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1.
Hilary Gunn Michelle Cameron Phu Hoang Stephen Lord Steve Shaw Jennifer Freeman 《Archives of physical medicine and rehabilitation》2018,99(10):2022-2029
Objective
This study evaluated the relationship between physiological and perceived fall risk in people with multiple sclerosis (MS).Design
Secondary analysis of data from prospective cohort studies undertaken in Australia, the United Kingdom, and the United States.Setting
Community.Participants
Ambulatory people with MS (N=416) (age 51.5±12.0 years; 73% female; 62% relapsing-remitting MS; 13.7±9.9 years disease duration).Interventions
Not applicable.Main Outcome Measures
All participants completed measures of physiological (Physiological Profile Assessment [PPA]) and perceived (Falls Efficacy Scale-international [FESi]) fall risk and prospectively recorded falls for 3 months.Results
155 (37%) of the participants were recurrent fallers (≥2 falls). Mean PPA and FESi scores were high (PPA 2.14±1.87, FESi 34.27±11.18). The PPA and the FESi independently predicted faller classification in logistic regression, which indicated that the odds of being classified as a recurrent faller significantly increased with increasing scores (PPA odds ratio [OR] 1.30 [95% CI 1.17-1.46], FESi OR 1.05 [95% CI 1.03-1.07]). Classification and regression tree analysis divided the sample into four groups based on cutoff values for the PPA: (1) low physiological/low perceived risk (PPA <2.83, FESi <27.5), (2) low physiological/high perceived risk (PPA <2.83, FESi >27.5), (3) high physiological/low perceived risk (PPA >2.83, FESi <35.5), and (4) high physiological/high perceived risk (PPA <2.83, FESi >35.5). Over 50% of participants had a disparity between perceived and physiological fall risk; most were in group 2. It is possible that physiological risk factors not detected by the PPA may also be influential.Conclusions
This study highlights the importance of considering both physiological and perceived fall risk in MS and the need for further research to explore the complex interrelationships of perceptual and physiological risk factors in this population. This study also supports the importance of developing behavioral and physical interventions that can be tailored to the individual’s needs. 相似文献2.
Alexander T. Peebles Adam P. Bruetsch Sharon G. Lynch Jessie M. Huisinga 《Archives of physical medicine and rehabilitation》2018,99(10):2030-2037
Objectives
To compare physiological impairments between persons with multiple sclerosis (MS) with a history of falls and persons with MS without a history of falls, and to investigate the association between physiological impairments and dynamic balance.Design
Cross-sectional study.Setting
University motion analysis laboratory.Participants
Persons with MS (N=55; 27 recurrent fallers and 28 nonfallers). Participants were classified as fallers if they self-reported ≥2 falls in the previous 6 months.Interventions
None.Main Outcome Measures
Physiological impairment was assessed with sensorimotor delays, spasticity, plantar cutaneous sensation, and the sensory, cerebellar, and pyramidal subscales of the Expanded Disability Status Scale (EDSS). Dynamic balance was assessed using the average and variability of margin of stability and variability of trunk accelerations.Results
Compared with nonfallers, fallers had lower plantar sensation, longer sensorimotor delays, more spasticity, and more impairment in the pyramidal and cerebellar subscales of the EDSS. Additionally, these impairments were all moderately to strongly correlated with worse dynamic balance.Conclusions
This study highlights the multifactorial nature of instability in persons with MS. A better understanding of the physiological mechanisms of dynamic instability in persons with MS can be used to improve methods of monitoring disease progression, identifying which impairments to target through interventions, and appropriately evaluating intervention efficacy. 相似文献3.
Thibaut Demaneuf Zoe Aitken Amalia Karahalios Teng Ieng Leong Alysha M. De Livera George A. Jelinek Tracey J. Weiland Claudia H. Marck 《Archives of physical medicine and rehabilitation》2019,100(1):128-139
Objective
To systematically review the evidence of the effect of exercise compared with passive control on pain in people with multiple sclerosis.Data Source and Study Selection
Five electronic databases were searched for randomized controlled trials published up to March 2017 that recruited people with multiple sclerosis where exercise was the intervention and pain was an outcome (PROSPERO registration number CRD42017060489).Statistical Analysis
A random-effects meta-analysis was conducted to estimate the standardized mean difference of the effect of exercise on pain between treatment and control groups. We assessed risk of bias, fitted meta-regression models to explore heterogeneity between studies, and assessed small study effects.Data Synthesis
Ten studies met the inclusion criteria (total sample size=389), and all studies were at high risk of bias. We found that exercise interventions were associated with less pain compared with passive control groups (standardized mean difference=?.46; 95% CI, ?.92 to .00). There was high between-study heterogeneity (I2=77.0%), which was not explained by the prespecified study characteristics. There was also some evidence of small study effects.Conclusion
This is the first systematic review of the effect of exercise interventions on pain in people with multiple sclerosis, a chronic neurological disorder that affects 2.5 million people. We found some evidence that exercise compared with passive control alleviates pain in this population, but there were limitations in reporting and study quality with high risk of bias of individual studies and heterogeneity between studies. 相似文献4.
