospitalet, Department of Neurology, Juliane Maries Vej 28, Copenhagen, DK-2100, Denmark
| | - John Vissing
- Rigshospitalet, Department of Neurology, Juliane Maries Vej 28, Copenhagen, DK-2100, Denmark
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Knak KL, Sheikh AM, Andersen H, Witting N, Vissing J. Intrarater reliability and validity of outcome measures in myotonic dystrophy type 1. Neurology 2020; 94:e2508-e2520. [PMID: 32457208 DOI: 10.1212/wnl.0000000000009625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 12/05/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To investigate intrarater reliability and concurrent and construct validity of muscle strength, balance, and functional mobility measures in individuals with noncongenital myotonic dystrophy type 1 (DM1). METHODS Seventy-eight adults with noncongenital DM1 participated in visit 1, and 73 of the them participated in visit 2 separated by 1 to 2 weeks. The assessments consisted of muscle strength tests with handheld dynamometry (HHD) and stationary dynamometry in the lower limb. The balance tests consisted of the step test, Timed Up and Go test, feet-together stance, tandem stance, 1-leg stance, and modified Clinical Test of Sensory Integration and Balance on a balance platform. The functional mobility tests consisted of the 10-m walk test (10mWT) and 10-times Sit-to-Stand test. RESULTS The HHD and stationary dynamometry had sufficient intrarater reliability for most muscle groups on a group (SEM% ≤15%) and individual (minimal detectable difference [MDD95%] ≤30%) level, but the HHD was most reliable. Stationary dynamometry measured a higher torque than HHD for all extensor muscles, but for single individuals, none of the devices were favored. Overall, intrarater reliability and validity were sufficient only for the dynamic balance tests, not the static balance tests. Both functional mobility tests were sufficiently reliable and valid, but the 10mWT was most reliable. CONCLUSION Overall, HHD is recommended as a reliable and valid tool for single individuals and for flexor muscles on a group level. For balance assessments, the dynamic balance tests are recommended as the most valid and reliable balance tests. Both functional mobility tests are recommended for valid and reliable outcomes, but the 10mWT was superior for reliability.
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Affiliation(s)
- Kirsten L Knak
- From the Department of Neurology (K.L.K., A.M.S., N.W., J.V.), Rigshospitalet, Copenhagen; and Department of Neurology (H.A.), Aarhus University Hospital, Denmark.
| | - Aisha M Sheikh
- From the Department of Neurology (K.L.K., A.M.S., N.W., J.V.), Rigshospitalet, Copenhagen; and Department of Neurology (H.A.), Aarhus University Hospital, Denmark
| | - Henning Andersen
- From the Department of Neurology (K.L.K., A.M.S., N.W., J.V.), Rigshospitalet, Copenhagen; and Department of Neurology (H.A.), Aarhus University Hospital, Denmark
| | - Nanna Witting
- From the Department of Neurology (K.L.K., A.M.S., N.W., J.V.), Rigshospitalet, Copenhagen; and Department of Neurology (H.A.), Aarhus University Hospital, Denmark
| | - John Vissing
- From the Department of Neurology (K.L.K., A.M.S., N.W., J.V.), Rigshospitalet, Copenhagen; and Department of Neurology (H.A.), Aarhus University Hospital, Denmark
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Jimenez-Moreno AC, Nikolenko N, Kierkegaard M, Blain AP, Newman J, Massey C, Moat D, Sodhi J, Atalaia A, Gorman GS, Turner C, Lochmüller H. Analysis of the functional capacity outcome measures for myotonic dystrophy. Ann Clin Transl Neurol 2019; 6:1487-1497. [PMID: 31402614 PMCID: PMC6689676 DOI: 10.1002/acn3.50845] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/11/2019] [Accepted: 06/26/2019] [Indexed: 11/30/2022] Open
Abstract
