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Abasıyanık Z, Kahraman T, Baba C, Sağıcı Ö, Ertekin Ö, Özakbaş S. Discriminative ability of the original and short form of the Activities-specific Balance Confidence scale and its individual items for falls in people with multiple sclerosis. Acta Neurol Belg 2024; 124:957-964. [PMID: 38483733 PMCID: PMC11139692 DOI: 10.1007/s13760-024-02515-y] [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: 09/25/2023] [Accepted: 02/23/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Balance confidence is an essential component of fall risk assessment in persons with multiple sclerosis (pwMS). AIMS The aims of this cross-sectional study were to 1) investigate the ability of the 16-item Activities-specific Balance Confidence scale (ABC-16), 6-item Activities-specific Balance Confidence scale (ABC-6), and each item of the ABC-16 for distinguishing fallers and 2) determine cutoff scores for these scales to discriminate fallers and non-fallers in pwMS. METHODS One hundred and fifty-six participants [fallers/non-fallers: 60 (38.5%)/96 (61.5%), median EDSS: 1.5] were enrolled. Balance confidence was assessed using the ABC-16 and ABC-6. The self-reported number of falls in the past three months was recorded. Descriptive assessments, including walking, balance, and cognition were performed. Logistic regression and receiver operating characteristic analyses were conducted to estimate the sensitivities and specificities of the ABC-16 and ABC-6. RESULTS Both the ABC-16 (AUC: 0.85) and ABC-6 (AUC: 0.84) had the discriminative ability for falls. Each item of the ABC-16 scale was a significantly related to falls [odds ratio (OR) range: 1.38 to 1.89]. Items 8 and 10 had the highest odds ratio (OR: 1.85; 95%CI: 1.47-2.33, OR: 1.89; 95%CI: 1.49-2.40; respectively). We found cutoff scores of ≤ 70 of 100 (sensitivity: 71.67, specificity: 86.46) and ≤ 65/100 (sensitivity: 76.67, specificity: 79.17) in discrimination between fallers and non-fallers for the ABC-16 and ABC-6, respectively. CONCLUSION Both original and short forms of the ABC scale are an efficient tool for discriminating fallers and non-fallers in pwMS. Although all items are related to falls, outdoor walking activities have the strongest associations with falls than other items.
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Affiliation(s)
- Zuhal Abasıyanık
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey.
- Graduate School of Health Sciences, Dokuz Eylül University, Izmir, Turkey.
| | - Turhan Kahraman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
- Department of Health Professions, Faculty of Health and Education, Manchester Metropolitan University, Manchester, UK
| | - Cavid Baba
- Graduate School of Health Sciences, Dokuz Eylül University, Izmir, Turkey
| | - Özge Sağıcı
- Graduate School of Health Sciences, Dokuz Eylül University, Izmir, Turkey
| | - Özge Ertekin
- Department of Neurological Physiotherapy-Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
| | - Serkan Özakbaş
- Izmir University of Economics, Medical Point Hospital, Izmir, Turkey
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VanNostrand M, Bae M, Ramsdell JC, Kasser SL. Information processing speed and disease severity predict real-world ambulation in persons with multiple sclerosis. Gait Posture 2024; 111:99-104. [PMID: 38657478 DOI: 10.1016/j.gaitpost.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Impairments in real-world gait quality and quantity are multifaceted for individuals with multiple sclerosis (MS), encompassing mobility, cognition, and fear of falling. However, these factors are often examined independently, limiting insights into the combined contributions they make to real-world ambulation. RESEARCH QUESTION How do mobility, cognition, and fear of falling contribute to real-world gait quality and quantity in individuals with MS? METHODS Twenty individuals with MS underwent a series of cognitive assessments, including the Paced Auditory Serial Addition Test (PASAT), Symbol Digits Modalities Test (SDMT), Stroop Test, and the Selective Reminding Test (SRT). Participants also completed the Falls Efficacy Scale - International (FES-I) and walking impairment using the Patient Determined Disease Steps (PDDS). Following the in-lab session, participants wore an inertial sensor on their lower back and asked to go about their typical daily routines for three days. Metrics of gait speed, stride regularity, time spent walking, and total bouts were extracted from the real-world data. RESULTS Significant correlations were found between both real-world gait speed and stride regularity and the SDMT, FES-I, and PDDS. Backward linear regression analysis was conducted for gait speed and stride regularity, with PDDS and SDMT included in the final model for both metrics. These variables explained 63% of the variance in gait speed and 69% of the variance in stride regularity. Results were not significant for gait quantity after adjusting for age and sex. SIGNIFICANCE The study's results provide insight regarding the roles of cognition, walking impairment, and fear of falling on real-world ambulation. Deeper understanding of these contributions can inform the development of targeted interventions that aim to improve walking. Additionally, the absence of significant correlations between gait metrics, cognition, and fear of falling with gait quantity underscores the need for further research to identify factors that increased walking in this population.
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Affiliation(s)
- Michael VanNostrand
- University of Vermont, Rehabilitation and Movement Science, Burlington, VT, USA.
| | - Myeongjin Bae
- University of Vermont, Rehabilitation and Movement Science, Burlington, VT, USA
| | - John C Ramsdell
- University of Vermont, Electrical and Biomedical Engineering, Burlington, VT, USA
| | - Susan L Kasser
- University of Vermont, Rehabilitation and Movement Science, Burlington, VT, USA
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Bae M, Ku B, VanNostrand M, Kasser SL. Home-Based Balance Training on Balance and Mobility in Persons With Multiple Sclerosis: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2024:S0003-9993(24)01015-3. [PMID: 38810817 DOI: 10.1016/j.apmr.2024.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 05/16/2024] [Accepted: 05/16/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVES To (1) examine the effects of home-based balance training on balance and mobility outcomes; (2) evaluate comparable effects between home- and center-based balance training; (3) determine the effects of different levels of supervision on treatment effects; and (4) investigate dose-response relationships of home-based balance training on balance and mobility performance in persons with multiple sclerosis (MS). DATA SOURCES Literature searches were conducted in MEDLINE, EMBASE, PsycINFO, SPORTSDiscus, and CINAHL in April 2023. Other literature sources included website and citation searches. STUDY SELECTION The study included randomized controlled trials of home-based balance training that included balance and mobility outcomes in persons with MS. DATA EXTRACTION Data extracted from each study included (1) number of participants; (2) dropout rate; (3) sex; (4) MS phenotype; (5) age; (6) Expanded Disability Status Scale (range); (7) exercise dose; (8) level of supervision; (9) type of intervention; (10) exercise progression; (11) type of control; and (12) outcomes measures. For the meta-analysis, mean and SD of the balance and mobility outcomes in both the intervention and control groups were used. The methodological quality of included studies was evaluated by Tool for the Assessment of Study Quality and Reporting in Exercise. DATA SYNTHESIS Eleven studies were identified in this systematic review and meta-analysis. Each balance and mobility outcome was standardized using Hedges' g. CONCLUSIONS This meta-analysis revealed comparable results between home- and center-based balance training in terms of balance and mobility improvement. There was also no evidence for the superiority of home-based balance training over no training except for static steady-state balance. This study revealed that training sessions (>36 sessions) and total exercise time (>1100min) were significant moderators for overall balance improvements. Results also indicated that, when designing future interventions, at least an indirect level of supervision (eg, weekly or biweekly phone/video calls) is warranted to maintain adherence.
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Affiliation(s)
- Myeongjin Bae
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT
| | - Byungmo Ku
- Department of Adapted Physical Education, Yong-In University, Yongin-si, South Korea
| | - Michael VanNostrand
- Department of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
| | - Susan L Kasser
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT.
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Kaddoura R, Faraji H, Othman M, Abu Hijleh A, Loney T, Goswami N, Benamer HTS. Exploring Factors Associated with Falls in Multiple Sclerosis: Insights from a Scoping Review. Clin Interv Aging 2024; 19:923-938. [PMID: 38803468 PMCID: PMC11129740 DOI: 10.2147/cia.s460475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/17/2024] [Indexed: 05/29/2024] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory condition that causes demyelination of the central nervous system accompanied by a wide range of symptoms. The high prevalence of falls among patients diagnosed with MS within the initial six months highlights the importance of this issue. The objective of this study is to identify factors associated with falls in MS patients in order to increase awareness and reduce the risk of falls. This scoping review used specific Mesh terms to formulate the literature search around falls and MS using Medline, Google Scholar, Scopus, and Embase search engines. English papers published between 2012 and 2022, studies with a clear definition of falls, McDonald's diagnostic criteria for MS, and those with Expanded Disability Status Scale (EDSS) or Patient Determined Disease Steps (PDDS) scores were included. Critical data from the selected articles were extracted and classified according to the different factors associated with falls in MS patients. Eighteen articles were included in this review. The most important factors associated with falls in MS patients identified were the severity and progression of the disease, mobility and balance problems, bladder dysfunction, fear of falling, fatigue, and cognitive dysfunction. In conclusion, this scoping review yielded the most common factors associated with falls in patients with MS. Study findings can be used to develop future interventions focusing on improving mobility, proprioception, and balance to decrease fall risk and injury amongst MS patients.
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Affiliation(s)
- Rachid Kaddoura
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Hanan Faraji
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Malek Othman
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Amin Abu Hijleh
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Tom Loney
- Department of Basic Sciences, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Nandu Goswami
- Division of Physiology and Pathophysiology, Medical University of Graz, Graz, Austria
- Center for Space and Aviation Health, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Hani T S Benamer
- Department of Clinical Sciences, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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Meijer U, Flink M, Tuvemo Johnson S, Kierkegaard M, Gottberg K, Ytterberg C. Preventing falls in multiple sclerosis: a qualitative study on user requirements for a self-management programme. Disabil Rehabil 2024:1-8. [PMID: 38711397 DOI: 10.1080/09638288.2024.2348725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 04/24/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE To explore perspectives of ambulatory and non-ambulatory people with MS (PwMS) and health care professionals (HCPs) on falls and falls management to gain a deeper understanding of how a self-management programme can be designed to fit the needs of end users. MATERIALS AND METHODS Twelve PwMS and seven HCPs participated in three four-hour workshops based on Design Thinking. Collected data were field notes and digital post-it notes gathered at the workshops. Data were analyzed using qualitative content analysis with an inductive approach. RESULTS Two main categories, "Managing the complexity of fall-risk behaviour" and "Embracing diversity to establish group engagement", comprising a total of seven categories were constructed from the analysis. The first main category reflects the challenges PwMS face in managing fall risk in their daily lives, and the support needed to address these challenges. The second main category highlights how engaging in peer learning activities can fulfil individual needs and improve learning outcomes for PwMS. CONCLUSION A self-management fall prevention programme that is relevant to PwMS regardless of ambulation level should include the development of self-tailored behavioural strategies to prevent falls along with interactive learning activities with other PwMS.
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Affiliation(s)
- Ulrika Meijer
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Maria Flink
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Susanna Tuvemo Johnson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Department of Women's and children's health, Uppsala University, Uppsala, Sweden
| | - Marie Kierkegaard
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Academic Specialist Center, Center of Neurology, Stockholm Health Services, Stockholm, Sweden
| | - Kristina Gottberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Charlotte Ytterberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
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Monaghan PG, VanNostrand M, Fritz NE. Backwards walking speed reserve in persons with multiple sclerosis. Mult Scler Relat Disord 2024; 85:105556. [PMID: 38520947 PMCID: PMC11070283 DOI: 10.1016/j.msard.2024.105556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/15/2024] [Accepted: 03/16/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Decreased gait speed is common in persons with Multiple Sclerosis (PwMS) and has been associated with elevated fall risk. The walking speed reserve (WSR) indicates the ability to increase gait speed on demand and has previously been examined in PwMS. Backward walking is a sensitive measure of fall risk in PwMS; however, no studies have reported on the utility of backward walking speed reserve (BW-WSR) as a clinical assessment tool of functional mobility or fall risk in PwMS, nor have they associated this measure with cognition. METHODS 23 PwMS completed walking trials at their preferred walking speed (PWS) and maximal walking speed (MWS). Participants performed these walking trials in both the forward (FW) and backward direction (BW). The forward walking speed reserve (FW-WSR) was calculated as the difference between MWS and PWS in the forward direction, while the backward walking speed reserve (BW-WSR) was calculated as the difference between MWS and PWS in the back backward direction. Correlation analyses examined the relationship between the FW- and BW-WSR with clinical assessments of functional mobility (the timed up-and-go) as well as cognitive functioning (the Symbol Digit Modalities Test, the Brief Visuospatial Memory Test-Revised, the California Verbal Learning Test, and the Trail Making Test A and B). Correlations also examined the relationship between FW- and BW-WSR with prospective falls. RESULTS A lower BW-WSR was associated with disease severity and poorer performance on clinical walking and balance assessment, as well as with decreased information processing speed and attentional performance. Interestingly, FW-WSR showed similar relations. Neither FW- or BW-WSR were associated with prospective risk in this small sample of PwMS. CONCLUSION The BW-WSR did not offer a distinct advantage over other measures, such as the FW-WSR, PWS, or MWS, in the forward or backward direction. The selection of the most sensitive clinical measures of functional mobility and fall risk is crucial; our study holds valuable clinical implications for PwMS by providing novel insights into functional mobility assessments in PwMS.