James S. Krause Clara E. Dismuke-Greer Melinda Jarnecke Chao Li Karla S. Reed Phillip Rumrill 《Archives of physical medicine and rehabilitation》2019,100(5):931-937.e1
Objective
To identify demographic, educational, and disease-related characteristics associated with the odds of employment and earnings among participants with multiple sclerosis (MS).Design
Cross-sectional using self-report assessment obtained by mail or online.Setting
Medical university in the southeastern United States.Participants
Participants with MS (N=1059) were enrolled from a specialty hospital in the southeastern United States. All were adults younger than 65 years at the time of assessment.Interventions
Not applicable.Main Outcome Measures
Current employment status and earnings.Results
MS factors were highly related to employment, yet not as strongly to conditional earnings. Those with no symptoms reported 6.25 greater odds of employment than those with severe current symptoms. Compared with those with progressive MS, those with relapsing or remitting had greater odds of employment (odds ratio [OR]=2.24). Participants with no perceived cognitive impairment had 1.83 greater odds of employment than those with moderate to severe perceived cognitive impairment. Those with <10 years since MS diagnosis had 2.74 greater odds of employment compared with those with >20 years since diagnosis. An absence of problematic fatigue was highly related to the probability of employment (OR=5.01) and higher conditional earnings ($14,454), whereas the remaining MS variables were unrelated to conditional earnings. For non-MS variables, education was highly related to employment status and conditional earnings, because those with a postgraduate degree had 2.87 greater odds of employment and $44,346 greater conditional earnings than those with no more than a high school certificate. Non-Hispanic whites had 2.22 greater odds of employment and $16,118 greater conditional earnings than non-Hispanic blacks, and men reported $30,730 more in conditional earnings than women.Conclusions
MS indicators were significantly associated with employment status including time since diagnosis, fatigue, symptom severity, and presence of cognitive impairment. However, among those who were employed, conditional earnings were less highly related to these factors and more highly related to educational attainment. 相似文献5.
Mehdi Kargarfard Ardalan Shariat Lee Ingle Joshua A. Cleland Mina Kargarfard 《Archives of physical medicine and rehabilitation》2018,99(2):234-241
Objective
To assess the effects of an 8-week aquatic exercise training program on functional capacity, balance, and perceptions of fatigue in women with multiple sclerosis (MS).Design
Randomized controlled design.Setting
Referral center of an MS society.Participants
Women (N=32; mean age ± SD, 36.4±8.2y) with diagnosed relapsing-remitting MS. After undergoing baseline testing by a neurologist, participants were allocated to either an intervention (aquatic training program, n=17) or a control group (n=15).Interventions
The intervention consisted of an 8-week aquatic training program (3 supervised training sessions per week; session duration, 45–60min; 50%–75% estimated maximum heart rate).Main Outcome Measures
Six-minute walk test (6-MWT), balance (Berg Balance Scale [BBS]), and perceptions of fatigue (Modified Fatigue Impact Scale; [MFIS]) at baseline and after the 8-week intervention. Differences over time between the experimental and control groups were assessed by a 2×2 (group by time) repeated-measures analysis of variance.Results
Thirty-two women completed the 8-week aquatic training intervention (experimental group, n=17; control group, n=15). All outcome measures improved in the experimental group: 6-MWT performance (pretest mean ± SD, 451±58m; posttest mean ± SD, 503±57m; P<.001); BBS (pretest mean ± SD, 53.59±1.70; posttest mean ± SD, 55.18±1.18; P<.001), and MFIS (pretest mean ± SD, 43.1±14.6; posttest mean ± SD, 32.8±5.9; P<.01). A significant group-by-time interaction was evident between the experimental and control groups for 6-MWT (P<.001, partial eta2 [ηp2]=.551), BBS (P<.001, ηp2=.423), and MFIS (P<.001, ηp2=.679).Conclusions
Aquatic exercise training improved functional capacity, balance, and perceptions of fatigue in women with MS. 相似文献6.
