Influence of creatine monohydrate ingestion on muscle metabolites and intense exercise capacity in individuals with multiple sclerosis

OBJECTIVE: To evaluate the effectiveness of ingesting creatine monohydrate in elevating intramuscular creatine stores and improving exercise capacity in individuals with multiple sclerosis (MS). DESIGN: Randomized, double-blind, placebo-controlled, pre-posttrial. SETTING: A university-based exercise physiology laboratory. PARTICIPANTS: Sixteen individuals with relapsing-remitting MS (median Expanded Disability Status Scale score, 4.75; range, 1.5-6.0). INTERVENTION: Eight individuals with MS were randomized to the creatine group (20g/d of creatine monohydrate for 5d), and 8 others were randomized to the placebo group. Needle biopsies were performed on the vastus lateralis at rest before and after treatment. Subjects performed 3 bouts of 30 maximal knee extensions and flexions at 180 degrees /s with 1 minute of recovery between bouts before and after treatment. MAIN OUTCOME MEASURES: Intramuscular total creatine, phosphocreatine, free creatine, and total work output. RESULTS: Creatine ingestion did not significantly elevate intramuscular total creatine, phosphocreatine, or free creatine or improve total work production. CONCLUSION: Creatine ingestion had no significant effect on muscle creatine stores or high-intensity exercise capacity in individuals with MS.     

Manual wheelchair pushrim dynamics in people with multiple sclerosis

OBJECTIVES: To define differences in pushrim dynamics during manual wheelchair propulsion by users with multiple sclerosis (MS) relative to 2 control groups of subjects with spinal cord injury (SCI) and no disability (ND) and to investigate changes in propulsion biomechanics at different speeds and with fatigue. DESIGN: Case-control. SETTING: Biomechanics laboratory. PARTICIPANTS: A convenience sample of 42 people, 8 women and 6 men per group. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The propulsion pattern, mean maximum speed, percentage of time in push and recovery phases, push angle, push frequency, mean maximum resultant pushrim force, mean work and push cycle, and hand-to-pushrim coupling and decoupling effects. RESULTS: The MS groups tended to use an arcing propulsion pattern more than did the control groups (Pmax=.003). The MS group pushed at a lower mean maximum velocity (v) when allowed to choose the speed of propulsion (v(MS),.67+/-.20m/s; v(SCI), 1.10+/-0.23m/s; P=.001), when asked to push at 1m/s (v(MS),.91+/-.26m/s; v(SCI), 1.12+/-0.11m/s; v(ND), 1.05+/-0.13m/s; P=.010), and were unable to maintain a self-selected speed during a 5-minute trial (Deltav(MS),.15+/-.02m/s; Deltav(ND),.03+/-.06m/s; P<.001). The MS group spent a higher proportion of time in the push phase of propulsion (Pmax=.001). In general, the MS group had smaller push angles, but push frequencies similar to the controls. Statistically adjusted MS group pushrim forces and work per push measures varied depending on context, but in all trials the MS group displayed a braking effect when grasping and releasing the pushrim. The MS group had declines in most measures when pushing at a self-selected speed for 5 minutes. In all trials, the MS group was more likely to display asymmetry between right and left sides in biomechanic parameters. CONCLUSIONS: Manual wheelchair users with MS have difficulty grasping and releasing the pushrim and maintaining speed during a fatigue trial. This likely leads to a slow self-selected speed of propulsion that may not be functional. Clinicians should remember these results when prescribing manual wheelchairs for people with MS.     

Passive mechanical properties of gastrocnemius in people with multiple sclerosis

Background

There is evidence to suggest that contractile properties of muscles in people with multiple sclerosis change as a consequence of demyelination in central nervous system. However, passive properties of muscles in people with multiple sclerosis have not been previously investigated. The purpose of this study was to characterise passive mechanical properties of gastrocnemius in people with multiple sclerosis and to compare these properties with those of gastrocnemius in neurologically normal people.

Methods

Ten people with multiple sclerosis having signs and symptoms of weakness in the legs (Disease step 1–3) and 10 age- and sex-matched healthy people participated in the study. Ultrasound images of muscle fascicles of medial gastrocnemius as well as passive ankle torque and ankle angle data were obtained simultaneously as the ankle was rotated through its full range with the knee in a range of positions. Analysis of ultrasound images and passive ankle torque–angle relations allowed us to derive the slack lengths and maximal strains of whole muscle–tendon units, muscle fascicles and tendons. Paired-samples t-tests were used to compare these variables in the two groups.

Result

There was no difference between subjects with multiple sclerosis and healthy controls in the mean slack lengths and mean maximal strains of the whole muscle–tendon units or of their fascicles or tendons.

