The effect of tibialis anterior weakness on foot drop and toe clearance in patients with facioscapulohumeral dystrophy

BACKGROUND

Facioscapulohumeral dystrophy is a genetic disease characterized by progressive muscle weakness leading to a complex combination of postural instability, foot drop during swing and compensatory strategies during gait that have been related to an increased risk of falling. The aim is to assess the effect of tibialis anterior muscle weakness on foot drop and minimum toe clearance of patients with facioscapulohumeral dystrophy during gait.

METHODS

Eight patients allocated to a subgroup depending on the severity of tibialis anterior muscle weakness, assessed by manual muscle testing (i.e., severe and mild weakness), and eight matched control participants underwent gait analysis at self-selected walking speeds.

FINDINGS

Walking speed, for all facioscapulohumeral dystrophy patients, and step length, for patients with severe weakness only, were significantly decreased compared to control participants. Minimum toe clearance was similar across all groups, but its variability was increased only for patients with severe weakness. A greater foot drop was systematically observed for patients with severe weakness during swing and only in late swing for patients with mild weakness. Individual strategies to compensate for foot drop remain unclear and may depend on other muscle impairment variability.

INTERPRETATION

Although all patients were able to control the average height of their foot trajectory during swing, patients with severe tibialis anterior muscle weakness exhibited increased foot drop and minimum toe clearance variability. Manual muscle testing is a simple, cheap and effective method to assess tibialis anterior muscle weakness and seems promising to identify facioscapulohumeral dystrophy patients with an increased risk of tripping.

Impact of a Wearable Activity Tracker on Disease Flares in Spondyloarthritis: A Randomized Controlled Trial

OBJECTIVE

To evaluate the impact of a wearable activity tracker used to encourage physical activity, on disease flares in spondyloarthritis patients.

METHODS

This randomized controlled trial involved randomizing 108 spondyloarthritis patients into tracker and non-tracker groups. The participants were then subjected to assessments of disease activity, performance (6-Minute Walk Test), and quality of life (Short-Form-36 Health Survey Questionnaire) at the 12^th, 24^th, and 36^th week. The primary outcome of was the change in the frequency of flare episodes (categorized as no flare, flare in <3 days, and flare in >3 days) between baseline and 12 weeks.

RESULTS

The results of the study showed that at the 12^th week, the mean change (Δ) of the number of flares improved in both groups: -0.32 (95% confidence interval (CI) -0.66, 0.02) and -0.38 (95% CI -0.68, 60.09) in the tracker and non-tracker group, respectively. However, the between-group differences were insignificant (p=0.87). Performance scores improved in both groups at the 12^th, 24^th, and 36^th week (p<0.01, p<0.01, and p<0.01). The different dimensions of quality of life also improved at the 12^th week (p<0.01). Conversely, moderate flares (p<0.01) and performance (p<0.01) improved over time; however, the influence of a wearable activity tracker was not significant (p=0.29 and p=0.66, respectively).

CONCLUSION

The use of a wearable activity tracker did not affect the number of flares, performance, and quality of life of spondyloarthritis patients. Nevertheless, this study confirmed the benefits of physical activity on flares, disease activity, quality of life, and physical performance in spondyloarthritis patients.