Katie L. Cederberg Julia M. Balto Robert W. Motl 《Archives of physical medicine and rehabilitation》2018,99(5):920-926
Objective
To examine self-regulation strategies as correlates of physical activity in persons with multiple sclerosis (MS).Design
Cross-sectional, or survey, study.Setting
University-based research laboratory.Participants
Convenience sample of persons with MS (N=68).Interventions
Not applicable.Main Outcome Measures
Exercise Self-Efficacy Scale (EXSE), 12-item Physical Activity Self-Regulation Scale (PASR-12), and Godin Leisure-Time Exercise Questionnaire (GLTEQ).Results
Correlation analyses indicated that GLTEQ scores were positively and significantly associated with overall self-regulation (r=.43), self-monitoring (r=.45), goal-setting (r=.27), reinforcement (r=.30), time management (r=.41), and relapse prevention (r=.53) PASR-12 scores. Regression analyses indicated that relapse prevention (B=5.01; SE B=1.74; β=.51) and self-monitoring (B=3.65; SE B=1.71; β=.33) were unique predictors of physical activity behavior, and relapse prevention demonstrated a significant association with physical activity behavior that was accounted for by EXSE.Conclusions
Our results indicate that self-regulatory strategies, particularly relapse prevention, may be important correlates of physical activity behavior that can inform the design of future behavioral interventions in MS. 相似文献7.
Phu D. Hoang Michelle H. Cameron Simon C. Gandevia Stephen R. Lord 《Archives of physical medicine and rehabilitation》2014
Objectives
To determine whether impaired performance in a range of vision, proprioception, neuropsychological, balance, and mobility tests and pain and fatigue are associated with falls in people with multiple sclerosis (PwMS).Design
Prospective cohort study with 6-month follow-up.Setting
A multiple sclerosis (MS) physiotherapy clinic.Participants
Community-dwelling people (N=210; age range, 21–74y) with MS (Disease Steps 0–5).Interventions
Not applicable.Main Outcome Measures
Incidence of falls during 6 months' follow-up.Results
In the 6-month follow-up period, 83 participants (39.7%) experienced no falls, 57 (27.3%) fell once or twice, and 69 (33.0%) fell 3 or more times. Frequent falling (≥3) was associated with increased postural sway (eyes open and closed), poor leaning balance (as assessed with the coordinated stability task), slow choice stepping reaction time, reduced walking speed, reduced executive functioning (as assessed with the difference between Trail Making Test Part B and Trail Making Test Part A), reduced fine motor control (performance on the 9-Hole Peg Test [9-HPT]), and reported leg pain. Increased sway with the eyes closed, poor coordinated stability, and reduced performance in the 9-HPT were identified as variables that significantly and independently discriminated between frequent fallers and nonfrequent fallers (model χ23=30.1, P<.001). The area under the receiver operating characteristic curve for this model was .712 (95% confidence interval, .638–.785).Conclusions
The study reveals important balance, coordination, and cognitive determinants of falls in PwMS. These should assist the development of effective strategies for prevention of falls in this high-risk group. 相似文献8.
Filippo Savoldi Zahra Nasr Wei Hu Nathan D. Schilaty Adriana M. Delgado Jay Mandrekar Kenton R. Kaufman Lawrence Berglund Brian G. Weinshenker 《Mayo Clinic proceedings. Mayo Clinic》2019,94(8):1427-1435
ObjectiveTo measure McArdle sign (rapidly reversible weakness induced by neck flexion) both qualitatively and quantitatively and to evaluate its specificity and clinical utility for diagnosis of multiple sclerosis (MS).Patients and MethodsIn this prospective study, McArdle sign was evaluated by a technician blinded to diagnosis by measuring changes in finger extensor strength in successive trials of neck extension and flexion, first clinically and then with a torque measurement device. We studied 25 healthy controls and 81 patients with finger extensor weakness. Patients were not selected for having McArdle sign. Fifty-two patients had MS, 24 had other myelopathies, and 5 had peripheral nerve lesions accounting for their weakness. The study was conducted between February 1, 2016, and June 30, 2017.ResultsThe median clinical McArdle sign and the 2 quantitative measures of neck flexion–induced strength reduction were greater in patients with MS than in the other groups (P<.001). Baseline strength did not confound the difference. The area under the receiver operating characteristic curve was 0.84 (95% CI, 0.75-0.93) comparing patients with MS vs healthy controls and 0.84 (95% CI, 0.75-0.93) comparing MS vs patients with other myelopathies. The 2 quantitative and 1 clinical measurement of McArdle sign by the technician who performed the quantitative testing were correlated (r=.57 and r=.58; P<.001), and in turn, the technician's and unblinded referring physician's clinical assessments were correlated (r=.58; P<.001). McArdle sign was evident in some patients who had minor disability and who were in early phases of MS.ConclusionMcArdle sign, when defined as greater than 10% neck flexion–induced reduction in strength, is entirely specific and 65% sensitive for a diagnosis of MS when compared with other conditions that mimic MS-associated myelopathy. It may facilitate diagnosis in certain clinical situations.Trial Registrationclinicaltrials.gov Identifier: NCT03122873. 相似文献
9.