Objectives Defining clinically relevant outcome measures for myotonic dystrophy type 1 (DM1) that can be valid and feasible for different phenotypes has proven problematic. The Outcome Measures for Myotonic Dystrophy (OMMYD) group proposed a battery of functional outcomes: 6‐minute walk test, 30 seconds sit and stand test, timed 10 m walk test, timed 10 m walk/run test, and nine‐hole peg test. This, however, required a large‐scale investigation, Methods A cohort of 213 patients enrolled in the natural history study, PhenoDM1, was analyzed in cross‐sectional analysis and subsequently 98 patients were followed for longitudinal analysis. We aimed to assess: (1) feasibility and best practice; (2) intra‐session reliability; (3) validity; and (4) behavior over time, of these tests. Results OMMYD outcomes proved feasible as 96% of the participants completed at least one trial for all tests and more than half (n = 113) performed all three trials of each test. Body mass index and disease severity associate with functional capacity. There was a significant difference between the first and second trials of each test. There was a moderate to strong correlation between these functional outcomes and muscle strength, disease severity and patient‐reported outcomes. All outcomes after 1 year detected a change in functional capacity except the nine‐hole peg test. Conclusions These tests can be used as a battery of outcomes or independently based on the shown overlapping psychometric features and strong cross‐correlations. Due to the large and heterogeneous sample of this study, these results can serve as reference values for future studies.
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Affiliation(s)
- Aura Cecilia Jimenez-Moreno
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK.,Welcome Trust Mitochondrial Research Centre, Institute of Neurosciences, Newcastle University, Newcastle upon Tyne, UK
| | - Nikoletta Nikolenko
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK.,National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Marie Kierkegaard
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Functional Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
| | - Alasdair P Blain
- Welcome Trust Mitochondrial Research Centre, Institute of Neurosciences, Newcastle University, Newcastle upon Tyne, UK
| | - Jane Newman
- Welcome Trust Mitochondrial Research Centre, Institute of Neurosciences, Newcastle University, Newcastle upon Tyne, UK
| | - Charlotte Massey
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Dionne Moat
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK.,The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jas Sodhi
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK.,The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Antonio Atalaia
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK.,Center of Research in Myology, Sorbonne Université, Paris, France
| | - Grainne S Gorman
- Welcome Trust Mitochondrial Research Centre, Institute of Neurosciences, Newcastle University, Newcastle upon Tyne, UK
| | - Chris Turner
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Hanns Lochmüller
- Department of Neuropediatrics and Muscle Disorders, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Centro Nacional de Análisis Genómico (CNAG-CRG), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Barcelona, Spain.,Research Institute, The Children's Hospital of Eastern Ontario, Ottawa, Canada.,Division of Neurology, Department of Medicine, Ottawa University, Ottawa, Canada
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Solbakken G, Bjørnarå B, Kirkhus E, Nguyen B, Hansen G, Frich JC, Ørstavik K. MRI of trunk muscles and motor and respiratory function in patients with myotonic dystrophy type 1. BMC Neurol 2019; 19:135. [PMID: 31216995 PMCID: PMC6582475 DOI: 10.1186/s12883-019-1357-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 06/06/2019] [Indexed: 12/14/2022] Open
Abstract
Background Myotonic Dystrophy 1 (DM1) causes progressive myopathy of extremity muscles. DM1 may also affect muscles of the trunk. The aim of this study was to investigate fat infiltration and muscle size in trunk muscles in DM1 patients, and in an age and gender matched control group. Further, explore how fat infiltration and degree of atrophy in these muscles are associated with motor and respiratory function in DM1 patients. Method We measured fat infiltration and trunk muscle size by MRI in 20 patients with genetically confirmed classic form of DM1, and compared these cases with 20 healthy, age and gender matched controls. In the DM1 group, we investigated correlations between MRI findings and clinical measures of muscle strength, mobility and respiration. We used sum scores for fat infiltration and muscle size in trunk flexors and trunk extensors in the analysis of group differences and correlations. Results Significant differences between cases and controls were present for fat infiltration in