Interpretations

These data suggests that typically, in people with multiple sclerosis who have impaired lower limbs but are still ambulatory, the passive mechanical properties of the gastrocnemius muscles are normal.     

Effect of inspiratory muscle training in patients with multiple sclerosis

OBJECTIVE: To evaluate whether inspiratory muscle training (IMT) improves inspiratory muscle strength, respiratory capacity, fatigue, and subjective perception of physical endurance in patients with advanced multiple sclerosis (MS). DESIGN: Randomized controlled trial. SETTING: Outpatient clinic in Sweden. PARTICIPANTS: Fifteen severely disabled patients with MS, randomized to a training or control group. INTERVENTION: Seven patients trained with a Threshold inspiratory muscle trainer, twice every other day, with 3 sets of 10 loaded inspirations (40%-60% of patients' maximal inspiratory pressure [Pimax]) over a 10-week period.Main Outcome Measures: Spirometry, Pimax, maximal expiratory pressure (Pemax), clinical assessments, and questionnaires on the patients' fatigue severity and physical endurance were evaluated. RESULTS: After training, the Pimax (P<.008) and Pemax (P<.02) increased in the training group. The improvement in Pimax after 10 weeks of training was higher than the improvement in the control group (P<.01) and was maintained 1 month after the training period ended. The training affected neither respiratory function nor the patients' symptoms. CONCLUSIONS: IMT had a beneficial effect on inspiratory muscle strength in patients with MS and is recommended as a complement to ordinary physical training.     

Illness and demographic correlates of chronic pain among a community-based sample of people with multiple sclerosis

Douglas C, Wollin JA, Windsor C. Illness and demographic correlates of chronic pain among a community-based sample of people with multiple sclerosis.

Objective

To investigate the prevalence, nature, and correlates of pain among a community-based sample with multiple sclerosis (MS).

Design

A cross-sectional survey and structured pain interview.

Setting

Community.

Participants

People with MS (N=219) recruited through systematic sampling from a randomly ordered MS society membership database.

Interventions

Not applicable.

Main Outcome Measures

Pain presence or absence, pain intensity (numeric rating scales), pain quality (McGill Pain Questionnaire), pain location(s) and extent (pain drawing), pain duration and frequency, provoking and relieving pain factors, and pain management techniques.

Results

Pain was common with some 67.1% of the sample reporting pain during the 2 weeks preceding the study. Comprehensive pain assessment revealed that a substantial subset of these subjects experience chronic pain conditions characterized by moderate-to-severe pain intensity. Among those with pain, 75% reported pain in 3 or more locations, with participants reporting an average of 4.0±1.8 distinct pain sites. Women and people with more severe MS-related disability were significantly more likely to report both the presence of pain and greater pain intensity. In contrast, being in a married or in a de facto relationship and longer time since MS diagnosis were significantly associated with lower pain intensity.

Conclusions

Given the high prevalence and nature of pain experienced by people with MS, health care providers need to approach pain with a priority similar to that given to other MS-related problems such as mobility and functional independence. Women and people with more severe MS-related disability appear to be at particular risk for significant pain problems and therefore these groups warrant particular attention, such that routine clinical assessment should trigger routine pain assessment.     

Use of goal attainment scaling in inpatient rehabilitation for persons with multiple sclerosis

Khan F, Pallant JF, Turner-Stokes L. Use of goal attainment scaling in inpatient rehabilitation for persons with multiple sclerosis.

Objectives

To use goal attainment scaling (GAS) to measure clinically important functional change in persons with multiple sclerosis (MS) and to assess its responsiveness compared with standard measures used to evaluate progress in rehabilitation.

Design

Prospective, observational cohort study.

Setting

Tertiary inpatient rehabilitation unit in Victoria, Australia.

Participants

Consecutive sample of 24 persons with MS admitted for comprehensive rehabilitation program. The male-to-female ratio was 10:14, and the mean age ± standard deviation was 52.0±8.3 years (range, 37−62y). Over half (n=14 [58.3%]) had secondary progressive MS.

Interventions

Not applicable.

Main Outcome Measures

GAS scores were calculated for 5 to 10 priority goals set prospectively by each patient in agreement with the multidisciplinary treating team and compared with standard outcome measures—the FIM instrument and Barthel Index—rated on admission and discharge from the program. Patients were categorized into responders and nonresponders based on an overall clinical global impression.

Results

Of 203 selected goals, 167 were achieved at the predicted level. GAS recorded outcomes for 105 individualized goals not measured by the FIM and Barthel Index. Although all 3 measures showed statistically significant change from admission to discharge (P<.001), only GAS scores strongly correlated with the Clinical Global Impression scale (ρ=−.86, P<.001). GAS discharge scores differed significantly between the responder and nonresponder groups (Mann-Whitney, z=−3.78, P<.001). Different measures of effect size gave different results, but GAS was consistently more responsive than either the FIM or Barthel Index.