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Affiliation(s)
- Patrick G Monaghan
- Department of Health Care Sciences, Wayne State University, Detroit, MI, United States.
| | - Michael VanNostrand
- Department of Health Care Sciences, Wayne State University, Detroit, MI, United States
| | - Nora E Fritz
- Department of Health Care Sciences, Wayne State University, Detroit, MI, United States; Department of Neurology, Wayne State University, Detroit, MI, United States
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Killam-Worrall L, Brand R, Castro JR, Patel DS, Huynh K, Lindley B, Torres BP. Baclofen and Tizanidine Adverse Effects Observed Among Community-Dwelling Adults Above the Age of 50 Years: A Systematic Review. Ann Pharmacother 2024; 58:523-532. [PMID: 37589096 DOI: 10.1177/10600280231193080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVE This review highlights adverse effects of baclofen and tizanidine in older community-dwelling adults. DATA SOURCES A literature search was conducted, including search terms of "adverse effect," "baclofen," "elderly," "falls," "fractures," and "tizanidine." Studies were included if they described community-dwelling adults aged 50 years and older who received oral baclofen or tizanidine. The Federal Drug Administration Adverse Event Reporting System (FAERS) data were compiled for adverse effect incidence. STUDY SELECTION AND DATA EXTRACTION The literature search was completed in July 2019 and updated in June 2023. Reviews performed by 2 independent reviewers yielded 15 records. FAERS identified 486 (baclofen) and 305 (tizanidine) adverse effects of interest. DATA SYNTHESIS Two retrospective cohort studies evaluating baclofen use in older adults showed increased hospitalizations for encephalopathy in chronic kidney disease (7.2% vs 0.1%) and end-stage renal disease (daily dose 20 mg or more; relative risk [RR] 19.8, 95% CI = [14.0-28.0]). Other articles were case reports; 10 articles reported dyskinesias, encephalopathy or disorientation, and drowsiness associated with baclofen, and 5 articles reported bradycardia and/or hypotension with tizanidine. The FAERS Public Dashboard revealed 12.1% and 28.7% overall incidence of adverse effects of interest, with a 27.8% and 29.2% incidence of falls for baclofen and tizanidine, respectively. Baclofen and tizanidine are associated with concerning adverse effects in older adults. Alternative agents should be considered, but, if necessary, providers should start at lower doses and increase slowly. CONCLUSIONS This review highlights the importance of using baclofen and tizanidine with caution in older adults.
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Affiliation(s)
- Lisa Killam-Worrall
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Sciences Center, Fort Worth, TX, USA
| | - Romana Brand
- Wise Regional Health System Emergency Department, Decatur, TX, USA
| | | | | | | | - Bryn Lindley
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Sciences Center, Fort Worth, TX, USA
| | - Brittany Palasik Torres
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Sciences Center, Fort Worth, TX, USA
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Hoang P, Sturnieks DL, Butler A, Chaplin C, Hicks C, Lo J, Ratanapongleka M, Robinson S, Smith N, Turner J, Krishnan AV, Barnett M, Gandevia S, Lord SR, Menant JC. A custom-built step exergame training programme to prevent falls in people with multiple sclerosis: A multicentre randomised controlled trial. Mult Scler 2024; 30:571-584. [PMID: 38362861 DOI: 10.1177/13524585241229360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
BACKGROUND Cognitive-motor step training can improve stepping, balance and mobility in people with multiple sclerosis (MS), but effectiveness in preventing falls has not been demonstrated. OBJECTIVES This multisite randomised controlled trial aimed to determine whether 6 months of home-based step exergame training could reduce falls and improve associated risk factors compared with usual care in people with MS. METHODS In total, 461 people with MS aged 22-81 years were randomly allocated to usual care (control) or unsupervised home-based step exergame training (120 minutes/week) for 6 months. The primary outcome was rate of falls over 6 months from randomisation. Secondary outcomes included physical, cognitive and psychosocial function at 6 months and falls over 12 months. RESULTS Mean (standard deviation (SD)) weekly training duration was 70 (51) minutes over 6 months. Fall rates did not differ between intervention and control groups (incidence rates (95% confidence interval (CI)): 2.13 (1.57-2.69) versus 2.24 (1.35-3.13), respectively, incidence rate ratio: 0.96 (95% CI: 0.69-1.34, p = 0.816)). Intervention participants performed faster in tests of choice-stepping reaction time at 6 months. No serious training-related adverse events were reported. CONCLUSION The step exergame training programme did not reduce falls among people with MS. However, it significantly improved choice-stepping reaction time which is critical to ambulate safely in daily life environment.
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Affiliation(s)
- Phu Hoang
- Neuroscience Research Australia, Randwick, NSW, Australia/School of Population Health, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
- Multiple Sclerosis Plus, Lidcombe, NSW Australia
| | - Daina L Sturnieks
- Neuroscience Research Australia, Randwick, NSW, Australia
- School of Biomedical Sciences, University of New South Wales, Sydney, NSW, Australia
- UNSW Ageing Futures Institute, University of New South Wales, Sydney, NSW, Australia
| | - Anna Butler
- Neuroscience Research Australia, Randwick, NSW, Australia
| | - Carly Chaplin
- Neuroscience Research Australia, Randwick, NSW, Australia
| | - Cameron Hicks
- Neuroscience Research Australia, Randwick, NSW, Australia
| | - Joanne Lo
- Neuroscience Research Australia, Randwick, NSW, Australia
| | | | | | - Natassia Smith
- Neuroscience Research Australia, Randwick, NSW, Australia
| | - Jessica Turner
- Neuroscience Research Australia, Randwick, NSW, Australia
| | - Arun V Krishnan
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
- Department of Neurology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Michael Barnett
- Sydney Neurology MS Clinic, The Brain and Mind Centre, Camperdown, NSW, Australia
| | - Simon Gandevia
- Neuroscience Research Australia, Randwick, NSW, Australia
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Stephen R Lord
- Neuroscience Research Australia, Randwick, NSW, Australia
- School of Population Health, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
| | - Jasmine C Menant
- Neuroscience Research Australia, Randwick, NSW, Australia
- School of Population Health, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
- UNSW Ageing Futures Institute, University of New South Wales, Sydney, NSW, Australia
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Abou L, Peters J, Freire B, Sosnoff JJ. Fear of falling and common symptoms of multiple sclerosis: Physical function, cognition, fatigue, depression, and sleep - A systematic review. Mult Scler Relat Disord 2024; 84:105506. [PMID: 38422635 DOI: 10.1016/j.msard.2024.105506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/03/2024] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Fear of falling (FOF) is a common concern among persons with multiple sclerosis (MS) and affects the performance of their daily living activities. Falls may result in FOF, leading to worsening of symptoms of MS, physical deconditioning, and exposure to future falls. This may trigger a vicious cycle between FOF and falls. A better understanding of the relationship between FOF and symptoms of MS may be helpful to develop a conceptual model to guide fall prevention interventions. OBJECTIVE To synthesize the correlational and predictive relationships between FOF and common symptoms of MS. METHODS Databases including PubMed, Embase, Web of Science, Scopus, CINHAL, PsycINFO, and SPORTDiscuss were searched from inception to October 2023. Studies examining correlations and/or predictions between FOF and common MS symptoms that include measures of gait, postural control, fatigue, cognition, pain, sleep, depression, and anxiety were identified by two independent reviewers. Both reviewers also conducted the methodological quality assessment of the included studies. RESULTS Twenty-three studies with a total of 2819 participants were included in the review. Correlational findings indicated that increased FOF was significantly associated with greater walking deficits (lower gait speed, smaller steps), reduced mobility, and poorer balance. Increased FOF was also significantly correlated with higher cognitive impairments, more fatigue, sleep disturbances, and depression. Decreased gait parameters, reduced balance, lower physical functions, cognitive impairments, and sleep deficits were found as significant predictors of increased FOF. CONCLUSION Evidence indicates significant correlational and bidirectional predictive relationships exist between FOF and common MS symptoms. A comprehensive conceptual framework accounting for the interaction between FOF and MS symptoms is needed to develop effective falls prevention strategies.
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Affiliation(s)
- Libak Abou
- Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
| | - Joseph Peters
- Kansas City University College of Osteopathic Medicine, Kansas City University of Medicine and Bioscience, Kansas City, MO, USA
| | - Bruno Freire
- Health and Sports Sciences Center, Santa Catarina State University, Florianópolis, SC, Brazil
| | - Jacob J Sosnoff
- Department of Physical Therapy, Rehabilitation Science, & Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
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Abou L, McCloskey C, Wernimont C, Fritz NE, Kratz AL. Examination of Risk Factors Associated With Falls and Injurious Falls in People With Multiple Sclerosis: An Updated Nationwide Study. Arch Phys Med Rehabil 2024; 105:717-724. [PMID: 38043675 DOI: 10.1016/j.apmr.2023.11.011] [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: 08/09/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE To provide an update on risk factors associated with falls and injurious falls among people with multiple sclerosis (PwMS) in the United States. DESIGN Nationwide cross-sectional web-based survey. SETTING Community setting. PARTICIPANTS Adult PwMS (n=965). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Participants completed self-report surveys of demographics, clinical data, concerns about falling, occurrence of falls, factors associated with falls, and injurious falls in the past 6 months. Participants also completed Patient-Reported Outcomes Measurement Information System (PROMIS) measures of depression, pain interference, and physical function, and the Fatigue Severity Scale. RESULTS The most common self-reported factors associated with falls included personal factors such as poor balance (75%), muscle weakness (54%), and/or fatigue (35%), environmental factors such as general surface conditions (37%) and/or distraction (15%), and activities-related factors such as urgency to complete a task (35%) and/or multitasking (27%). Logistic regression analyses indicated that higher fatigue severity (OR=1.19, P<.01) and higher pain interference (OR=1.02, P<.01) were associated with higher odds of experiencing at least 1 fall. Any level of concern, even minimal concern about falling was also significantly associated with a higher odd of experiencing at least 1 fall (ORs range 2.78 - 3.95, all P<.01). Fair to very high concerns about falling compared with no concern about falling (ORs range=5.17 - 10.26, all P<.05) was significantly associated with higher odds of sustaining an injurious fall. CONCLUSIONS Findings suggest falls prevention approaches in PwMS should be multifactorial and include personal, environmental, and activities-related factors. Particular attention on fatigue, pain, and concern about falling may be needed to reduce incidence of falls and injurious falls in this population.
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Affiliation(s)
- Libak Abou
- Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI.
| | - Chloe McCloskey
- Department of Physical Medicine and Rehabilitation, Kaiser Permanente Health System, Redwood City, CA
| | - Cory Wernimont
- Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Nora E Fritz
- Departments of Health Care Sciences & Neurology, Wayne State University, Detroit, MI
| | - Anna L Kratz
- Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI
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Molhemi F, Monjezi S, Mehravar M, Shaterzadeh-Yazdi MJ, Majdinasab N. Validity, reliability, and responsiveness of Persian version of mini-balance evaluation system test among ambulatory people with multiple sclerosis. Physiother Theory Pract 2024; 40:565-575. [PMID: 36065714 DOI: 10.1080/09593985.2022.2119908] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/27/2022] [Accepted: 08/27/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND AND PURPOSE Mini-Balance Evaluation Systems Test (mini-BESTest) is a widely used measure to assess balance impairments. This study aimed to assess the validity, reliability, responsiveness, and minimal clinically important change (MCIC) of the Persian mini-BESTest among ambulatory People with Multiple Sclerosis (PwMS). METHODS Fifty ambulatory PwMS participated in this study. Persian mini-BESTest validated against Berg Balance Scale (BBS) and Timed-Up and Go (TUG) with/without a cognitive task. To assess the reliability, the Persian mini-BESTest was re-administered for a sample of 30 participants after 1 week. Also, 32 PwMS were tested before and after a 4-week of balance and gait training to assess the responsiveness. RESULTS No floor/ceiling effect was found for the mini-BESTest total score. There were significant excellent correlations (p < .001) between mini-BESTest and BBS (r = 0.71), TUG (r = -0.76), and cognitive TUG (r = -0.73). No strong correlations were observed between the subscales (r = 0.37-0.55). Test-retest reliability and internal consistency of Persian mini-BESTest total score were excellent, with Intra-class Correlation Coefficient (ICC3,1 and Cronbach's alpha level of 0.89 and 0.80, respectively. The minimal detectable change was 4 points. The Persian mini-BESTest had acceptable responsiveness (AUC = 0.83), and MCIC was 5 points. CONCLUSION The Persian mini-BESTest is a valid, reliable, and responsive measure of balance performance in Iranian ambulatory PwMS.
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Affiliation(s)
- Farshad Molhemi
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Saeideh Monjezi
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Mehravar
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad-Jafar Shaterzadeh-Yazdi
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nastaran Majdinasab
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Bonardet N, Bardel B, Lefaucheur JP, Sorel M, Créange A. Impact of textured surfaces on the orthostatic balance of patients with multiple sclerosis. Neurophysiol Clin 2024; 54:102941. [PMID: 38382135 DOI: 10.1016/j.neucli.2023.102941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 12/21/2023] [Accepted: 12/21/2023] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVE To perform posturographic measurements with eyes open or closed using floor coverings with different textured surfaces to study postural control in patients with multiple sclerosis (MS). METHODS Static posturographic recordings were performed with eyes open and eyes closed on a forceplate with no covering (control condition) or covered by a textured mat with small pimples (height 2 mm) or large pimples (height 7 mm). Several posturographic variables were measured, focusing on displacements of the center of pressure (CoP) including the average velocity (Vav), the total length (L) of all displacements, and the surface (S) of the confidence ellipse. The recordings made with the textured mats were compared to the control condition with eyes open or closed. Then, the differences between the recordings made with large vs. small pimples on the one hand, and with eyes closed vs. open were calculated to assess the impact of pimple height or eye closure on posturographic measurements. Clinical assessment was based on the Expanded Disability Status Scale (EDSS) and its functional system (FS) subscores, the Modified Fatigue Impact Scale (MFIS), the Unipodal Stance test (UST), and the Timed Up-and-Go test (TUG). RESULTS Forty-six MS patients (mean EDSS score: 3.6) completed the study. Several posturographic variables, including Vav and L, deteriorated when measured on a textured mat, especially with large pimples and in eyes open condition. In contrast, no difference was found with small pimples and eyes closed, as compared to the control condition (no covering). The deleterious impact of pimple height on posturography correlated positively with the alteration of balance and gait clinically assessed by the UST and the TUG, and also with the MFIS physical and cerebral EDSS-FS subscores, and negatively with the cerebellar and brainstem subscores. On the other hand, the impact of eye closure on posturography was negatively correlated with the visual EDSS-FS subscore. DISCUSSION Static posturographic measurements made with different textured surfaces and visual conditions can be considered as a sensitive tool to measure "proprioceptive reserves". Actually, when cerebellar, brainstem, or visual functions are impaired, the resources of the sensory (proprioceptive) system, if preserved, can be recruited at a higher level and compensate for dysfunctions of other postural controls to maintain a satisfactory balance. In addition, this procedure of static posturographic examination can provide objective measurements correlated with clinical testing of balance and gait and could usefully complement EDSS scoring to assess disability affecting postural control and the risk of falling in MS patients.