Brenda Jeng Brian M. Sandroff Robert W. Motl 《Archives of physical medicine and rehabilitation》2018,99(10):2038-2044
Objective
This study examined aerobic capacity, upper leg muscular strength, and static postural control as correlates of the energetic cost of walking (Cw) in moderate multiple sclerosis (MS) mobility disability.Design
Cross-sectional study.Setting
University-based laboratory.Participants
Persons (N=44) with MS (aged 48.43±8.64 years) who have reached a benchmark of moderate mobility disability (ie, Expanded Disability Status Scale scores between 4.0 and 6.0) participated in the study.Main Outcome Measures
Cw was based on (1) net oxygen consumption collected using a portable metabolic unit and (2) walking speed during the 6-minute walk test. Participants underwent standard assessments of peak aerobic capacity, upper leg muscular strength, and static postural control.Results
The data were analyzed using bivariate correlation and linear regression analyses. Cw was inversely correlated with peak oxygen consumption (r=–.308, P<.05), peak power output (r=–.548, P<.00), and peak torque at 75° knee flexion (r=–.340, P<.05), whereas Cw was positively correlated center of pressure area sway (r=.319, P<.05), and mediolateral sway velocity (r=.411, P<.05). 40.3% of variance in Cw was explained by peak power output (β=–.526, P<.01) and mediolateral sway velocity (β=.339, P<.05).Conclusion
Our findings demonstrate that aerobic power and postural sway may be important correlates of Cw in moderate MS mobility disability. Peak power output reflects a person’s physiological functional reserve that is directly relevant for understanding the penalty of walking impairment on the energetic demands of walking. The association between mediolateral postural sway and Cw suggests that mechanical inefficiency controlling the trajectory of the body’s center of pressure during ambulation may contribute to the elevated Cw. 相似文献10.
Claudia Eliza Patrocinio de Oliveira Osvaldo Costa Moreira Zoila Marilú Carrión-Yagual Carlos Medina-Pérez José Antonio de Paz 《Archives of physical medicine and rehabilitation》2018,99(5):819-825
Objective
To compare the effects of classic progressive resistance training (PRT) versus eccentric strength-enhanced training (EST) on the performance of functional tests and different strength manifestations in the lower limb of people with multiple sclerosis (PwMS).Design
Experimental trial.Setting
Strength training program.Participants
PwMS (N=52; 19 men, 33 women) belonging to MS associations from the Castilla y León, Spain.Interventions
Participants were assigned to 1 of 2 groups: a control group that performed PRT or an experimental group that performed EST. In both groups, the knee extensor muscles were trained for 12 weeks.Main Outcome Measures
Before and after 12 weeks of training, maximal voluntary isometric contraction and 1 repetition maximum (1RM) of the knee extensors were evaluated, as were the Chair Stand Test (CST) and Timed 8-Foot Up and Go (TUG) functional tests.Results
No differences were found between the groups in the initial values for different tests. Intragroup comparisons found significant differences in CST (F=69.4; P<.001), TUG (F=40.0; P<.001), and 1RM (F=57.8; P<.001). For intergroup comparisons, EST presented better results than PRT in the CST (EST, 4.7%±2.8%; PRT, 1.9%±2.8%; F=13.1; P=.001) and TUG (EST, ?2.9±4.7; PRT, ?.41±5.6; F=5.6; P=.022).Conclusions
In PwMS, EST leads to improvements in 1RM, TUG, and CST that are similar to those of PRT. However, for patients who participated in this study, the EST seems to promote a better transfer of strength adaptations to the functional tests, which are closer to daily-living activities. 相似文献11.