Conclusions

This preliminary study suggests that GAS is a responsive and useful outcome measure for the rehabilitation of persons with MS, providing added value to standardized outcome measurement.     

Resistance training improves gait kinematics in persons with multiple sclerosis

OBJECTIVE: To evaluate the effects of an 8-week lower-body resistance-training program on walking mechanics in persons with multiple sclerosis (MS). DESIGN: Repeated-measures design, evaluating gait kinematics before and after an 8-week progressive resistance-training intervention. SETTING: Biomechanics laboratory and fitness center (with conventional, commercially available resistance-training equipment). PARTICIPANTS: Eight ambulatory subjects with MS (age, 46.0+/-11.5 y) with Expanded Disability Status Scale scores ranging from 2.5 to 5.5. INTERVENTION: An 8-week progressive resistance-training program. MAIN OUTCOME MEASURES: Kinematic gait parameters including knee range of motion, duration of stance, swing, and double-support phases in seconds and as percentages of the stride time, percentage of stride time spent in stance, swing, and double-support phases, step length, foot angle, stride length, velocity, step width, and toe clearance for both the more affected and less affected lower limbs. Isometric strength, 3-minute stepping, fatigue, and self-reported disability were also measured. RESULTS: After 2 months of resistance training, there were significant increases (P<.05) in percentage of stride time in the swing phase, step length, stride length, and foot angle; and significant decreases (P<.05) in percentage of stride time in the stance and double-support phases, duration of the double-support phase, and toe clearance. Isometric leg strength improved (P<.05) in 2 of the 4 muscle groups tested. Fatigue indices decreased (P=.04), whereas self-reported disability tended to decrease (P=.07) following the training program. Three-minute stepping increased by 8.7%. CONCLUSIONS: Resistance training may be an effective intervention strategy for improving walking and functional ability in moderately disabled persons with MS.     

Progressive resistance exercise for people with multiple sclerosis

Purpose. This study aimed to determine if participation in a progressive resistance exercise (PRE) programme can: (1) increase the ability to generate maximal muscle force, (2) increase muscle endurance, (3) increase functional activity, and (4) improve overall psychological function of people with multiple sclerosis (MS).

Methods. A pre-post single group research design with a 4-week baseline familiarisation phase was used. Nine people (mean age 45.6 years, SD 10.7) with MS attended a gymnasium three times over 4 weeks for familiarization. Participants then completed a twice-weekly 10-week PRE programme, with two sets of 10 – 12 repetitions of each exercise. Outcome measures of muscle strength (1RM for arms and legs), muscle endurance (repetitions at half 1RM), walking speed, the 2-min walk test (2MWT), a timed stairs test, and the impact of MS on physical and psychological function were taken at weeks 2, 4, and 14.

Results. Participants attended 94.3% (SD 8.2%) of the training sessions, with no adverse events. After accounting for baseline stability, significant improvements (P < 0.05) were found in arm strength (14.4%), leg endurance (170.9%), fast walking speed (6.1%), and there was a trend for increased distance in the 2MWT (P = 0.06). The perceived impact of MS on physical function was reduced (P = 0.02).

Conclusions. Adults with MS benefited from a PRE programme by improving muscle performance and physical activities, without adverse events. These findings suggest that PRE may be a feasible and useful fitness alternative for people with mild to moderate disability due to MS.     

Manual wheelchair propulsion pattern use by people with multiple sclerosis

Purpose.?To determine the most commonly used manual wheelchair propulsion pattern by people with multiple sclerosis (MS) and to assess which factors influence the preference.

Method.?Sixty manual wheelchair users with MS from an MS outpatient rehabilitation centre in Northern Italy were assessed on upper limb range of motion and trunk stability to determine if these factors or demographic, disease or wheelchair use history, influenced the choice of wheelchair propulsion pattern.

Results.?Fifty-four (90%) subjects used the arcing propulsion pattern, the least efficient pattern as reported in the literature. Sixteen (26.7%) subjects had impaired trunk stability and 38 (63.3%) subjects demonstrated some deficit on either extremity for active range flexion–extension. Twenty (33%) subjects had no deficits on active range flexion–extension and had normal trunk control. Upper limb range of motion and trunk stability were not significant in determining the preference for propulsion pattern (p?=?1.05 and 0.38, respectively). Demographic and disease factors and wheelchair use history were also not significant in determining propulsion pattern.

Conclusions.?The person with MS uses the least efficient pattern overall, requiring frequent repetition, although a smaller range of movement. This may be an energy conservation technique that helps in managing fatigue.     