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Affiliation(s)
- Nathalie Bonardet
- EA 4391, ENT, Faculté de Santé, Université Paris-Est Créteil, Créteil, France; Centre d'Evaluation et Traitement de la Douleur, Centre Hospitalier du Sud Seine-et-Marne, Nemours, France.
| | - Benjamin Bardel
- EA 4391, ENT, Faculté de Santé, Université Paris-Est Créteil, Créteil, France; Unité de Neurophysiologie Clinique, Hôpital Universitaire Henri Mondor, AP-HP, Créteil, France
| | - Jean-Pascal Lefaucheur
- EA 4391, ENT, Faculté de Santé, Université Paris-Est Créteil, Créteil, France; Unité de Neurophysiologie Clinique, Hôpital Universitaire Henri Mondor, AP-HP, Créteil, France
| | - Marc Sorel
- EA 4391, ENT, Faculté de Santé, Université Paris-Est Créteil, Créteil, France; Centre d'Evaluation et Traitement de la Douleur, Centre Hospitalier du Sud Seine-et-Marne, Nemours, France
| | - Alain Créange
- EA 4391, ENT, Faculté de Santé, Université Paris-Est Créteil, Créteil, France; Service de Neurologie, Hôpital Universitaire Henri Mondor, AP-HP, Créteil, France
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Block VJ, Koshal K, Wijangco J, Miller N, Sara N, Henderson K, Reihm J, Gopal A, Mohan SD, Gelfand JM, Guo CY, Oommen L, Nylander A, Rowson JA, Brown E, Sanders S, Rankin K, Lyles CR, Sim I, Bove R. A Closed-Loop Falls Monitoring and Prevention App for Multiple Sclerosis Clinical Practice: Human-Centered Design of the Multiple Sclerosis Falls InsightTrack. JMIR Hum Factors 2024; 11:e49331. [PMID: 38206662 PMCID: PMC10811573 DOI: 10.2196/49331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/14/2023] [Accepted: 10/19/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Falls are common in people with multiple sclerosis (MS), causing injuries, fear of falling, and loss of independence. Although targeted interventions (physical therapy) can help, patients underreport and clinicians undertreat this issue. Patient-generated data, combined with clinical data, can support the prediction of falls and lead to timely intervention (including referral to specialized physical therapy). To be actionable, such data must be efficiently delivered to clinicians, with care customized to the patient's specific context. OBJECTIVE This study aims to describe the iterative process of the design and development of Multiple Sclerosis Falls InsightTrack (MS-FIT), identifying the clinical and technological features of this closed-loop app designed to support streamlined falls reporting, timely falls evaluation, and comprehensive and sustained falls prevention efforts. METHODS Stakeholders were engaged in a double diamond process of human-centered design to ensure that technological features aligned with users' needs. Patient and clinician interviews were designed to elicit insight around ability blockers and boosters using the capability, opportunity, motivation, and behavior (COM-B) framework to facilitate subsequent mapping to the Behavior Change Wheel. To support generalizability, patients and experts from other clinical conditions associated with falls (geriatrics, orthopedics, and Parkinson disease) were also engaged. Designs were iterated based on each round of feedback, and final mock-ups were tested during routine clinical visits. RESULTS A sample of 30 patients and 14 clinicians provided at least 1 round of feedback. To support falls reporting, patients favored a simple biweekly survey built using REDCap (Research Electronic Data Capture; Vanderbilt University) to support bring-your-own-device accessibility-with optional additional context (the severity and location of falls). To support the evaluation and prevention of falls, clinicians favored a clinical dashboard featuring several key visualization widgets: a longitudinal falls display coded by the time of data capture, severity, and context; a comprehensive, multidisciplinary, and evidence-based checklist of actions intended to evaluate and prevent falls; and MS resources local to a patient's community. In-basket messaging alerts clinicians of severe falls. The tool scored highly for usability, likability, usefulness, and perceived effectiveness (based on the Health IT Usability Evaluation Model scoring). CONCLUSIONS To our knowledge, this is the first falls app designed using human-centered design to prioritize behavior change and, while being accessible at home for patients, to deliver actionable data to clinicians at the point of care. MS-FIT streamlines data delivery to clinicians via an electronic health record-embedded window, aligning with the 5 rights approach. Leveraging MS-FIT for data processing and algorithms minimizes clinician load while boosting care quality. Our innovation seamlessly integrates real-world patient-generated data as well as clinical and community-level factors, empowering self-care and addressing the impact of falls in people with MS. Preliminary findings indicate wider relevance, extending to other neurological conditions associated with falls and their consequences.
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Affiliation(s)
- Valerie J Block
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, CA, United States
| | - Kanishka Koshal
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Jaeleene Wijangco
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Nicolette Miller
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Narender Sara
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Kyra Henderson
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Jennifer Reihm
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Arpita Gopal
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, CA, United States
| | - Sonam D Mohan
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Jeffrey M Gelfand
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Chu-Yueh Guo
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Lauren Oommen
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Alyssa Nylander
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - James A Rowson
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Ethan Brown
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Stephen Sanders
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Katherine Rankin
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
| | - Courtney R Lyles
- University of California San Francisco Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
- Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, United States
| | - Ida Sim
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Riley Bove
- Department of Neurology, University of California San Francisco Weill Institute, University of California San Francisco, San Francisco, CA, United States
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Arntzen EC, Braaten T, Fikke HK, Normann B. Feasibility of a new intervention addressing group-based balance and high-intensity training, physical activity, and employment in individuals with multiple sclerosis: a pilot randomized controlled trial. FRONTIERS IN REHABILITATION SCIENCES 2024; 4:1258737. [PMID: 38259873 PMCID: PMC10801079 DOI: 10.3389/fresc.2023.1258737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/08/2023] [Indexed: 01/24/2024]
Abstract
Background and purpose Impaired sensorimotor function, reduced physical activity and unemployment are common challenges in persons with multiple sclerosis (pwMS), even when disability is low. CoreDISTparticipation is a new, multidisciplinary intervention delivered across healthcare levels systematically addressing these elements. This study primarily aimed to evaluate the feasibility of CoreDISTparticipation in terms of process, resources, management, and scientific outcomes. The secondary aim was to evaluate initial efficacy in terms of possible short-term effects compared with the usual care on barriers to employment, balance, walking, health-related quality of life (HRQoL), and physical activity. Methods This assessor-blinded prospective pilot randomized controlled trial included 29 pwMS [Expanded Disability Status Scale (EDSS): 0-3.5] randomly allocated to the intervention group (CoreDISTparticipation) (n = 15) or usual care (n = 14). CoreDISTparticipation consists of three phases: (1) hospital outpatient clinic: MS nurse work-focused session and physiotherapist exploring balance; (2) municipality: a digital meeting with pwMS, employer, MS nurse, and physiotherapist addressing employment and physical activity, 4 weeks indoor CoreDIST balance training (60 min × 2/week); and (3) 4 weeks outdoor CoreDIST balance training and high-intensity running/walking (60 min × 2/week). Assessments were undertaken at baseline and at weeks 6 and 11. Primary feasibility metric outcomes were the reporting of process, resources, management, and scientific outcomes. Efficacy measures included evaluation of the Multiple Sclerosis Work Difficulties Questionnaire-23 Norwegian Version (MSWDQ-23NV) and 6 Minute Walk-test as well as the Trunk Impairment Scale-modified Norwegian Version, Mini-Balance Evaluation Systems Test (Mini-BESTest), Multiple Sclerosis Walking Scale-12, Multiple Sclerosis Impact Scale-29 Norwegian Version (MSIS-29NV), ActiGraph wGT3x-BT monitors, and AccuGait Optimized force platform. The statistical analyses included repeated-measures mixed models performed in IBM SPSS Version 29. Results The primary feasibility metric outcomes demonstrated the need for minor adjustments in regard to the content of the intervention and increasing the number of staff. In regard to the efficacy measures, one person attended no postintervention assessments and was excluded, leaving 28 participants (mean EDSS: 1.8, SD: 1). The mean percentage employment was 46.3 (SD: 35.6) and 65.4 (SD: 39.3) in the CoreDISTparticipation and usual care group, respectively. No between-group differences were found. MSWDQ-23NV demonstrated a within-group difference of 5.7 points from baseline to Week 11 (P = 0.004; confidence interval: 2.2-9.3). Mini-BESTest and MSIS-29NV demonstrated within-group differences. The study is registered in ClinicalTrials.gov (Identifier: NCT05057338). Discussion The CoreDISTparticipation intervention is feasible to support pwMS when the identified feasibility metric outcomes in regard to process, resource, management, and scientific outcome metrics are adjusted to improve feasibility. Regarding efficacy measures, no between-group differences were detected; however, within-group differences in barriers to employment, balance, and HRQoL were detected for the CoreDISTparticipation group. A larger comparative trial is needed to explore between-group differences and should accurately and precisely define usual care and address the identified limitations of this study.
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Affiliation(s)
- Ellen Christin Arntzen
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Department of Physiotherapy, Kongsgården Physiotherapy, Bodø, Norway
| | - Tonje Braaten
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | | | - Britt Normann
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Department of Physiotherapy, Nordland Hospital Trust, Bodø, Norway
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Javier-Ormazábal A, González-Platas M, Jiménez-Sosa A, Herrero P, Lapuente-Hernández D. The Effectiveness of a Single Dry Needling Session on Gait and Quality of Life in Multiple Sclerosis: A Double-Blind Randomized Sham-Controlled Pilot Trial. Healthcare (Basel) 2023; 12:10. [PMID: 38200916 PMCID: PMC10778988 DOI: 10.3390/healthcare12010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Gait disorders are a major cause of disability and reduced health-related quality of life in people with multiple sclerosis (pwMS). Dry needling (DN) has demonstrated positive results to improve gait parameters in patients with stroke. The main aim of this study was to evaluate the effect of a single session of DN in the gait performance of pwMS. METHODS A double-blind parallel randomized sham-controlled pilot trial was conducted. Study participants received a single session of active DN or sham DN in the gastrocnemius medialis muscle. Pre-treatment and immediately post-treatment measurements were taken, as well as at one and four weeks after the intervention. Outcomes related to gait performance (Timed 25-Foot Walk), self-perceived walking capacity (Multiple Sclerosis Walking Scale), risk of falls (Timed Up and Go test), disability level (Expanded Disability Status Score) and quality of life (Multiple Sclerosis Quality of Life-54 questionnaire and Analogic Quality of Life scale) were evaluated. RESULTS 18 patients who had multiple sclerosis participated in the study. The group who received active DN showed within-group significant statistical differences immediately after treatment for gait performance (p = 0.008) and risk of falls (p = 0.008), as well as for self-perceived walking capacity at one week (p = 0.017) and four weeks (p = 0.011) and quality of life at four weeks (p = 0.014). Regarding the comparison between groups, only significant results were obtained in the physical domain of the quality of life at four weeks (p = 0.014). CONCLUSIONS DN seems to be a promising therapeutic tool for the treatment of gait disorders in pwMS. However, when results were compared with sham DN, no differences were found.
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Affiliation(s)
- Alberto Javier-Ormazábal
- Division of Physiotherapy, Hospital Universitario de Canarias, Carretera Ofra S/N, 38320 San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
- Research Institute of Biomedical and Health Sciences, Universidad de Las Palmas de Gran Canaria, C. Juan de Quesada 30, 35001 Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Montserrat González-Platas
- Research Institute of Biomedical and Health Sciences, Universidad de Las Palmas de Gran Canaria, C. Juan de Quesada 30, 35001 Las Palmas de Gran Canaria, Las Palmas, Spain
- Division of Neurology, Hospital Universitario de Canarias, Carretera Ofra S/N, 38320 San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
| | - Alejandro Jiménez-Sosa
- Research Unit, Hospital Universitario de Canarias, Carretera Ofra S/N, 38320 San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
| | - Pablo Herrero
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, C/Domingo Miral s/n, 50009 Zaragoza, Zaragoza, Spain
- iHealthy Research Group, IIS Aragon, Avda San Juan Bosco 13, 50009 Zaragoza, Zaragoza, Spain
| | - Diego Lapuente-Hernández
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, C/Domingo Miral s/n, 50009 Zaragoza, Zaragoza, Spain
- iHealthy Research Group, IIS Aragon, Avda San Juan Bosco 13, 50009 Zaragoza, Zaragoza, Spain
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Kushner T, Mosquera-Lopez C, Hildebrand A, Cameron MH, Jacobs PG. Risky movement: Assessing fall risk in people with multiple sclerosis with wearable sensors and beacon-based smart-home monitoring. Mult Scler Relat Disord 2023; 79:105019. [PMID: 37801954 DOI: 10.1016/j.msard.2023.105019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/25/2023] [Accepted: 09/22/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND People with multiple sclerosis (PwMS) fall frequently causing injury, social isolation, and decreased quality of life. Identifying locations and behaviors associated with high fall risk could help direct fall prevention interventions. Here we describe a smart-home system for assessing how mobility metrics relate to real-world fall risk in PwMS. METHODS We performed a secondary analysis of a dataset of real-world falls collected from PwMS to identify patterns associated with increased fall risk. Thirty-four individuals were tracked over eight weeks with an inertial sensor comprising a triaxial accelerometer and time-of-flight radio transmitter, which communicated with beacons positioned throughout the home. We evaluated associations between locations in the home and movement behaviors prior to a fall compared with time periods when no falls occurred using metrics including gait initiation, time-spent-moving, movement length, and an entropy-based metric that quantifies movement complexity using transitions between rooms in the home. We also explored how fall risk may be related to the percent of times that a participant paused while walking (pauses-while-walking). RESULTS Seventeen of the participants monitored sustained a total of 105 falls that were recorded. More falls occurred while walking (52%) than when stationary despite participants being largely sedentary, only walking 1.5±3.3% (median ± IQR) of the time that they were in their home. A total of 28% of falls occurred within one second of gait initiation. As the percentage of pauses-while-walking increased from 20 to 60%, the likelihood of a fall increased by nearly 3 times from 0.06 to 0.16%. Movement complexity, which was quantified using the entropy of room transitions, was significantly higher in the 10 min preceding falls compared with other 10-min time segments not preceding falls (1.15 ± 0.47 vs. 0.96 ± 0.24, P = 0.02). Path length was significantly longer (151.3 ± 156.1 m vs. 95.0 ± 157.2 m, P = 0.003) in the ten minutes preceding a fall compared with non-fall periods. Fall risk also varied among rooms but not consistently across participants. CONCLUSIONS Movement metrics derived from wearable sensors and smart-home tracking systems are associated with fall risk in PwMS. More pauses-while-walking, and more complex, longer movement trajectories are associated with increased fall risk. FUNDING Department of Veterans Affairs (RX001831-01A1). National Science Foundation (#2030859).