trunk flexors (p = 0.001) and trunk extensors (p = < 0.001), and for muscle size in trunk flexors (p = 0.002) and trunk extensors (p = 0.030). Fat infiltration in trunk flexors were significant correlated to back extension strength (rho = − 0.523 p = 0.018), while muscle size in trunk flexors was significantly correlated to trunk flexion strength (rho = 0.506 p = 0.023). Fat infiltration in trunk flexors was significantly correlated with lower general mobility (rho = − 0.628, p = 0.003), reduced balance (rho = 0.630, p < 0.003) and forced vital capacity (rho − 0.487 p = 0.040). Conclusions Trunk muscles in DM1 patients had significant higher levels of fat infiltration and reduced muscle size compared to age and gender matched controls. In DM1 patients, fat infiltration was associated with reduced muscle strength, mobility, balance and lung function, while muscle size was associated with reduced muscle strength and lung function. These findings are of importance for clinical management of the disease and could be useful additional outcome measures in future intervention studies. Electronic supplementary material The online version of this article (10.1186/s12883-019-1357-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gro Solbakken
- Department of Neurology, Rheumatology and Rehabilitation, Drammen Hospital Vestre Viken Hospital Trust, P.O. Box 800, 3004, Drammen, Norway. .,Institute of Clinical Medicine University of Oslo, P.O. Box 1171 Blindern, 0318, Oslo, Norway.
| | - Bård Bjørnarå
- Department of Diagnostic Imaging, Drammen Hospital, Vestre Viken Hospital Trust, P.O. Box 800, 3004, Drammen, Norway
| | - Eva Kirkhus
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, Oslo. P.O. Box 4950 Nydalen, N-0424, Oslo, Norway
| | - Bac Nguyen
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, Oslo. P.O. Box 4950 Nydalen, N-0424, Oslo, Norway
| | - Gunnar Hansen
- Department of Neurology, Rheumatology and Rehabilitation, Drammen Hospital Vestre Viken Hospital Trust, P.O. Box 800, 3004, Drammen, Norway
| | - Jan C Frich
- Faculty of Medicine, University of Oslo, P.O. Box 1130 Blindern, 0318, Oslo, Oslo, Norway
| | - Kristin Ørstavik
- Department of Neurology, Section for Rare Neuromuscular Disorders, Oslo University Hospital, Oslo. P.O. Box 4950 Nydalen, N-0424, Oslo, Norway
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Petitclerc É, Hébert LJ, Mathieu J, Desrosiers J, Gagnon C. Relationships between Lower Limb Muscle Strength Impairments and Physical Limitations in DM1. J Neuromuscul Dis 2018; 5:215-224. [PMID: 29865087 DOI: 10.3233/jnd-170291] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although adult and late-onset DM1 phenotypes DM1 present distinct lower limb weaknesses portraits, resulting physical limitations have never been described separately for each phenotype. OBJECTIVE To characterize the lower limb weaknesses and physical limitations among the DM1 adult and late-onset phenotypes separately and to document the contribution of weaknesses on mobility to optimize the management of this population. METHODS The strength of four muscle groups among 198 participants was quantified. Participants were categorized according to the severity of their muscular involvement using the Muscular Impairment Rating Scale (MIRS). Physical limitations were assessed using the Timed up-and-go (TUG), Berg Balance Scale (BBS) and 10 meters comfortable walking speed (10MWT). Multiple linear regressions were performed to identify the contribution of each muscle group to the mobility tests scores. RESULTS Late-onset demonstrated less weakness and physical limitations (p < 0.001 - 0.002) than the adult phenotype, but 21.9-47.5% of participants with this phenotype showed mobility scores below reference values. Physical limitations were observed in the first two MIRS grades (37.5-42.1% of the participants) for the TUG and 10MWT. Ankle dorsiflexors and knee extensors were the two muscle groups that showed the strongest relationships with mobility scores. CONCLUSION Although less impaired, the late-onset phenotype shows significant lower limb muscle weakness associated with physical limitations. The surprising presence of quantitative lower limb muscle weakness in the first two MIRS grades needs to be considered when using this scale. Both ankle dorsiflexors and knee extensors appear to be good indicators of physical limitations in DM1.