Abiodun Emmanuel Akinwuntan Hannes Devos Kelly Baker Kendra Phillips Vibha Kumar Suzanne Smith Mitzi Joi Williams 《Archives of physical medicine and rehabilitation》2014
Objective
To determine the potential to improve driving-related skills using a simulator-based program in persons with relapsing-remitting multiple sclerosis (RRMS).Design
Pre-post intervention.Setting
A university driving simulator laboratory.Participants
Participants (N=50) with RRMS and Expanded Disability Status Scale (EDSS) scores between 1 and 7 were enrolled. Pre- and posttraining data from 36 participants (mean age ± SD, 46±11y; 30 women) who received training and 6 participants (mean age ± SD, 48±13y; 5 women) who did not receive training (control group) were compared.Interventions
Five hours of driving training in a simulator.Main Outcome Measures
Performance on a road test at pre- and posttraining. Secondary outcome measures were performance on visual, physical, and cognitive tests.Results
Overall, no significant differences were observed between the training and control groups before and after training. However, 4 of the 7 participants in the training group who failed the road test at pretraining passed posttraining, while the only participant in the control group who failed at pretraining still failed at posttraining. The training group also improved on perception of red and colored numbers, the Paced Auditory Serial Addition Test, and the dot cancellation test of the Stroke Driver Screening Assessment battery and reported less fatigue. These improvements were most pronounced among those with an EDSS score between 3 and 7.Conclusions
This pilot study demonstrates the potential of using a simulator to improve driving-related visual, cognitive, and on-road skills in individuals with RRMS, particularly those with an EDSS score >3. Future randomized controlled trials with adequate power are needed to expand this field of study. 相似文献12.
《Clinical therapeutics》2020,42(2):240-250
PurposeThis study aims to compare the disease progression and disease-modifying treatment–switching patterns between patients with high-disease-activity (HDA) relapsing-remitting multiple sclerosis (RRMS) and patients with low-disease-activity (LDA) RRMS in real-world clinical practice.MethodsThe confirmed disease progression and time to switch of 6647 patients from the Swedish multiple sclerosis registry were analyzed using a marginal structural model that compared patients with relapsing HDA (HDA-R) and lesion HDA (HDA-L) following definitions in European labels of disease-modifying therapies with patients with LDA. Time to milestone and stratified drug cohort analyses were used for internal validation.FindingsA total of 262 patients with LDA, 985 patients with HDA-R, and 683 patients with HDA-L were included in the primary analysis. The HDA-R subgroup had statistically significant greater risk of disease progression (hazard ratio = 1.23; 95% CI, 1.03–1.46) and no difference in time to switch compared with the LDA subgroup. The HDA-L subgroup had statistically significant shorter time to switch (hazard ratio = 1.47; 95% CI, 1.31–1.66) and no difference in disease progression compared with the LDA subgroup.ImplicationsCompared with past research on HDA RRMS grounded mainly in randomized controlled trials of individual disease-modifying therapies, the main contribution of this study is that HDA, as identified by relapses, in real-world clinical settings has a clearer association with disease progression than HDA identified by new magnetic resonance imaging lesions. Taking into account that the HDA-L subgroup had a shorter time to switch, there is evidence of an unmet need for effective treatments in clinical practice for both the HDA-R and HDA-L subgroups. 相似文献
13.