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Affiliation(s)
- Taisa Kushner
- Artificial Intelligence for Medical Systems Lab, Department of Biomedical Engineering, Oregon Health & Science University, Portland OR, United States; Galois Inc, Portland OR, USA
| | - Clara Mosquera-Lopez
- Artificial Intelligence for Medical Systems Lab, Department of Biomedical Engineering, Oregon Health & Science University, Portland OR, United States
| | - Andrea Hildebrand
- Biostatistics and Design Program Core, Oregon Health & Science University, Portland OR, United States
| | - Michelle H Cameron
- Department of Neurology, VA Portland Health Care System, Oregon Health & Science University, Portland OR, United States
| | - Peter G Jacobs
- Artificial Intelligence for Medical Systems Lab, Department of Biomedical Engineering, Oregon Health & Science University, Portland OR, United States.
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Özkeskin M, Özden F, Ar E, Yüceyar N. The reliability and validity of the 30-second chair stand test and modified four square step test in persons with multiple sclerosis. Physiother Theory Pract 2023; 39:2189-2195. [PMID: 35471847 DOI: 10.1080/09593985.2022.2070811] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 04/19/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The 30-second Chair Stand Test (30s-CST) and Modified Four Square Step Test (mFSST) are used to determine the functional status of individuals with multiple sclerosis (MS). No other studies have demonstrated the reliability and validity of the 30s-CST and mFSST. PURPOSE To identify the test-retest reliability, concurrent validity and the known-group validity of the 30s-CST and mFSST in persons with MS. METHODS A total of 64 persons with MS were enrolled. 30s-CST, mFSST, Timed Up and Go Test (TUG) and Five Times Sit to Stand (FTST) tests were performed. 30s-CST and mFSST were conducted again one-hour later. RESULTS The mean age of the persons with MS were 37.9±11.3 years. The test-retest reliability of the 30s-CST and mFSST were excellent (ICC30s-CST = 0.974, 95%CI: 0.95-0.98; ICCmFSST = 0.992, 95%CI: 0.98-0.99). The 30s-CST was strongly correlated with FTST and TUG (r1 = -0.871, p1 = 0.0001; r2 = -0.741,p2 = 0.0001). There was a strong relationship between mFSST with TUG and FTST (r1 = 0.781,p1 = 0.0001;r2 = 0.788,p2 = 0.0001). The SEM95 and MDC95 values of the 30s-CST and mFSST were 0.41/1.13 and 0.34/0.94, respectively. Besides, there were significant differences between the persons with or without fall history in 30s-CST (MD: 1.66, CI: 0.27 to 3.05, p = .019) and mFSST CST (MD:-2.70, CI: -4.73 to -0.67, p = .010) performances. CONCLUSION The 30s-CST and mFSST are both valid and reliable in mildly-disabled individuals with MS.
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Affiliation(s)
- Mehmet Özkeskin
- Ege University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Suat Cemile Balcioğlu Campus, İzmir, Turkey
| | - Fatih Özden
- Köyceğiz Vocational School of Health Services, Department of Health Care Services, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Ege Ar
- Ege University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Suat Cemile Balcioğlu Campus, İzmir, Turkey
| | - Nur Yüceyar
- Faculty of Medicine, Department of Neurology, Ege University, İzmir, Turkey
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18
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Gopal A, Gelfand JM, Bove R, Block VJ. Fall Assessment and Monitoring in People With Multiple Sclerosis: A Practical Evidence-Based Review for Clinicians. Neurol Clin Pract 2023; 13:e200184. [PMID: 37720138 PMCID: PMC10503932 DOI: 10.1212/cpj.0000000000200184] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/07/2023] [Indexed: 09/19/2023]
Abstract
Purpose of Review Falls occur in more than half of all people with multiple sclerosis (MS) but tend to be underdiagnosed and underreported in clinical encounters. This narrative review aims to summarize evidence-based approaches for evaluating fall risk and proven treatment strategies to reduce falling in people with MS to improve care for people with MS and to enhance interprofessional care coordination between treating neurologic and physical therapy (PT) teams. Recent Findings Screening not just for falls but for near-falls as well because fear of falling can improve fall assessment and identify patients who may benefit from fall prevention interventions. A number of barriers, including time constraints during visits and the fallacy that falling is inevitable in MS, can limit clinician awareness about patient falls and delay timely referral to PT. Consultation with physical therapists for individualized fall prevention treatment can reduce risk of falling. Interventional studies have also shown that PT-guided exercise programs improve balance confidence in people with MS. However, people with MS are often under-referred to PT by treating clinicians. Summary A clinical approach is provided to summarize practical, accessible, evidence-based, low-burden measurements and interventions likely to improve ascertainment of patients at risk of falling and optimize timely PT referral and treatment.
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Affiliation(s)
- Arpita Gopal
- UCSF Weill Institute for Neurosciences (AG, JMG, RB), MS and Neuroinflammation Clinic, Department of Neurology; and Department of Physical Therapy and Rehabilitation Science (VJB), University of California, San Francisco
| | - Jeffrey M Gelfand
- UCSF Weill Institute for Neurosciences (AG, JMG, RB), MS and Neuroinflammation Clinic, Department of Neurology; and Department of Physical Therapy and Rehabilitation Science (VJB), University of California, San Francisco
| | - Riley Bove
- UCSF Weill Institute for Neurosciences (AG, JMG, RB), MS and Neuroinflammation Clinic, Department of Neurology; and Department of Physical Therapy and Rehabilitation Science (VJB), University of California, San Francisco
| | - Valerie J Block
- UCSF Weill Institute for Neurosciences (AG, JMG, RB), MS and Neuroinflammation Clinic, Department of Neurology; and Department of Physical Therapy and Rehabilitation Science (VJB), University of California, San Francisco
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19
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Finlayson M, Feys P, Dalgas U, Kos D. Intermediate outcomes for clinical trials of multiple sclerosis rehabilitation interventions: Conceptual and practical considerations. Mult Scler 2023; 29:1186-1194. [PMID: 37555489 PMCID: PMC10413783 DOI: 10.1177/13524585231189674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Rehabilitation is an essential health care service and a critical component of comprehensive multiple sclerosis (MS) care. OBJECTIVE As part of a 2-day meeting hosted by the International Advisory Committee on Clinical Trials in MS in December 2022, a panel initiated a discussion on the conceptual and practical issues related to selecting intermediate outcomes for clinical trials of MS rehabilitation interventions. RESULTS The overarching goal of rehabilitation - optimal functioning - was acknowledged as a complex biopsychosocial phenomenon that varies with patient priorities and environmental context. This complexity means that multiple causal pathways and potential intermediate outcomes must be carefully considered during the design of clinical trials in MS rehabilitation that aim to improve functioning. In addition, practical issues must be considered such as psychometric properties of outcome measures, measure type, and characteristics of the target population, including severity of dysfunction. CONCLUSION This article uses the International Classification of Functioning, Disability and Health as a foundation for determining relevant intermediate outcomes for clinical trials of MS rehabilitation interventions.
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Affiliation(s)
- Marcia Finlayson
- School of Rehabilitation Therapy, Queen’s University, Kingston ON, Canada
| | - Peter Feys
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium; UMSC Hasselt, Pelt, Belgium
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Daphne Kos
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; National Multiple Sclerosis Center Melsbroek, Steenokkerzeel, Belgium
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20
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Arntzen EC, Bidhendi-Yarandi R, Sivertsen M, Knutsen K, Dahl SSH, Hartvedt MG, Normann B, Behboudi-Gandevani S. The effect of exercise and physical activity-interventions on step count and intensity level in individuals with multiple sclerosis: a systematic review and meta-analysis of randomized controlled trials. Front Sports Act Living 2023; 5:1162278. [PMID: 37583464 PMCID: PMC10425270 DOI: 10.3389/fspor.2023.1162278] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/05/2023] [Indexed: 08/17/2023] Open
Abstract
Background Reduced physical activity is a worldwide challenge in individuals with multiple sclerosis (MS). The aim of this systematic review and meta-analysis was to identify devise-measured effects of physical activity, exercise and physiotherapy-interventions on step count and intensity level of physical activity in individuals with MS. Methods A systematic search of the databases of PubMed (including Medline), Scopus, CINHAL and Web of Science was carried out to retrieve studies published in the English language from the inception to the first of May 2023. All trials concerning the effectiveness of different types of exercise on step count and intensity level in people with MS were included. The quality of the included studies and their risk of bias were critically appraised using The modified consolidated standards of reporting trials and the Cochrane Risk of Bias tool, respectively. The pooled standardized mean difference (SMD) and 95% CI of the step-count outcome and moderate to vigorous intensity level before versus after treatment were estimated in both Intervention and Control groups using the random effect model. The Harbord test were used to account for heterogeneity between studies and assess publication bias, respectively. Further sensitivity analysis helped with the verification of the reliability and stability of our review results. Results A total of 8 randomized clinical trials (involving 919 individuals with MS) were included. The participants (including 715 (77.8%) female and 204 (22.2%) male) had been randomly assigned to the Intervention (n = 493) or Control group (n = 426). The pooled mean (95% CI) age and BMI of participants were 49.4 years (95% CI: 47.4, 51.4 years) and 27.7 kg/m2 (95% CI: 26.4, 29 kg/m2), respectively. In terms of the comparison within the Intervention and the Control groups before and after the intervention, the results of the meta-analysis indicate that the pooled standardized mean difference (SMD) for step-count in the Intervention group was 0.56 (95% CI: -0.42, 1.54), while in the Control group it was 0.12 (95% CI: -0.05, 0.28). Furthermore, there was no significant difference in the pooled SMD of step-count in the physical activity Intervention group compared to the Controls after the intervention (pooled standard mean difference = 0.19, 95% CI: -0.36,0.74). Subgroup analysis on moderate to vigorous intensity level of physical activity revealed no significant effect of the physical activity intervention in the Intervention group compared to the Control group after the intervention, or within groups before and after the intervention. Results of meta regression showed that age, BMI, duration of disease and Expanded Disability Status Scale (EDSS) score were not the potential sources of heterogeneity (all p > 0.05). Data on the potential harms of the interventions were limited. Conclusion The results of this meta-analysis showed no significant differences in step count and moderate to vigorous physical activity level among individuals with MS, both within and between groups receiving physical activity interventions. More studies that objectively measure physical activity are needed. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42022343621.
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Affiliation(s)
| | - Razieh Bidhendi-Yarandi
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Karina Knutsen
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | | | | | - Britt Normann
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Physiotherapy Department, Nordland Hospital Trust, Bodø, Norway
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21
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Berg-Hansen P, Moen SM, Klyve TD, Gonzalez V, Seeberg TM, Celius EG, Austeng A, Meyer F. The instrumented single leg stance test detects early balance impairment in people with multiple sclerosis. Front Neurol 2023; 14:1227374. [PMID: 37538255 PMCID: PMC10394643 DOI: 10.3389/fneur.2023.1227374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/28/2023] [Indexed: 08/05/2023] Open
Abstract
Balance impairment is frequent in people with multiple sclerosis (pwMS) and affects risk of falls and quality of life. By using inertial measurement units (IMUs) on the Single Leg Stance Test (SLS) we aimed to discriminate healthy controls (HC) from pwMS and detect differences in balance endurance and quality. Thirdly, we wanted to test the correlation between instrumented SLS parameters and self-reported measures of gait and balance. Fifty-five pwMS with mild (EDSS<4) and moderate disability (EDSS≥4) and 20 HC performed the SLS with 3 IMUs placed on the feet and sacrum and filled the Twelve Item Multiple Sclerosis Walking Scale (MSWS-12) questionnaire. A linear mixed model was used to compare differences in the automated balance measures. Balance duration was significantly longer in HC compared to pwMS (p < 0.001) and between the two disability groups (p < 0.001). Instrumented measures identified that trunk stability (normalized mediolateral and antero-posterior center of mass stability) had the strongest association with disability (R2 marginal 0.30, p < 0.001) and correlated well with MSWS-12 (R = 0.650, p < 0.001). PwMS tended to overestimate own balance compared to measured balance duration. The use of both self-reported and objective assessments from IMUs can secure the follow-up of balance in pwMS.
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Affiliation(s)
- Pål Berg-Hansen
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | | | | | - Victor Gonzalez
- SINTEF Digital, Smart Sensor and Micro Systems, Oslo, Norway
| | | | - Elisabeth Gulowsen Celius
- Department of Neurology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Frédéric Meyer
- Department of Informatics, University of Oslo, Oslo, Norway
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22
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Abou L, Rice LA. Frequency and characteristics of falls, fall-related injuries, and fear of falling among wheelchair users with spinal cord injury. J Spinal Cord Med 2023; 46:560-568. [PMID: 35943367 PMCID: PMC10274528 DOI: 10.1080/10790268.2022.2097995] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
CONTEXT/OBJECTIVE To investigate the frequency and characteristics of falls, fall-related injuries, and fear of falling (FOF) among non-ambulatory individuals with spinal cord injury (SCI). METHODS This is a cross-sectional study design that included 59 non-ambulatory individuals with SCI. Participants completed a survey on demographics, SCI characteristics (type of injury, level of injury, and time since injury), FOF, activities curtailment due to FOF, and frequency of falls and fall-related injuries in the past 6 months. Characteristics of the most recent falls and fall-related injuries were also collected. A directed content analysis was used to analyze qualitative data. RESULTS Overall, 63% of the study participants reported falling at least once, 46.7% reported injuries after falls, and 73% reported FOF during the previous 6 months. Participants commonly reported falling inside of the house (74.6%), during transfers (43.2%), and associated with obstacles on the way (54.5%) or surface conditions (36.4%). Almost half of the participants (42.3%) reported never received education on fall prevention from a healthcare professional. CONCLUSIONS The results confirm that falls, fall-related injuries, and FOF are a common concern in this population. These findings contribute to the knowledge base for the future development of fall prevention programs specific for non-ambulatory individuals with SCI.