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Affiliation(s)
- Émilie Petitclerc
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke (Québec), Canada.,Groupe de recherche interdisciplinaire sur les maladies neuromusculaires, NeuromuscularClinic, Centre intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-St-Jean, site Jonquière, rue de l'Hôpital, Jonquière (Québec), Canada
| | - Luc J Hébert
- Faculty of Medicine, Rehabilitation (Physiotherapy) and Department of Radiology, Université Laval, avenue de la Médecine, Pavillon Ferdinand-Vandry, Québec, QC, Canada
| | - Jean Mathieu
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke (Québec), Canada.,Groupe de recherche interdisciplinaire sur les maladies neuromusculaires, NeuromuscularClinic, Centre intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-St-Jean, site Jonquière, rue de l'Hôpital, Jonquière (Québec), Canada
| | - Johanne Desrosiers
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke (Québec), Canada
| | - Cynthia Gagnon
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke (Québec), Canada.,Groupe de recherche interdisciplinaire sur les maladies neuromusculaires, NeuromuscularClinic, Centre intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-St-Jean, site Jonquière, rue de l'Hôpital, Jonquière (Québec), Canada
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11
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Towards clinical outcome measures in myotonic dystrophy type 2: a systematic review. Curr Opin Neurol 2018; 31:599-609. [DOI: 10.1097/wco.0000000000000591] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Hammarén E, Kjellby-Wendt G, Lindberg C. Muscle force and other factors for falls in myotonic dystrophy type 1: studies of persons with a rare disease. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2017. [DOI: 10.1080/21679169.2017.1381310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- E. Hammarén
- Department of Physiotherapy, Sahlgrenska University Hospital, Göteborg, Sweden
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| | - G. Kjellby-Wendt
- Department of Physiotherapy, Sahlgrenska University Hospital, Göteborg, Sweden
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| | - C. Lindberg
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
- Department of Clinical Genetics, Sahlgrenska University Hospital, Göteborg, Sweden
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13
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Symonds T, Campbell P, Randall JA. A review of muscle- and performance-based assessment instruments in DM1. Muscle Nerve 2017; 56:78-85. [DOI: 10.1002/mus.25468] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Tara Symonds
- Clinical Outcomes Solutions; Folkestone Kent United Kingdom
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14
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Kierkegaard M, Petitclerc E, Hébert LJ, Gagnon C. Is one trial enough for repeated testing? Same-day assessments of walking, mobility and fine hand use in people with myotonic dystrophy type 1. Neuromuscul Disord 2017; 27:153-158. [DOI: 10.1016/j.nmd.2016.11.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/05/2016] [Accepted: 11/30/2016] [Indexed: 10/20/2022]
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Solbakken G, Ørstavik K, Hagen T, Dietrichs E, Naerland T. Major involvement of trunk muscles in myotonic dystrophy type 1. Acta Neurol Scand 2016; 134:467-473. [PMID: 26984572 DOI: 10.1111/ane.12565] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The motor impairments in Myotonic Dystrophy 1 (DM1) are assumed to progress from distal toward proximal parts of the extremities in the Juvenile and Adult forms of DM1. On occasion and late in progress spine deformity is observed. In this study we have examined whether and to what extent trunk muscles are impaired in DM1, and if this impairment is correlated with the duration of the disorder, walking capacity, mobility, balance, and CTG-repeats. MATERIALS & METHODS Manual muscle testing (MMT) of skeletal muscle strength in trunk and extremities, reassessment of the mutation size, time since first symptom, the 6 min walk test (6MWT), Rivermead mobility index (RIM) and Timed up & go (TUG) were sampled in 38 adult DM1 outpatients. RESULTS We found significant impairment in trunk muscles. Trunk muscle strength decreased significantly with increasing mutation size (r = -0.64, P < 0.001). Reduced walking capacity, mobility and balance were significantly related to decreased trunk muscle strength. CONCLUSION DM1 affects trunk muscle groups. The trunk impairments seem to occur relatively early in disease progression. Awareness of trunk impairments may be of importance for everyday functioning and for understanding the risk of injuries due to falls reported among DM1 patients. It may also help in identification of DM1 patients and considered outcome measure in future clinical trials.