Douglas N. Martini Eline Zeeboer Andrea Hildebrand Brett W. Fling Cinda L. Hugos Michelle H. Cameron 《Archives of physical medicine and rehabilitation》2018,99(10):2050-2058
Objective
To evaluate the effect of the Assistive Device Selection, Training and Education Program (ADSTEP) on falls and walking and sitting activity in people with multiple sclerosis (PwMS).Design
Randomized controlled trial.Setting
Veterans affairs medical center.Participants
PwMS (N=40) using a walking aid at baseline who had fallen in the previous year.Interventions
Participants were randomly assigned to ADSTEP or control. ADSTEP had 6 weekly, 40-minute, 1-on-1 sessions with a physical therapist, starting with walking aid selection and fitting, followed by task-oriented progressive gait training. Control was usual medical care with the option of ADSTEP after the study.Main Outcome Measures
The following were assessed at baseline, intervention completion, and 3 months later: falls, timed Up and Go, timed 25-foot walk, 2-minute walk, Four Square Step Test, International Physical Activity Questionnaire, Quebec User Evaluation of Satisfaction with Assistive Technologies, Multiple Sclerosis Walking Scale-12, Activities-Specific Balance Confidence Scale, and Multiple Sclerosis Impact Scale-29. Effect on these outcomes was estimated by a 2-by-2 repeated measures general linear model.Results
Fewer ADSTEP than control participants fell (χ2=3.96, P<.05. number needed to treat =3.3). Time spent sitting changed significantly differently with ADSTEP than with control from baseline to intervention completion (F=11.16, P=.002. ADSTEP: reduced 87.00±194.89min/d; control: increased 103.50±142.21min/d; d=0.88) and to 3-month follow-up (F=9.25, P=.004. ADSTEP: reduced 75.79±171.57min/d; control: increased 84.50±149.23min/d; d=0.79). ADSTEP yielded a moderate effect on time spent walking compared to control at 3-month follow-up (P>.05. ADSTEP 117.53±148.40min/d; control 46.43±58.55min/d; d=0.63).Conclusions
ADSTEP prevents falls, reduces sitting, and may increase walking in PwMS. 相似文献14.
Blathin Casey Susan Coote Sara Hayes Stephen Gallagher 《Archives of physical medicine and rehabilitation》2018,99(10):2059-2075
Objectives
To (1) systematically review the literature on behavioral interventions for people with multiple sclerosis (MS) that aim to change physical activity (PA) behavior; and (2) explore whether these interventions are clinically effective in improving PA, are theory based, and use established behavior change techniques (BCTs).Data Sources
A systematic electronic search was conducted on databases EBSCO (including AMED, Biomedical Reference Collection: Expanded, CINHAL, MEDLINE, PsycArticles, PsycInfo), PubMed, EMBASE, and Web of Science from April 2017 to May 2017.Study Selection
Studies were included if (1) the interventions aimed to change PA behavior among people with MS; (2) PA was recognized as a primary outcome measure; and (3) they had a randomized controlled trial (RCT) design.Data Extraction
The resulting behavioral interventions were coded using the Theory Coding Scheme and the CALO-RE taxonomy to assess theory base and BCTs. A meta-analysis was conducted to assess effectiveness.Data Synthesis
Fourteen RCTs were included. Combined, there was a significant (P=.0003; d=1.00; 95% confidence interval, .46–1.53) short-term change in self-report PA behavior for studies with nonactive control groups. There was no change in objective or long-term PA. Studies failed to discuss results in relation to theory and did not attempt to refine theory. Fifty percent of BCTs within the CALO-RE were used, with BCTs of “goal-setting” and “action-planning” being the most frequently used.Conclusions
Current evidence supports the efficacy of PA intervention on subjective but not objective outcomes. However, conclusions from this review should be interpreted with caution because of the small number of studies included and small sample size. Further, while using theory in intervention design, interventions in this review have not reported the refining of theory. Exploration of the use of additional BCTs to change PA behavior is also required within future interventions. 相似文献15.
《Archives of physical medicine and rehabilitation》2014,95(12):2428-2434
ObjectiveTo evaluate the effects of a balance exercise program on falls in people with mild to moderate multiple sclerosis (MS).DesignMulticenter, single-blinded, single-group, pretest-posttest trial.SettingSeven rehabilitation units within 5 county councils.ParticipantsCommunity-dwelling adults with MS (N=32) able to walk 100m but unable to maintain 30-second tandem stance with arms alongside the body.InterventionSeven weeks of twice-weekly, physiotherapist-led 60-minute sessions of group-based balance exercise targeting core stability, dual tasking, and sensory strategies (CoDuSe).Main Outcome MeasuresPrimary outcomes: number of prospectively reported falls and proportion of participants classified as fallers during 7 preintervention weeks, intervention period, and 7 postintervention weeks. Secondary outcomes: balance performance on the Berg Balance Scale, Four Square Step Test, sit-to-stand test, timed Up and Go test (alone and with cognitive component), and Functional Gait Assessment Scale; perceived limitations in walking on the 12-item MS Walking Scale; and balance confidence on the Activities-specific Balance Confidence Scale rated 7 weeks before intervention, directly after intervention, and 7 weeks later.ResultsNumber of falls (166 to 43; P≤.001) and proportion of fallers (17/32 to 10/32; P≤.039) decreased significantly between the preintervention and postintervention periods. Balance performance improved significantly. No significant differences were detected for perceived limitations in walking, balance confidence, the timed Up and Go test, or sit-to-stand test.ConclusionsThe CoDuSe program reduced falls and proportion of fallers and improved balance performance in people with mild to moderate MS but did not significantly alter perceived limitations in walking and balance confidence. 相似文献
16.