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Affiliation(s)
- Libak Abou
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Laura A. Rice
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
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Jawad A, Baattaiah BA, Alharbi MD, Chevidikunnan MF, Khan F. Factors contributing to falls in people with multiple sclerosis: The exploration of the moderation and mediation effects. Mult Scler Relat Disord 2023; 76:104838. [PMID: 37390785 DOI: 10.1016/j.msard.2023.104838] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/12/2023] [Accepted: 06/14/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND The prevalence of multiple sclerosis (MS) has significantly increased in recent decades. People with MS have a high risk of falling; these falls may lead to serious injuries, affecting their quality of life PURPOSE: The aim of this study is to assess the factors affecting falls in people with MS and map out the most significant ones. This study also aims to determine whether fatigue has a moderation effect and balance has a mediation effect on falls in people with MS METHODS: In total, 103 people with MS with a mean age of 32.09 ± 7.17 were enrolled. All subjects were assessed for multiple variables including balance using the Berg Balance Scale (BBS), speed of gait using the Timed Up and Go (TUG) test, fear of falling using the Falls Efficacy Scale-International (FES-I), level of fatigue using the Modified Fatigue Impact Scale (MFIS), and lower limb muscle strength using a handheld digital dynamometer RESULTS: Simple binary logistic regression analysis showed significant results for BBS (OR: 10.88; 95% CI: 4.24-27.96; p < 0.0001), TUG (OR: 1.18; 95% CI: 1.09-1.28; p < 0.0001), FES-I (OR: 1.06; 95% CI: 1.02-1.10; p = 0.001), and MFIS (OR: 1.04; 95% CI: 1.02-1.07; p < 0.0001) as factors affecting falls. According to multivariate analysis, balance (OR: 3.924; 95% CI: 1.307-11.780, p = 0.015), speed of gait (OR: 1.122; 95% CI: 1.023-1.231; p = 0.015), and fatigue (OR: 1.029; 95% CI: 1.002-1.058; p = 0.038) were the strongest predicting factors of falls. Hayes's PROCESS analysis showed that fatigue had a significant moderation effect on the relationship between gait speed and falls (MFIS; β; 0.10; p < 0.0001; 95% CI: 0.07-0.14) and balance had a mediation effect on the relationship between gait speed and falls (BBS; indirect effect; 0.08; 95% CI: 0.02-0.13) CONCLUSIONS: People with MS with impaired balance, slower gait speeds, higher levels of fatigue, and a fear of falling were at a high risk of falling. The relationship between gait speed and falls can be mediated by impaired balance and moderated by the level of fatigue. Our data suggest that targeting balance and fatigue while developing rehabilitation interventions could decrease the incidence of falls among people with MS.
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Affiliation(s)
- Adel Jawad
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia; Department of Physical Therapy, King Fahad Hospital, Jeddah, Saudi Arabia
| | - Baian A Baattaiah
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia
| | - Mutasim D Alharbi
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia
| | - Mohamed Faisal Chevidikunnan
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia
| | - Fayaz Khan
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia.
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Dogruoz Karatekin B, İcagasioglu A, Pasin O. Validity, reliability and minimal detectable change of Mini-BESTest Turkish version in neurological disorders. Acta Neurol Belg 2023:10.1007/s13760-023-02299-7. [PMID: 37326807 DOI: 10.1007/s13760-023-02299-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 05/31/2023] [Indexed: 06/17/2023]
Abstract
AIMS It is aimed to investigate the psychometric properties of Mini-BESTestTR in Turkish patients with neurological disorders. METHODS A total of 61 people between the ages of 42 and 80, who were patients with Parkinson's disease, stroke or multiple sclerosis for more than 1 year, were included in the study. For inter-rater reliability, two independent researchers applied the scale two times within 5 days for test-retest reliability. The relationship of mini-BESTestTR with Berg Balance Scale (BBS) to assess concurrent validity, and Timed Get up and Go (TUG), Functional Reach Test (FRT) and Functional Ambulation Classification (FAC) for convergent validity was investigated. RESULTS The scores of the two evaluators were within the range of agreement (mean = - 0.278 ± 1.484, p > 0.05), and the Mini-BESTestTR had excellent inter-rater reliability [ICC (95% CI) = 0.989 (0.981-0.993)] and test-retest reliability [ICC (95% CI) = 0.998 (0.996-0.999)]. Mini-BESTestTR had a strong correlation with BBS (r = 0.853, p < 0.001) and TUG (r = - 0.856, p < 0.001), had a moderate correlation with FAC (r = 0.696, p < 0.001) and FRT (r = 0.650, p < 0.001). CONCLUSIONS Mini-BESTestTR showed significant correlations with other balance assessment measures, and concurrent and convergent validity of Mini-BESTestTR was demonstrated when administered to a sample of patients with chronic stroke, Parkinson's disease and multiple sclerosis.
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Affiliation(s)
- Bilinc Dogruoz Karatekin
- Physical Medicine and Rehabilitation Clinic, Goztepe Prof Dr Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Kadıköy, 34730, Istanbul, Turkey.
| | - Afitap İcagasioglu
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ozge Pasin
- Department of Biostatistics, Faculty of Medicine, Bezmialem Foundation University, Istanbul, Turkey
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25
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Kristensen NM, Taul-Madsen L, Gaemelke T, Riemenschneider M, Dalgas U, Hvid LG. Neuromuscular rate of force development discriminates fallers in ambulatory persons with multiple sclerosis - an exploratory study. Mult Scler Relat Disord 2023; 75:104758. [PMID: 37192588 DOI: 10.1016/j.msard.2023.104758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/18/2023] [Accepted: 05/09/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Falls as well as fall-related injuries (e.g., bone fractures) are common in persons with multiple sclerosis (pwMS). Whilst some studies have identified lower extremity maximal muscle strength (Fmax) as one among several risk factors, no previous studies have investigated the association between rate of force development (RFD; ability to generate a rapid rise in muscle force) and falls in pwMS. Not only is RFD substantially compromised (and more so than Fmax) in pwMS, studies involving other neurodegenerative populations have shown that RFD - to a greater extent than Fmax - is crucial for counteracting unexpected perturbations and avoiding falling. OBJECTIVE To explore whether knee extensor RFD (and Fmax) can discriminate fallers from non-fallers in pwMS. METHODS Knee extensor neuromuscular function (comprising RFD50ms and RFD200ms (force developed in the interval 0-50 ms and 0-200 ms, respectively) as well as Fmax) of the weaker leg was assessed by isokinetic dynamometry. Falls were determined by 1-year patient recall, with pwMS subsequently being classified as non-fallers (0 falls), fallers (1-2 falls), or recurrent fallers (≥3 falls). RESULTS A total of n=53 pwMS were enrolled in the study, with n=24 classified as non-fallers (63% females, 48 years, EDSS 2.2), n=16 as fallers (88% females, 57 years, EDSS 3.3), and n=13 as recurrent fallers (46% females, 60 years, EDSS 4.2). Compared with non-fallers, neuromuscular function was reduced in both fallers (RFD50 -4.42 [-7.47;-1.37] Nm.s-1.kg-1, -48%; RFD200 -1.45 [-2.98;0.07] Nm.s-1.kg-1, -24%; Fmax -0.42 [-0.81;-0.03] Nm.kg-1, -21%) and recurrent fallers (RFD50 -5.69 [-8.94;-2.43] Nm.s-1.kg-1, -62%; RFD200 -2.26 [-3.89;-0.63] Nm.s-1.kg-1, -38%; Fmax -0.38 [-0.80;0.03] Nm.kg-1, -19%). Across all participants, associations were observed between RFD50ms and falls (rs = -0.46 [-0.67;-0.24], between RFD200ms and falls (rs = -0.34 [-0.59;-0.09]), and between Fmax and falls (rs = -0.24 [-0.48;0.01]). CONCLUSION In this exploratory study, knee extensor neuromuscular function was able to discriminate fallers from non-fallers in pwMS, with RFD being superior to Fmax. Routine assessment of lower extremity neuromuscular function (RFD50ms in particular) may be a helpful tool in identifying pwMS at future risk of falling.
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Affiliation(s)
- Nick M Kristensen
- Exercise Biology, Department of Public Health, Aarhus University, Denmark
| | | | - Tobias Gaemelke
- Exercise Biology, Department of Public Health, Aarhus University, Denmark
| | - Morten Riemenschneider
- Exercise Biology, Department of Public Health, Aarhus University, Denmark; The Danish MS Hospitals, Ry and Haslev, Denmark
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Denmark
| | - Lars G Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Denmark; The Danish MS Hospitals, Ry and Haslev, Denmark.
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26
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Bae M, Kasser SL. High intensity exercise training on functional outcomes in persons with multiple sclerosis: A systematic review. Mult Scler Relat Disord 2023; 75:104748. [PMID: 37178578 DOI: 10.1016/j.msard.2023.104748] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/23/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND There is growing interest and evidence for high intensity training (HIT) in clinical populations, including persons with multiple sclerosis (MS). While HIT has been shown to be a safe modality in this group, it is still unclear what collective knowledge exists for HIT on functional outcomes. This study examined HIT modalities (e.g., aerobic, resistance, functional training) on functional outcomes such as walking, balance, postural control, and mobility in persons with MS. METHODS High intensity training studies, including RCTs and non-RCTs, that targeted functional outcomes in persons with MS were included in the review. A literature search was conducted in MEDLINE, EMBASE, PsycINFO, SPORTSDiscus, and CINAHL in April 2022. Other literature search methods were performed via website and citation searching. The methodological quality of included studies was assessed by TESTEX for RCTs and ROBINS-I for non-RCTs. This review synthesized the following data: study design and characteristics, participant characteristics, intervention characteristics, outcome measures, and effect sizes. RESULTS Thirteen studies (6 RCTs and 7 non-RCTs) were included in the systematic review. The included participants (N = 375) had varying functional levels (EDSS range: 0-6.5) and phenotypes (relapsing remitting, secondary progressive, primary progressive). HIT modalities involving high intensity aerobic training (n = 4), high intensity resistance training (n = 7), and high intensity functional training (n = 2), revealed a significant and consistent benefit on walking speed and walking endurance in response to HIT, while the evidence regarding balance and mobility improvement was less clear. CONCLUSION Persons with MS can successfully tolerate and adhere to HIT. While HIT appears to be an effective modality for improving some functional outcomes, the heterogeneous testing protocols, HIT modalities, and exercise doses among the studies preclude any conclusive evidence for its effectiveness thus necessitating future inquiry.
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Affiliation(s)
- Myeongjin Bae
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, USA
| | - Susan L Kasser
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, USA.
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Meyer BM, Cohen JG, Donahue N, Fox SR, O'Leary A, Brown AJ, Leahy C, VanDyk T, DePetrillo P, Ceruolo M, Cheney N, Solomon AJ, McGinnis RS. Chest-Based Wearables and Individualized Distributions for Assessing Postural Sway in Persons With Multiple Sclerosis. IEEE Trans Neural Syst Rehabil Eng 2023; 31:2132-2139. [PMID: 37067975 PMCID: PMC10408383 DOI: 10.1109/tnsre.2023.3267807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Typical assessments of balance impairment are subjective or require data from cumbersome and expensive force platforms. Researchers have utilized lower back (sacrum) accelerometers to enable more accessible, objective measurement of postural sway for use in balance assessment. However, new sensor patches are broadly being deployed on the chest for cardiac monitoring, opening a need to determine if measurements from these devices can similarly inform balance assessment. Our aim in this work is to validate postural sway measurements from a chest accelerometer. To establish concurrent validity, we considered data from 16 persons with multiple sclerosis (PwMS) asked to stand on a force platform while also wearing sensor patches on the sacrum and chest. We found five of 15 postural sway features derived from the chest and sacrum were significantly correlated with force platform-derived features, which is in line with prior sacrum-derived findings. Clinical significance was established using a sample of 39 PwMS who performed eyes-open, eyes-closed, and tandem standing tasks. This cohort was stratified by fall status and completed several patient-reported measures (PRM) of balance and mobility impairment. We also compared sway features derived from a single 30-second period to those derived from a one-minute period with a sliding window to create individualized distributions of each postural sway feature (ID method). We find traditional computation of sway features from the chest is sensitive to changes in PRMs and task differences. Distribution characteristics from the ID method establish additional relationships with PRMs, detect differences in more tasks, and distinguish between fall status groups. Overall, the chest was found to be a valid location to monitor postural sway and we recommend utilizing the ID method over single-observation analyses.
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Cortés-Pérez I, Osuna-Pérez MC, Montoro-Cárdenas D, Lomas-Vega R, Obrero-Gaitán E, Nieto-Escamez FA. Virtual reality-based therapy improves balance and reduces fear of falling in patients with multiple sclerosis. a systematic review and meta-analysis of randomized controlled trials. J Neuroeng Rehabil 2023; 20:42. [PMID: 37041557 PMCID: PMC10088228 DOI: 10.1186/s12984-023-01174-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/03/2023] [Indexed: 04/13/2023] Open
Abstract
OBJECTIVE This study aims to conduct a meta-analysis to assess the effect of virtual reality-based therapy (VRBT) on balance dimensions and fear of falling in patients with multiple sclerosis (PwMS). Secondarily, to determine the most recommendable dose of VRBT to improve balance. METHODS PubMed Medline, Web of Science, Scopus, CINAHL and PEDro were screened, without publication date restrictions, until September 30th, 2021. Randomized controlled trials (RCTs) comparing the effectiveness of VRBT against other interventions in PwMS were included. Functional and dynamic balance, confidence of balance, postural control in posturography, fear of falling and gait speed were the variables assessed. A meta-analysis was performed by pooling the Cohen's standardized mean difference (SMD) with 95% confidence interval (95% CI) using Comprehensive Meta-Analysis 3.0. RESULTS Nineteen RCTs, reporting 858 PwMS, were included. Our findings reported that VRBT is effective in improving functional balance (SMD = 0.8; 95%CI 0.47 to 1.14; p < 0.001); dynamic balance (SMD = - 0.3; 95%CI - 0.48 to - 0.11; p = 0.002); postural control with posturography (SMD = - 0.54; 95%CI - 0.99 to - 0.1; p = 0.017); confidence of balance (SMD = 0.43; 95%CI 0.15 to 0.71; p = 0.003); and in reducing fear of falling (SMD = - 1.04; 95%CI - 2 to - 0.07; p = 0.035); but not on gait speed (SMD = - 0.11; 95%CI: - 0.35 to 0.14; p = 0.4). Besides, the most adequate dose of VRBT to achieve the greatest improvement in functional balance was at least 40 sessions, five sessions per week and 40-45 min per sessions; and for dynamic balance, it would be between 8 and 19 weeks, twice a week and 20-30 min per session. CONCLUSION VRBT may have a short-term beneficial role in improving balance and reducing fear of falling in PwMS.