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Affiliation(s)
- G. Solbakken
- Department of Neurology; Drammen Hospital; Vestre Viken Health Trust; Drammen Norway
- Department of Neurology; Oslo University Hospital; Oslo Norway
| | - K. Ørstavik
- Department of Neurology; Oslo University Hospital; Oslo Norway
| | - T. Hagen
- Department of Neurology; Drammen Hospital; Vestre Viken Health Trust; Drammen Norway
| | - E. Dietrichs
- Department of Neurology; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - T. Naerland
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
- NevSom - Department of Rare Disorders and Disabilities; Oslo University Hospital; Oslo Norway
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16
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Bachasson D, Moraux A, Ollivier G, Decostre V, Ledoux I, Gidaro T, Servais L, Behin A, Stojkovic T, Hébert LJ, Puymirat J, Eymard B, Bassez G, Hogrel JY. Relationship between muscle impairments, postural stability, and gait parameters assessed with lower-trunk accelerometry in myotonic dystrophy type 1. Neuromuscul Disord 2016; 26:428-35. [DOI: 10.1016/j.nmd.2016.05.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 05/10/2016] [Accepted: 05/10/2016] [Indexed: 10/21/2022]
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Hammarén E, Lindberg C, Kjellby-Wendt G. Effects of a balance exercise programme in myotonic dystrophy type 1: A pilot study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2015. [DOI: 10.3109/21679169.2015.1049204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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18
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Muscle force, balance and falls in muscular impaired individuals with myotonic dystrophy type 1: a five-year prospective cohort study. Neuromuscul Disord 2014; 25:141-8. [PMID: 25475393 DOI: 10.1016/j.nmd.2014.11.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 11/04/2014] [Accepted: 11/10/2014] [Indexed: 11/21/2022]
Abstract
Individuals with myotonic dystrophy type 1 (DM1) have progressive muscle weakness with gait and balance impairments. We explored prospectively the natural history of muscle force, gait, balance, balance confidence and walking ability in muscular affected individuals with DM1. After five years data from 43 individuals (m/f:18/25) were analysed. All measures of balance showed statistically significant deterioration (p < 0.001) with averaged yearly loss of function by 3-4%. In the group as a whole, loss of muscle force was statistically significant in all lower limb muscles measured after five years: changes relative to baseline force were median -6% to -18%. For males muscle force loss was statistically significant in all leg muscles, but only in hip flexors for women. After five years 100% of the men had fallen during the previous year and 67% three times or more, in contrast only 60% of the women had fallen in the previous year and 36% three times or more. The proportion of individuals seeking medical care the previous year, after falling, was more than doubled after five years, albeit the number of falls had not changed. Awareness of this increased risk of falls is important for caregivers and patients.
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Factors of importance for dynamic balance impairment and frequency of falls in individuals with myotonic dystrophy type 1 – A cross-sectional study – Including reference values of Timed Up & Go, 10m walk and step test. Neuromuscul Disord 2014; 24:207-15. [DOI: 10.1016/j.nmd.2013.12.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 12/03/2013] [Accepted: 12/06/2013] [Indexed: 11/20/2022]
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