Y. Goverover B.M. Sandroff J. DeLuca 《Archives of physical medicine and rehabilitation》2018,99(4):635-640
Objectives
To (1) examine and compare dual-task performance in patients with multiple sclerosis (MS) and healthy controls (HCs) using mathematical problem-solving questions that included an everyday competence component while performing an upper extremity fine motor task; and (2) examine whether difficulties in dual-task performance are associated with problems in performing an everyday internet task.Design
Pilot study, mixed-design with both a within and between subjects' factor.Setting
A nonprofit rehabilitation research institution and the community.Participants
Participants (N=38) included persons with MS (n=19) and HCs (n=19) who were recruited from a nonprofit rehabilitation research institution and from the community.Interventions
Not applicable.Main Outcome Measures
Participant were presented with 2 testing conditions: (1) solving mathematical everyday problems or placing bolts into divots (single-task condition); and (2) solving problems while putting bolts into divots (dual-task condition). Additionally, participants were required to perform a test of everyday internet competence.Results
As expected, dual-task performance was significantly worse than either of the single-task tasks (ie, number of bolts into divots or correct answers, and time to answer the questions). Cognitive but not motor dual-task cost was associated with worse performance in activities of everyday internet tasks.Conclusions
Cognitive dual-task cost is significantly associated with worse performance of everyday technology. This was not observed in the motor dual-task cost. The implications of dual-task costs on everyday activity are discussed. 相似文献17.
Dawn M. Ehde Anne Arewasikporn Kevin N. Alschuler Abbey J. Hughes Aaron P. Turner 《Archives of physical medicine and rehabilitation》2018,99(7):1265-1272
Objective
To examine moderators of treatment effects in a randomized controlled trial comparing a telehealth self-management intervention with a telehealth multiple sclerosis (MS) education intervention for fatigue, pain, and mood in adults with MS.Design
Secondary analysis of a single-blind randomized controlled trial.Setting
Community.Participants
Adults with MS and chronic fatigue, chronic pain, and/or moderate depressive symptoms (N=163) recruited from across the United States.Interventions
Two 8-week, telephone-delivered symptom interventions delivered 1:1: a self-management intervention (n=75) and an MS education intervention (n=88).Main Outcome Measures
Outcome measures were fatigue impact pain interference, and depressive symptom severity assessed at baseline and posttreatment. Potential moderators of treatment effects assessed at baseline were demographics (age, sex, and education), clinical characteristics (disease duration and disability severity), symptoms (perceived cognitive impairment and pain intensity), baseline levels of the treatment outcomes (pain interference, fatigue impact and depressive symptom severity), and cognitive behavioral factors (pain catastrophizing, fatigue catastrophizing, self-efficacy, and patient activation).Results
Moderation analyses found significant moderation for fatigue impact but not for pain intensity or depressive symptom severity. Baseline patient activation interacted with treatment group to predict fatigue impact at posttreatment (P=.049). Among participants with high baseline patient activation, the self-management group reported significantly less fatigue at posttreatment than the education group. No other variables moderated the study outcomes.Conclusions
At the group level, participants responded to both interventions, regardless of disease characteristics, demographics, symptom levels, and cognitive behavioral factors. Self-management and education are both potentially beneficial symptom treatments that may be recommended to individuals with MS and chronic pain, fatigue, and/or depressive symptoms. 相似文献18.