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Affiliation(s)
- Irene Cortés-Pérez
- Department of Health Sciences, University of Jaén, Campus Las Lagunillas, s/n, Jaén, Spain
| | | | | | - Rafael Lomas-Vega
- Department of Health Sciences, University of Jaén, Campus Las Lagunillas, s/n, Jaén, Spain
| | - Esteban Obrero-Gaitán
- Department of Health Sciences, University of Jaén, Campus Las Lagunillas, s/n, Jaén, Spain.
| | - Francisco Antonio Nieto-Escamez
- Center for Neuropsychological Assessment and Neurorehabilitation (CERNEP), University of Almería, Almería, Spain
- Department of Psychology, University of Almería, Ctra. Sacramento, s/n, La Cañada, Almería, Spain
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Zanotto T, Sosnoff JJ, Backus D, Yarnot R, Worikat NA, Abou L, Peterson EW, Rice LA. Characteristics and consequences of falls among people with multiple sclerosis who use wheelchairs or scooters: Differences between injurious and non-injurious falls. Mult Scler Relat Disord 2023; 73:104631. [PMID: 36963170 DOI: 10.1016/j.msard.2023.104631] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/03/2023] [Accepted: 03/19/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Falls are common among people living with multiple sclerosis (MS) who use wheelchairs or scooters. Falls may lead to severe consequences including physical injuries. However, very little is known about the circumstances associated with injurious falls in this population. Therefore, we aimed to explore the differences in fall-related characteristics between injurious and non-injurious falls among people with MS who use wheelchairs or scooters. METHODS A convenience sample of 48 people with MS (age = 62.0 [13.0] years, gender = 81.3% female, primary mobility aid = power wheelchair) completed a fall-history survey that examined the characteristics and consequences of their most recent fall. Participants also completed standard questionnaires on quality of life, community participation, and fear of falling. RESULTS Most falls (85.4%) reported by participants occurred inside the house. Twelve (25.0%) participants reported experiencing fall-related injuries such as bruises, cuts, muscle strains, and fractures. People who reported being injured after a fall had a higher proportion of falls that occurred during transfers compared to those who were not injured (n = 10, 83.3% vs n = 17, 47.2%). Most participants (45.8%) did not receive any information from healthcare professionals on how to manage their fall-risk after their fall experience. No differences between injurious and non-injurious fallers in quality of life, community participation, and fear of falling were observed. CONCLUSIONS This cross-sectional investigation provides compelling evidence that people with MS who use wheelchairs or scooters are at high risk of fall-related injuries. The study findings underscore the importance of increasing health care providers' awareness about the frequency and consequences of falls. Further, it demonstrates the critical need for evidence-based interventions specifically designed to minimize fall-related injuries in this vulnerable population.
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Affiliation(s)
- Tobia Zanotto
- Department of Occupational Therapy Education, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA; Mobility Core, University of Kansas Center for Community Access, Rehabilitation Research, Education and Service, Kansas City, KS, USA.
| | - Jacob J Sosnoff
- Mobility Core, University of Kansas Center for Community Access, Rehabilitation Research, Education and Service, Kansas City, KS, USA; Department of Physical Therapy, Rehabilitation Science, and Athletic Training, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA; MS Research Collaborative, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Deborah Backus
- Crawford Research Institute, Shepherd Center, Atlanta, GA, USA
| | - Rebecca Yarnot
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Nida' Al Worikat
- Department of Occupational Therapy Education, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA
| | - Libak Abou
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Elizabeth W Peterson
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Laura A Rice
- MS Research Collaborative, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA; Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA; Center on Health, Aging and Disability, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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30
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Tuvemo Johnson S, Flink M, Peterson E, Gottberg K, Elf M, Johansson S, Kierkegaard M, Ytterberg C. Self-management of falls in people with multiple sclerosis: A scoping review. Clin Rehabil 2023; 37:162-176. [PMID: 36177511 PMCID: PMC9772893 DOI: 10.1177/02692155221128723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Falls are common in people with multiple sclerosis. There is rising interest in how the multifactorial and chronic nature of fall risk among people with multiple sclerosis can be addressed through self-management. Thus, the aims were to investigate the extent and the scope of publications on self-management of falls in people with multiple sclerosis, and to identify how the concept of self-management was defined and used. DATA SOURCES A systematic literature search in Medline, Cochrane, Web of Science and PsycInfo was conducted to identify publications until July 2022. REVIEW METHODS Published methodological guidance was followed. Articles targeting: (1) people with multiple sclerosis, (2) falls, and (3) self-management were selected. Of 1656 records, 203 publications were assessed for eligibility, of which 173 did not meet the inclusion criteria, and 16 publications did not contain empirical data. The type of publication, study focus, and study design was extracted. If applicable, key findings, self-management tasks and skills, and the definition of self-management were extracted. RESULTS Fourteen original articles met all inclusion criteria. Ten articles represented six different fall prevention interventions. Three publications were randomized controlled trials. Self-management content was variable and not comprehensive in nature. None of the 14 publications included a self-management definition. CONCLUSION The limited number of original articles and the even fewer intervention studies show that the research on self-management of falls in people with multiple sclerosis is in its infancy. To progress in the research area of self-management of falls, a more robust, consensus-based description of self-management frameworks and activities is needed.
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Affiliation(s)
- Susanna Tuvemo Johnson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden,Susanna Tuvemo Johnson, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Alfred Nobells allé 23, S-14183 Huddinge, Sweden.
| | - Maria Flink
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden,Women’s Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Elizabeth Peterson
- Department of Occupational Therapy, University of Illinois, Chicago, IL, USA
| | - Kristina Gottberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Marie Elf
- School of Education and Learning, Dalarna University, Falun, Sweden
| | - Sverker Johansson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden,Women’s Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Marie Kierkegaard
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden,Academic Specialist Center, Center of Neurology, Stockholm Health Services, Stockholm, Sweden
| | - Charlotte Ytterberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden,Women’s Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
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31
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Edwards EM, Stanley JA, Daugherty AM, Lynn J, Borich MR, Fritz NE. Associations between myelin water imaging and measures of fall risk and functional mobility in multiple sclerosis. J Neuroimaging 2023; 33:94-101. [PMID: 36266780 DOI: 10.1111/jon.13064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/26/2022] [Accepted: 10/08/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND AND PURPOSE Myelin water fraction (MWF) deficits as measured by myelin water imaging (MWI) have been related to worse motor function in persons with multiple sclerosis (PwMS). However, it is unknown if measures from MWI metrics in motor areas relate to fall risk measures in PwMS. The objective of this study was to examine the relationship between MWI measures in motor areas to performance on clinical measures of fall risk and disability in PwMS. METHODS Sixteen individuals with relapsing-remitting MS participated (1 male, 15 female; age 47.1 years [12.3]; Expanded Disability Status Scale 4.0 [range 0-6.5]) and completed measures of walking and fall risk (Timed 25 Foot Walk [T25FW] and Timed Up and Go). MWF and the geometric mean of the intra-/extracellular water T2 (geomT2IEW ) values reflecting myelin content and contribution of large-diameter axons/density, respectively, were assessed in three motor-related regions. RESULTS The geomT2IEW of the corticospinal tract (r = -.599; p = .018) and superior cerebellar peduncles (r = -.613; p = .015) demonstrated significant inverse relationships with T25FW, suggesting that decreased geomT2IEW was related to slower walking. Though not significant, MWF in the corticospinal tract and superior cerebellar peduncles also demonstrated fair relationships with the T25FW, suggesting that worse performance on the T25FW was associated with lower MWF values. CONCLUSIONS MWI of key motor regions was associated with walking performance in PwMS. Further MWI studies are needed to identify relationships between pathology and clinical function in PwMS to guide targeted rehabilitation therapies aimed at preventing falls.
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Affiliation(s)
- Erin M Edwards
- Translational Neuroscience Program, Wayne State University, Detroit, Michigan, USA.,Neuroimaging and Neurorehabilitation Laboratory, Wayne State University, Detroit, Michigan, USA
| | - Jeffrey A Stanley
- Translational Neuroscience Program, Wayne State University, Detroit, Michigan, USA.,Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan, USA
| | - Ana M Daugherty
- Department of Psychology, Wayne State University, Detroit, Michigan, USA.,Institute of Gerontology, Wayne State University, Detroit, Michigan, USA
| | - Jonathan Lynn
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan, USA
| | - Michael R Borich
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nora E Fritz
- Translational Neuroscience Program, Wayne State University, Detroit, Michigan, USA.,Neuroimaging and Neurorehabilitation Laboratory, Wayne State University, Detroit, Michigan, USA.,Department of Health Care Sciences, Wayne State University, Detroit, Michigan, USA.,Department of Neurology, Wayne State University, Detroit, Michigan, USA
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32
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Wochatz M, Schraplau A, Engel T, Zecher MM, Sharon H, Alt Y, Mayer F, Kalron A. Application of eccentric training in various clinical populations: Protocol for a multi-centered pilot and feasibility study in people with low back pain and people with multiple sclerosis. PLoS One 2022; 17:e0270875. [PMID: 36548298 PMCID: PMC9779041 DOI: 10.1371/journal.pone.0270875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 05/25/2022] [Indexed: 12/24/2022] Open
Abstract
Physical activity and exercise are effective approaches in prevention and therapy of multiple diseases. Although the specific characteristics of lengthening contractions have the potential to be beneficial in many clinical conditions, eccentric training is not commonly used in clinical populations with metabolic, orthopaedic, or neurologic conditions. The purpose of this pilot study is to investigate the feasibility, functional benefits, and systemic responses of an eccentric exercise program focused on the trunk and lower extremities in people with low back pain (LBP) and multiple sclerosis (MS). A six-week eccentric training program with three weekly sessions is performed by people with LBP and MS. The program consists of ten exercises addressing strength of the trunk and lower extremities. The study follows a four-group design (N = 12 per group) in two study centers (Israel and Germany): three groups perform the eccentric training program: A) control group (healthy, asymptomatic); B) people with LBP; C) people with MS; group D (people with MS) receives standard care physiotherapy. Baseline measurements are conducted before first training, post-measurement takes place after the last session both comprise blood sampling, self-reported questionnaires, mobility, balance, and strength testing. The feasibility of the eccentric training program will be evaluated using quantitative and qualitative measures related to the study process, compliance and adherence, safety, and overall program assessment. For preliminary assessment of potential intervention effects, surrogate parameters related to mobility, postural control, muscle strength and systemic effects are assessed. The presented study will add knowledge regarding safety, feasibility, and initial effects of eccentric training in people with orthopaedic and neurological conditions. The simple exercises, that are easily modifiable in complexity and intensity, are likely beneficial to other populations. Thus, multiple applications and implementation pathways for the herein presented training program are conceivable. Trial registration: DRKS00020483 (DRKS, German Clinical Trials Register; 24th January 2020 -retrospectively registered; https://www.drks.de/DRKS00020483).
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Affiliation(s)
- Monique Wochatz
- University of Potsdam, University Outpatient Clinic, Sports Medicine and Sports Orthopaedics, Potsdam, Germany
| | - Anne Schraplau
- University of Potsdam, University Outpatient Clinic, Sports Medicine and Sports Orthopaedics, Potsdam, Germany
- Faculty of Health Sciences, Joint Faculty of the University of Potsdam, The Brandenburg Medical School Theodor Fontane and the Brandenburg University of Technology, Cottbus, Senftenberg, Germany
| | - Tilman Engel
- University of Potsdam, University Outpatient Clinic, Sports Medicine and Sports Orthopaedics, Potsdam, Germany
| | - Mahli M. Zecher
- University of Potsdam, University Outpatient Clinic, Sports Medicine and Sports Orthopaedics, Potsdam, Germany
| | - Hadar Sharon
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Yasmin Alt
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Frank Mayer
- University of Potsdam, University Outpatient Clinic, Sports Medicine and Sports Orthopaedics, Potsdam, Germany
| | - Alon Kalron
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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33
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VanNostrand M, Sogoloff B, Giroux C, Bergmans L, Kasser SL. Predicting falls in adults with multiple sclerosis using patient-reported measures: Are perceptions of dual-tasking missing? Mult Scler Relat Disord 2022; 68:104115. [PMID: 36057172 DOI: 10.1016/j.msard.2022.104115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 07/15/2022] [Accepted: 08/13/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Mobility challenges and cognitive impairments prominent in adults with multiple sclerosis (MS) significantly increase the risk of falling. Examining perceptions of how the simultaneous performance of completing motor and cognitive tasks impacts fall risk may have clinical utility. The purpose of this study was to identify the most significant self-reported predictors of falling including perceived dual-tasking. METHODS Participants included 79 individuals with MS were surveyed and reported their fall history over the previous 3 months and completed the Multiple Sclerosis Walking Scale -12 (MSWS-12), Modified Fatigue Impact Scale (MFIS), Falls Efficacy Scale International (FES-I), and two Dual-Task Questionnaires (DTQ), a previously published original one and a newly expanded version. RESULTS Of the sample, 63 were classified as non-fallers and 16 as fallers. Backward stepwise regression analysis revealed that perceived ambulation disability and dual-tasking best predicted fall status (sensitivity of 57.7%, specificity of 90.6%, area under the receiving operating curve of 0.81 (95% CI 0.70-0.92). CONCLUSION The inclusion of self-reported dual-tasking perceptions has utility in predicting fall risk. Effective assessment toward this end offers the potential for early detection and intervention.
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Affiliation(s)
- Michael VanNostrand
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, United States of America
| | - Barbara Sogoloff
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, United States of America
| | - Carley Giroux
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, United States of America
| | - Lance Bergmans
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, United States of America
| | - Susan L Kasser
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, United States of America.
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Abou L, Peters J, Fritz NE, Sosnoff JJ, Kratz AL. Motor Cognitive Dual-Task Testing to Predict Future Falls in Multiple Sclerosis: A Systematic Review. Neurorehabil Neural Repair 2022; 36:757-769. [PMID: 36320121 DOI: 10.1177/15459683221131791] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND Mobility and cognitive impairments are often associated with increased fall risk among people with multiple sclerosis (PwMS). However, evidence on the concurrent assessment of gait or balance and cognitive tasks (dual-task) to predict falls appears to be inconsistent. OBJECTIVE To summarize the ability of gait or balance dual-task testing to predict future falls among PwMS. METHODS Seven databases including PubMed, Embase, Web of Science, Scopus, CINHAL, SPORTDiscuss, and PsycINFO were searched from inception to May 2022. Two independent reviewers identified studies that performed a dual-task testing among adults with multiple sclerosis and monitored falls prospectively for at least 3 months. Both reviewers also evaluated the quality assessment of the included studies. RESULTS Eight studies with 484 participants were included in the review. Most studies (75%) indicated that dual-task testing and dual-task cost did not discriminate prospective fallers (⩾1 fall) and non-fallers (0 fall) and were not found as predictors of future falls. However, dual-task cost of walking velocity (OR = 1.23, 95% CI 0.98-4.45, P = .05) and dual-task of correct response rate of serial 7 subtraction (OR = 1.34, 95% CI 1.04-3.74, P = .02) were significantly associated with increased risk of recurrent falls (≥2 falls). Pattern of cognitive-motor interference was also associated with an increased risk of falling. All studies presented with strong quality. CONCLUSION The scarce evidence indicates that dual-task testing is not able to predict future falls among PwMS. Further research with more complex motor and cognitive tasks and longer-term fall monitoring is required before dual-task testing can be recommended as a predictor of future falls in this population.
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Affiliation(s)
- Libak Abou
- Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Joseph Peters
- Department of Kinesiology & Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA.,Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Nora E Fritz
- Departments of Health Care Sciences & Neurology, Wayne State University, Detroit, MI, USA
| | - Jacob J Sosnoff
- Department of Physical Therapy, Rehabilitation Science, & Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
| | - Anna L Kratz
- Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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Ross BJ, Ross AJ, Lee OC, Waters TL, Familia MM, Sherman WF. Osteoporosis management and secondary fragility fracture rates in patients with multiple sclerosis: a matched cohort study. Osteoporos Int 2022; 33:1999-2010. [PMID: 35670832 DOI: 10.1007/s00198-022-06451-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 05/24/2022] [Indexed: 12/21/2022]
Abstract
UNLABELLED This study highlights the persistent osteoporosis treatment gap following fragility fractures. Patients with multiple sclerosis sustained more primary hip fractures than controls and exhibited significantly higher rates of falls within three years post-fracture. However, multiple sclerosis (MS) patients were significantly more likely to be diagnosed with osteoporosis and treated with medications. INTRODUCTION The purpose of this study was to compare rates of osteoporosis management, falls, and secondary fractures following primary fragility fractures among patients with MS versus matched controls. MATERIALS AND METHODS A retrospective matched cohort study was conducted using the PearlDiver database. Patients aged ≥ 50 years with primary fragility fractures were identified (n = 120,368). Within this population, patients with MS were matched 1:10 with controls across age, sex, and US region. Rates of osteoporosis diagnoses and pharmacologic treatment, low-energy falls, and secondary fragility fractures were compared at three years post-fracture via logistic regression. RESULTS A total of 1,232 patients with MS (mean age, 65.7 years) with primary fragility fractures were matched with 12,320 controls (mean age, 65.8 years). Primary hip fractures were significantly more common in the MS cohort (47.4% vs. 34.2%, p < 0.001). After the initial fracture, patients with MS were significantly more likely to receive a formal osteoporosis diagnosis (12.9% vs. 9.7%; OR 1.35; 95% CI, 1.13-1.61) and osteoporosis pharmacotherapy (14.4% vs. 11.9%; OR 1.24; 95% CI, 1.04-1.46). The MS cohort also exhibited significantly higher rates of falls (27.8% vs 22.7%; OR 1.15; 95% CI, 1.01-1.32). Rates of secondary fractures were comparable (6.3% vs. 5.0%; OR 1.10; 95% CI, 0.85-1.40). CONCLUSION Primary hip fragility fractures were significantly more common in patients with MS compared to matched controls. Following an initial fracture, patients with MS exhibited a significantly higher rate of falls but were more likely to be diagnosed with osteoporosis and treated with medications.
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Affiliation(s)
- Bailey J Ross
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Austin J Ross
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Olivia C Lee
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Orthopaedic Surgery, LSUHSC School of Medicine, New Orleans, LA, USA
- Department of Orthopaedic Surgery, Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA
| | - Timothy L Waters
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - McCayn M Familia
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - William F Sherman
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
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Kierkegaard M, Peterson E, Tuvemo Johnson S, Gottberg K, Johansson S, Elf M, Flink M, Ytterberg C. Online self-management fall prevention intervention for people with multiple sclerosis: a feasibility study protocol of a parallel group randomised trial. BMJ Open 2022; 12:e061325. [PMID: 35803627 PMCID: PMC9272100 DOI: 10.1136/bmjopen-2022-061325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Falls among people with multiple sclerosis (PwMS) are common and associated with injuries, fear of falling and low health-related quality of life. Considerations of behavioural, environmental, psychological and physical influences (including ambulation status) are needed to meet fall prevention needs for PwMS. Thus, using a codesign process involving key stakeholders a novel online self-management fall prevention intervention was created specifically for ambulatory and non-ambulatory PwMS. The feasibility, acceptability, fidelity and outcome of this complex intervention will be explored. Findings will inform a future full-scale randomised controlled trial. METHODS AND ANALYSIS A mixed-method design will be used. Forty-eight PwMS, stratified for ambulation level, will be randomised to control (n=24) or intervention (n=24). Both groups will receive a brochure about fall risk factors and fall prevention. The intervention is group-based (eight PwMS in each group); will be delivered online; and involve six, 2-hour weekly sessions and a booster session 8 weeks after the sixth session. Each intervention group will be led by a trained facilitator. Data collection will be performed at baseline, and after seven and 18 weeks. Outcome measures will capture data on fall prevention behaviours, fear of falling, falls self-efficacy, social and everyday activities, perceived impact of MS and number of falls. Feasibility of recruitment process, data collection procedures, outcome measures, and delivery, and intervention acceptability, fidelity and outcomes will be evaluated. Both quantitative and qualitative methods will be used. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Swedish Ethical Review Authority (registration number 2021-04817). Results will be disseminated in peer-review journals, at conferences, research meetings, in social media and through the patient organisation Neuro Sweden. TRIAL REGISTRATION NUMBER NCT04317716.
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Affiliation(s)
- Marie Kierkegaard
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Academic Specialist Center, Region Stockholm, Stockholm, Sweden
| | - Elizabeth Peterson
- Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Susanna Tuvemo Johnson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Gottberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Sverker Johansson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Marie Elf
- School of Education and Learning, Dalarna University, Falun, Sweden
| | - Maria Flink
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Charlotte Ytterberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
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Ehsani F, Ahmadi M, Masoudian N, Jaberzadeh S. Priming of postural training with cerebellar anodal transcranial direct current stimulation for its effects on postural balance and fear of falling in patients with multiple sclerosis: A randomized, double-blind, sham-controlled study. J Clin Neurosci 2022; 99:294-301. [DOI: 10.1016/j.jocn.2022.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 02/14/2022] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
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Abou L, Rice LA. Risk factors associated with falls and fall-related injuries among wheelchair users with spinal cord injury. Arch Rehabil Res Clin Transl 2022; 4:100195. [PMID: 35756987 PMCID: PMC9214309 DOI: 10.1016/j.arrct.2022.100195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Shorter time since injury and higher mobility levels as well as poor physical health are associated with higher risk of falls and fall-related injuries, respectively in wheelchair users with spinal cord injury. The findings indicate good discriminant ability and clinical utility of the factors presented to identify wheelchair users who are at risk of falls and fall-related injuries.
Objective To identify risk factors for falls and fall-related injuries for wheelchair users with spinal cord injury (SCI). Design Cross-sectional study. Setting Community setting. Participants Fifty-nine community dwelling wheelchair users (N=59), 47.5% male, median age of 52.5 years (IQR, 21 years) with chronic SCI, median time since injury of 16.6 years (IQR, 27.3 years). Interventions No intervention. Main Outcome Measures Outcomes were incidence of falls and fall-related injuries. Participants reported on falls and fall-related injuries experienced in the previous 6 months. Independent variables were self-reported and performance-based measures. Self-reported measures included demographics, characteristics of SCI, fear of falling, psychological measures, functional independence, wheelchair skills, environmental barriers, quality of life, and community participation. Performance-based measures included transfer quality and sitting balance assessments. Logistic regression analyses were conducted to identify factors influencing falls and fall-related injuries. Results In total, 152 falls and 30 fall-related injuries were reported from a total of 37 fallers. After logistic regression analysis, the model with the greatest levels of clinical utility and discriminative ability for falls (sensitivity 81%; specificity 55%; area under the receiving operating characteristic curve [AUC] statistics=0.73; 95% CI, 0.60-0.86) included the variables of shorter time since SCI, high mobility level, and having received education on fall prevention. The model for fall-related injuries (sensitivity 79%; specificity 75%; AUC statistics=0.77; 95% CI, 0.59-0.96) included the variables of older male individual, lower physical health score, and having received education on fall prevention. Conclusions The regression models presented may be used to identify wheelchair users with SCI at greater risk of falls and fall-related injuries. The findings may help to refer those in need to tailored fall and fall-related injury prevention programs. The findings presented in this study were based on a relatively small sample convenience; therefore, further prospective studies with a larger sample size are warranted.
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Bilek F, Demir CF. Validity and reliability of the 3-meter backward walk test in mildly disabled persons with multiple sclerosis. Mult Scler Relat Disord 2022; 58:103532. [PMID: 35066275 DOI: 10.1016/j.msard.2022.103532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/12/2021] [Accepted: 01/14/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND One of the biggest problems for persons with Multiple Sclerosis (PwMS) is dizziness, poor posture, and balance problems that cause injury-causing falls. The aim of our study was to reveal the test-retest reliability and validity of the 3-Meter Backward Walk Test (3MBWT) in mildly disabled PwMS. METHODS This study included a total of 93 mildly disabled PwMS with mean EDSS of 1.89. 3MBWT, Functional Access Test (FRT), Dynamic Gait Index (DGI), Timed 25-Foot Walk (T25FW), and Timed-Up and Go (TUG) were applied to the patients. To measure test-retest reliability, a second evaluation was performed three days after the first evaluation. RESULTS Cronbach's alpha coefficient was found to be 0.998 (excellent). For intra-rater agreement, the ICC values in the individual test were 0.998. The SEM value was 0.18, the MDC value was found to be 0.50. A very strong correlation was revealed between the 3MBWT and FRT (r: -0.931, p: 0.001), TUG (r: 0.968, p: 0.001), T25FW (r: 0.879, p: 0.001), DGI (r: -0.871, p: 0.001) and falling history (r: 0.932, p: 0.001). CONCLUSION The 3MBWT was observed to be valid and reliable in mildly disabled PwMS. 3MBWT is an effective and reliable tool for measuring ability to walk backward in mildly disabled PwMS.
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Affiliation(s)
- Furkan Bilek
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Fırat University, Elazığ, Turkey.
| | - Caner Feyzi Demir
- Department of Neurology, Faculty of Medical, Fırat University, Elazığ, Turkey
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González LM, Ospina LN, Sperling LE, Chaparro O, Cucarián JD. Therapeutic Effects of Physical Exercise and the Mesenchymal Stem Cell Secretome by Modulating Neuroinflammatory Response in Multiple Sclerosis. Curr Stem Cell Res Ther 2021; 17:621-632. [PMID: 34886779 DOI: 10.2174/1574888x16666211209155333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/14/2021] [Accepted: 10/22/2021] [Indexed: 11/22/2022]
Abstract
Multiple sclerosis (MS) is a neurodegenerative, demyelinating, and chronic inflammatory disease characterized by central nervous system (CNS) lesions that lead to high levels of disability and severe physical and cognitive disturbances. Conventional therapies are not enough to control the neuroinflammatory process in MS and are not able to inhibit ongoing damage to the CNS. Thus, the secretome of mesenchymal stem cells (MSC-S) has been postulated as a potential therapy that could mitigate symptoms and disease progression. We considered that its combination with physical exercise (EX) could induce superior effects and increase the MSC-S effectiveness in this condition. Recent studies have revealed that both EX and MSC-S share similar mechanisms of action that mitigate auto-reactive T cell infiltration, regulate the local inflammatory response, modulate the proinflammatory profile of glial cells, and reduce neuronal damage. Clinical and experimental studies have reported that these treatments in an isolated way also improve myelination, regeneration, promote the release of neurotrophic factors, and increase the recruitment of endogenous stem cells. Together, these effects reduce disease progression and improve patient functionality. Despite these results, the combination of these methods has not yet been studied in MS. In this review, we focus on molecular elements and cellular responses induced by these treatments in a separate way, showing their beneficial effects in the control of symptoms and disease progression in MS, as well as indicating their contribution in clinical fields. In addition, we propose the combined use of EX and MSC-S as a strategy to boost their reparative and immunomodulatory effects in this condition, combining their benefits on synaptogenesis, neurogenesis, remyelination, and neuroinflammatory response. The findings here reported are based on the scientific evidence and our professional experience that will bring significant progress to regenerative medicine to deal with this condition.