Abbey J. Hughes Katherine M. Dunn Trisha Chaffee Jagriti Bhattarai Meghan Beier 《Archives of physical medicine and rehabilitation》2018,99(10):2045-2049
Objective
To assess the diagnostic and clinical utility of the 2-item Generalized Anxiety Disorder Scale (GAD-2) for screening anxiety symptoms in individuals with multiple sclerosis (MS).Design
Cross-sectional.Setting
University-affiliated MS neurology and rehabilitation center.Participants
The sample comprised adults (N=99) (ages 19-72; mean ± SD=46.2±13.0; 75% women) with a physician-confirmed MS diagnosis who were receiving care in a university-affiliated MS center. Disease durations ranged from 1 to 37 years (mean ± SD=10.7±8.4).Interventions
Not applicable.Main Outcome Measures
Participants completed the 7-item Generalized Anxiety Disorder Scale (GAD-7) and GAD-2. Internal consistency was calculated for both measures. Area under the receiver operating characteristics curve (AUC), the 95% confidence interval for the AUC, and Youden’s J were calculated to determine the optimal GAD-2 cutoff score for identifying clinically significant anxiety symptoms, as defined by the previously validated GAD-7 cutoff score of ≥8.Results
Internal consistency was excellent for the GAD-7 (Cronbach α=.91) and acceptable for the GAD-2 (α=.77), and the measures were highly correlated (r=.94). The GAD-2 had excellent overall accuracy for identifying clinically significant anxiety symptoms (AUC=0.97; 95% confidence interval, 0.94-1.00). A GAD-2 cutoff score of ≥3 provided an optimal balance of good sensitivity (0.87) and excellent specificity (0.92) for detecting clinically significant anxiety symptoms. Alternatively, a cutoff score of ≥2 provided excellent sensitivity (1.00) and fair specificity (0.76).Conclusions
The GAD-2 is a clinically useful and psychometrically valid tool for screening anxiety symptoms in MS rehabilitation and neurology care settings. Importantly, this tool has the potential to identify individuals with MS who are at risk for anxiety disorders and who may benefit from rehabilitation psychology interventions to ultimately improve functioning and quality of life. 相似文献19.
Morgan K. Boes Rachel E. Bollaert Richard M. Kesler Yvonne C. Learmonth Mazharul Islam Matthew N. Petrucci Robert W. Motl Elizabeth T. Hsiao-Wecksler 《Archives of physical medicine and rehabilitation》2018,99(3):484-490
Objective
To determine whether a powered ankle-foot orthosis (AFO) that provides dorsiflexor and plantar flexor assistance at the ankle can improve walking endurance of persons with multiple sclerosis (MS).Design
Short-term intervention.Setting
University research laboratory.Participants
Participants (N=16) with a neurologist-confirmed diagnosis of MS and daily use of a prescribed custom unilateral passive AFO.Interventions
Three 6-minute walk tests (6MWTs), 1 per footwear condition: shoes (no AFO), prescribed passive AFO, and portable powered AFO (PPAFO). Assistive devices were worn on the impaired limb.Main Outcome Measures
Distance walked and metabolic cost of transport were recorded during each 6MWT and compared between footwear conditions.Results
Each participant completed all three 6MWTs within the experimental design. PPAFO use resulted in a shorter 6MWT distance than did a passive AFO or shoe use. No differences were observed in metabolic cost of transport between footwear conditions.Conclusions
The current embodiment of this PPAFO did not improve endurance walking performance during the 6MWT in a sample of participants with gait impairment due to MS. Further research is required to determine whether expanded training or modified design of this powered orthosis can be effective in improving endurance walking performance in persons with gait impairment due to MS. 相似文献20.
《Archives of physical medicine and rehabilitation》2019,100(10):1932-1938
Objective(1) Identify the proportion of participants with spinal cord dysfunction (SCD) reporting each of 10 job benefits and compare the proportions between participants with spinal cord injury (SCI) and multiple sclerosis (MS); and (2) examine if diagnostic criteria, demographics, education level, and functional limitations are associated with the number of job benefits received.DesignEconometric modeling of cross-sectional data using a 2-step data analytic model of employment and job benefits.SettingMedical university in the southeastern United States.ParticipantsParticipants (N=2624) were identified from the southeastern United States. After eliminating those age 65 and older, there were 2624 adult participants with SCD; 1234 had MS and 1390 had SCI.InterventionsNot applicable.Main Outcome MeasuresCurrent employment status; number of benefits received and specific benefits received.ResultsA greater proportion of participants with MS received benefits, with significant differences observed on all but 1 type of benefit. Among those who were employed, a greater number of benefits was associated with having MS, greater education, younger age, married or in an unmarried couple, and not having functional restrictions with cognition, doing errands, or shopping alone in the community, and walking.ConclusionsEmployed participants with MS were more likely to receive job benefits, indicative of a higher quality of employment, compared to participants with SCI. Employment without benefits is a form of underemployment that disproportionately affects individuals with many of the same characteristics that initially lead to disparities in probability of gainful employment. 相似文献