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Affiliation(s)
- Lina María González
- Physiotherapy Program, School of Medicine and Health Sciences, Universidad del Rosario AK 24 #63c-69, Bogotá. Colombia
| | - Laura Natalia Ospina
- Physiotherapy Program, School of Medicine and Health Sciences, Universidad del Rosario AK 24 #63c-69, Bogotá. Colombia
| | - Laura Elena Sperling
- Faculty of Pharmacy & Fundamental Health Science Institute, Federal University of Rio Grande do Sul Rua Ramiro Barcelos, 2600-Prédio Anexo - Floresta, Porto Alegre. Brazil
| | - Orlando Chaparro
- Physiology Department, Faculty of Medicine, Universidad Nacional de Colombia Ak 30 #45-03, Bogotá. Colombia
| | - Jaison Daniel Cucarián
- Physiotherapy Program, School of Medicine and Health Sciences, Universidad del Rosario AK 24 #63c-69, Bogotá. Colombia
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Cameron MH, Hildebrand A, Hugos CL, Judd GI, McMillan G, Jacobs PG. Free From Falls education and exercise program for reducing falls in people with multiple sclerosis: A randomized controlled trial. Mult Scler 2021; 28:980-988. [PMID: 34595963 DOI: 10.1177/13524585211046898] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND People with multiple sclerosis (PwMS) fall frequently. Community-delivered exercise and education reduce falls in older adults, but their efficacy in multiple sclerosis (MS) is unknown. OBJECTIVES To evaluate the impact of the Free From Falls (FFF) group education and exercise program on falls in PwMS. METHODS This was a prospective, assessor-blinded, two-arm parallel randomized controlled trial. Ninety-six participants were randomized to FFF (eight weekly 2 hour sessions) or the control condition (a fall prevention brochure and informing their neurologist of their fall history). Participants counted falls prospectively from enrollment through 6 months following intervention. Effects on fall frequency were evaluated by the Bayesian analysis. RESULTS The modeled mean fall frequency pre-intervention was 1.2 falls/month in the FFF group (95% credible intervals (CIs) = 0.8-2.0) and 1.4 falls/month in the control group (95% CI = 0.9-2.1). Fall frequency decreased by 0.6 falls/month in both groups over time (nadir 4-6 months post-intervention: FFF 0.6 falls/month (95% CI = 0.4-0.9); control 0.8 falls/month (95% CI = 0.5-1.1)). CONCLUSION In-person group exercise and education are not superior to written education and neurologist-initiated interventions for preventing falls in PwMS.
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Affiliation(s)
- Michelle H Cameron
- Department of Neurology, Oregon Health & Science University, Veterans Affairs Portland Health Care System, 3710 SW US Veterans Hospital Road, Portland, OR 97239, USA.,Department of Neurology, Oregon Health & Science University, Veterans Affairs Portland Health Care System, Portland, OR, USA
| | - Andrea Hildebrand
- Department of Neurology, Oregon Health & Science University, Veterans Affairs Portland Health Care System, Portland, OR, USA
| | - Cinda L Hugos
- Department of Neurology, Oregon Health & Science University, Veterans Affairs Portland Health Care System, Portland, OR, USA
| | - Grace I Judd
- School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Garnett McMillan
- National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, Portland, OR, USA
| | - Peter G Jacobs
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
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Hildebrand A, Jacobs PG, Folsom JG, Mosquera-Lopez C, Wan E, Cameron MH. Comparing fall detection methods in people with multiple sclerosis: A prospective observational cohort study. Mult Scler Relat Disord 2021; 56:103270. [PMID: 34562766 DOI: 10.1016/j.msard.2021.103270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/06/2021] [Accepted: 09/16/2021] [Indexed: 12/01/2022]
Abstract
Background Falls occur across the population but are more common, and have more negative sequelae, in people with multiple sclerosis (MS). Given the prevalence and impact of falls, accurate measures of fall frequency are needed. This study compares the sensitivity and false discovery rates of three methods of fall detection: the current gold standard, prospective paper fall calendars, real-time self-reporting and automated detection, the latter two from a novel body-worn device. Methods Falls in twenty-five people with MS were recorded for eight weeks with prospective fall calendars, real-time body-worn self-report, and an automated body-worn detector concurrently. Eligible individuals were adults with MS enrolled in a randomized controlled trial of a fall prevention intervention. Entry criteria were at least two falls or near-falls in the previous two months, Expanded Disability Status Scale ≤ 6.0, community dwelling, and no MS relapse in the previous month. The sensitivity (proportion of true falls detected) and false discovery rates (proportion of false reports generated) of the fall detection methods were compared. A true fall was a fall reported by at least two methods. A false report was a fall reported by only one method. The trial is registered on ClinicalTrials.gov (NCT02583386) and is closed. Results In the 1,276 person-days of fall counting with all three methods in use simultaneously there were 1344 unique fall events. Of these, 8.5% (114) were true falls and 91.5% (1230) were false reports. Fall calendars had the lowest sensitivity (0.614) and the lowest false discovery rate (0.067). The automated detector had the highest sensitivity (0.921) and the highest false discovery rate (0.919). All methods generated under one false report per day. There were no fall detection-related adverse events. Conclusion Fall calendars likely underestimate fall frequency by around 40%. The automated detector evaluated here misses very few falls but likely overestimates the number of falls by around one fall per day. Additional research is needed to produce an ideal fall detection and counting method for use in clinical and research applications. Funding United States Department of Veterans Affairs, Rehabilitations Research and Development Service.
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Affiliation(s)
- Andrea Hildebrand
- Department of Neurology, VA Portland Health Care System, Oregon Health and Science University, 3710 SW US Veterans Hospital Rd., Mail Code P3MSCOE, Portland, OR 97239, United States.
| | - Peter G Jacobs
- Department of Biomedical Engineering, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Mail Code CH13B, Portland, OR 97239, United States
| | - Jonathon G Folsom
- Department of Biomedical Engineering, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Mail Code CH13B, Portland, OR 97239, United States
| | - Clara Mosquera-Lopez
- Department of Biomedical Engineering, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Mail Code CH13B, Portland, OR 97239, United States
| | - Eric Wan
- Department of Electrical and Computer Engineering, Portland State University, 1900 SW 4th Avenue, Portland, OR 97201, United States
| | - Michelle H Cameron
- Department of Neurology, VA Portland Health Care System, Oregon Health and Science University, 3710 SW US Veterans Hospital Rd., Mail Code P-3-NEU, Portland, OR 97239, United States
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Weed L, Little C, Kasser SL, McGinnis RS. A Preliminary Investigation of the Effects of Obstacle Negotiation and Turning on Gait Variability in Adults with Multiple Sclerosis. SENSORS (BASEL, SWITZERLAND) 2021; 21:5806. [PMID: 34502697 PMCID: PMC8434341 DOI: 10.3390/s21175806] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/23/2021] [Accepted: 08/27/2021] [Indexed: 11/16/2022]
Abstract
Many falls in persons with multiple sclerosis (PwMS) occur during daily activities such as negotiating obstacles or changing direction. While increased gait variability is a robust biomarker of fall risk in PwMS, gait variability in more ecologically related tasks is unclear. Here, the effects of turning and negotiating an obstacle on gait variability in PwMS were investigated. PwMS and matched healthy controls were instrumented with inertial measurement units on the feet, lumbar, and torso. Subjects completed a walk and turn (WT) with and without an obstacle crossing (OW). Each task was partitioned into pre-turn, post-turn, pre-obstacle, and post-obstacle phases for analysis. Spatial and temporal gait measures and measures of trunk rotation were captured for each phase of each task. In the WT condition, PwMS demonstrated significantly more variability in lumbar and trunk yaw range of motion and rate, lateral foot deviation, cadence, and step time after turning than before. In the OW condition, PwMS demonstrated significantly more variability in both spatial and temporal gait parameters in obstacle approach after turning compared to before turning. No significant differences in gait variability were observed after negotiating an obstacle, regardless of turning or not. Results suggest that the context of gait variability measurement is important. The increased number of variables impacted from turning and the influence of turning on obstacle negotiation suggest that varying tasks must be considered together rather than in isolation to obtain an informed understanding of gait variability that more closely resembles everyday walking.
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Affiliation(s)
- Lara Weed
- Department of Electrical and Biomedical Engineering, University of Vermont, Burlington, VT 05405, USA;
| | - Casey Little
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT 05405, USA; (C.L.); (S.L.K.)
| | - Susan L. Kasser
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT 05405, USA; (C.L.); (S.L.K.)
| | - Ryan S. McGinnis
- Department of Electrical and Biomedical Engineering, University of Vermont, Burlington, VT 05405, USA;
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Eskut N, Koc AM, Köskderelioglu A, Unsal Bilgin YO, Tekindal MA. Is there a relationship between fall status, cognition and cerebellar lobule volume in patients with multiple sclerosis? APPLIED NEUROPSYCHOLOGY-ADULT 2021:1-11. [PMID: 34410894 DOI: 10.1080/23279095.2021.1962881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In this prospective case control study, relationship of detailed cerebellar volumetric data and cognition in patients with multiple sclerosis considering falling status using 3 D MRI and network analysis were evaluated. Participants consist of 106 adults with relapsing-remitting multiple sclerosis. Scores of Montreal cognitive assessment test, symbol digit modality Test, nine-hole peg test, berg balance scale test, timed up and go test, timed 25-foot walk test were worse in faller group than non faller group (p < 0.05 for all tests). There was no significant difference in terms of cerebellar lobule volumes between groups. But using artificial intelligence (AI) based network analysis, we brought a new perspective to interpreting the relationship between the cerebellum, cognition, gait, and balance. Overall, data from the study suggest a possible relationship between cerebellar volume changes and cognitive dysfunction through connectivity analysis in patients with multiple sclerosis. Further studies are needed to examine this issue by using connectivity analysis.
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Affiliation(s)
- Neslihan Eskut
- Neurology, University of Health Sciences Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Ali Murat Koc
- Radiology, University of Health Sciences Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Asli Köskderelioglu
- Neurology, University of Health Sciences Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Yaprak Ozum Unsal Bilgin
- Neurology, University of Health Sciences Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
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Boughen K, Neil T, Dullemond S, Lutowicz K, Bilgasem A, Hastings T, Brooks D, Vaughan-Graham J. Cranial Nerve Noninvasive Neuromodulation in Adults With Neurological Conditions: Protocol for a Scoping Review. JMIR Res Protoc 2021; 10:e29965. [PMID: 34319251 PMCID: PMC8367107 DOI: 10.2196/29965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/15/2021] [Accepted: 06/15/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cranial nerve noninvasive neuromodulation (CN-NINM) via translingual nerve stimulation (TLNS) is a promising new intervention combined with neurological rehabilitation to improve outcomes for persons with neurological conditions. A portable neuromodulation stimulation (PoNS) device rests on the tongue and stimulates cranial nerves V and VII (trigeminal and facial nerves, respectively). Emerging evidence suggests that CN-NINM using the PoNS device, combined with targeted physical therapy, improves balance and gait outcomes but has not yet been comprehensively reviewed. OBJECTIVE This review will describe CN-NINM via TLNS and its applications, effects, and implications for rehabilitation science in adult populations with neurological conditions. We will identify how CN-NINM via TLNS is currently being incorporated into neurological rehabilitation and identify gaps in evidence with respect to this novel technology. METHODS Joanna Briggs Institute methodology will be used to conduct this scoping review. Electronic databases MEDLINE, AMED, CINAHL, Embase, and Web of Science will be searched, as well as gray literature databases ProQuest, DuckDuckGo, and Google. Studies published in English and French between 2000 and 2021 will be included. Two reviewers will independently screen all titles and abstracts and full-text papers that meet the inclusion criteria. Data will be extracted and collated in a table to synthesize the results. Extracted data will be reported in a comprehensive summary. RESULTS The final manuscript is intended for submission to an indexed journal in September 2021. CONCLUSIONS This scoping review will be the first, to our knowledge, to address the current evidence on CN-NINM. The results will inform the use of CN-NINM in neurological rehabilitation and the development of recommendations for future research. TRIAL REGISTRATION Open Science Framework 10.17605/OSF.IO/XZQFM; https://osf.io/xzqfm. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/29965.
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Affiliation(s)
- Keaton Boughen
- Physiotherapy Program, School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Tyler Neil
- Physiotherapy Program, School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Shayan Dullemond
- Physiotherapy Program, School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Kevin Lutowicz
- Physiotherapy Program, School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Ahmed Bilgasem
- Physiotherapy Program, School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Tyler Hastings
- Physiotherapy Program, School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Dina Brooks
- Physiotherapy Program, School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Julie Vaughan-Graham
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Fritz NE, Edwards EM, Keller J, Eloyan A, Calabresi PA, Zackowski KM. Combining Magnetization Transfer Ratio MRI and Quantitative Measures of Walking Improves the Identification of Fallers in MS. Brain Sci 2020; 10:E822. [PMID: 33171942 PMCID: PMC7694635 DOI: 10.3390/brainsci10110822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 10/27/2020] [Accepted: 11/04/2020] [Indexed: 12/22/2022] Open
Abstract
Multiple sclerosis (MS) impacts balance and walking function, resulting in accidental falls. History of falls and clinical assessment are commonly used for fall prediction, yet these measures have limited predictive validity. Falls are multifactorial; consideration of disease-specific pathology may be critical for improving fall prediction in MS. The objective of this study was to examine the predictive value of clinical measures (i.e., walking, strength, sensation) and corticospinal tract (CST) MRI measures, both discretely and combined, to fall status in MS. Twenty-nine individuals with relapsing-remitting MS (mean ± SD age: 48.7 ± 11.5 years; 17 females; Expanded Disability Status Scale (EDSS): 4.0 (range 1-6.5); symptom duration: 11.9 ± 8.7 years; 14 fallers) participated in a 3T brain MRI including diffusion tensor imaging and magnetization transfer ratio (MTR) and clinical tests of walking, strength, sensation and falls history. Clinical measures of walking were significantly associated with CST fractional anisotropy and MTR. A model including CST MTR, walk velocity and vibration sensation explained >31% of the variance in fall status (R2 = 0.3181) and accurately distinguished 73.8% fallers, which was superior to stand-alone models that included only MRI or clinical measures. This study advances the field by combining clinical and MRI measures to improve fall prediction accuracy in MS.
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Affiliation(s)
- Nora E. Fritz
- Center for Movement Studies, Kennedy Krieger Institute, Baltimore, MD 21205, USA; (J.K.); (K.M.Z.)
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA
- Program in Physical Therapy and Department of Neurology, Wayne State University, Detroit, MI 48201, USA
- Translational Neuroscience Program, Wayne State University, Detroit, MI 48201, USA;
| | - Erin M. Edwards
- Translational Neuroscience Program, Wayne State University, Detroit, MI 48201, USA;
| | - Jennifer Keller
- Center for Movement Studies, Kennedy Krieger Institute, Baltimore, MD 21205, USA; (J.K.); (K.M.Z.)
| | - Ani Eloyan
- Department of Biostatistics, Brown University, Providence, RI 02912, USA;
| | - Peter A. Calabresi
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA;
| | - Kathleen M. Zackowski
- Center for Movement Studies, Kennedy Krieger Institute, Baltimore, MD 21205, USA; (J.K.); (K.M.Z.)
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA;
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