Suicidal ideation in multiple sclerosis

OBJECTIVE: To examine risk factors for suicidal ideation among people with multiple sclerosis (MS). DESIGN: Cohort study linking computerized medical records with a mailed self-report survey. SETTING: Veteran's Health Administration (VHA) region covering the northwestern United States. PARTICIPANTS: VHA patients with MS (N=445) who returned mailed surveys. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Suicidal ideation is assessed by the Patient Health Questionnaire (PHQ) suicide item with suicidal ideation more than half the days considered persistent. RESULTS: One hundred thirty-one (29.4%) of 445 respondents (95% confidence interval [CI], 25.4%-33.9%) endorsed suicidal ideation, and 35 (7.9%; 95% CI, 5.7%-10.8%) endorsed persistent suicidal ideation over the last 2 weeks. In bivariate analyses, suicidal ideation was associated with younger age, earlier disease course, progressive disease subtype, lower income, not being married, lower social support, not driving, higher levels of physical disability (mobility, bowel, bladder), and depression. Analyses on persistent suicidal ideation yielded similar results. In fully adjusted multivariate logistic regression, only depression severity and bowel disability were independently associated with suicidal ideation. Only depression severity was independently associated with persistent suicidal ideation. By using the 2-question depression screen (U.S. Preventive Services Task Force) consisting of the depression and anhedonia items from the PHQ-9, sensitivity and specificity were marginal for suicidal ideation (65.6% and 79.9%) but acceptable for persistent suicidal ideation (88.6% and 71.2%). CONCLUSIONS: Suicidal ideation is common among VHA patients with MS, and depression severity is the best risk marker. Brief screening for depression in MS should include the assessment of suicidal ideation.     

Poster 25: Intrathecal baclofen therapy in ambulatory patients with multiple sclerosis: effect on gait speed

Objective: To evaluate whether intrathecal baclofen (ITB) therapy causes a decrease in gait speed in ambulatory patients with multiple sclerosis (MS). Design: Longitudinal pre-post intervention study (24-wk follow-up). Setting: Spasticity clinic within a large outpatient comprehensive care center for MS. Participants: Patients with intractable lower-extremity spasticity, definitively diagnosed with MS and able to walk at least 25ft with or without support. Intervention: Implantation of a programmable ITB infusion system. All patients received inpatient and/or outpatient physical therapy after surgery. Main Outcomes Measure: Gait speed calculated from the Timed 25-Foot Walk. Results: 8 patients were analyzed (75% women; mean age, 37.4±6.1y; mean disease duration, 9.7±7.9y; median Expanded Disability Status Scale [EDSS] score, 6.5). There was no significant change in EDSS score during the study. There was statistically significant improvement of Modified Ashworth Scale scores between baseline and all follow-up visits. There was no statistically significant change in gait speed. Average gait speed was .48±.35m/s at baseline, .46±.41m/s at 4 weeks, .41±.37m/s at 12 weeks, and .48±.40m/s at 24 weeks. Conclusions: Our results suggest that ITB therapy improves severe spasticity, but does not affect gait speed measured on a short distance in ambulatory MS patients, up to 6 months after surgery. Further study is needed to assess the effect of ITB on gait endurance, gait quality, and patient quality of life.     

The efficacy of telephone counseling for health promotion in people with multiple sclerosis: a randomized controlled trial

Bombardier CH, Cunniffe M, Wadhwani R, Gibbons LE, Blake KD, Kraft GH. The efficacy of telephone counseling for health promotion in people with multiple sclerosis: a randomized controlled trial.

Objective

To determine if motivational interviewing-based telephone counseling increases health promotion activities and improves other health outcomes in people with multiple sclerosis (MS).

Design

Randomized controlled trial with wait-list controls and single-blinded outcome assessments conducted at baseline and at 12 weeks.

Setting

MS research and training center in the Pacific Northwest.

Participants

Community-residing persons (N=130) with physician confirmed MS aged 18 or older who were able to walk unassisted at least 90m (300ft).

Intervention

A single in-person motivational interview followed by 5 scheduled telephone counseling sessions to facilitate improvement in 1 of 6 health promotion areas: exercise, fatigue management, communication and/or social support, anxiety and/or stress management, and reducing alcohol or other drug use.

Main Outcome Measures

Health Promotion Lifestyle Profile II plus fatigue impact, subjective health, and objective measures of strength, fitness, and cognition. Intent-to-treat analyses of change scores were analyzed using nonparametric tests.

Results

Seventy persons were randomized to treatment and 60 to the control condition. The treatment group reported significantly greater improvement in health promotion activities, including physical activity, spiritual growth, and stress management as well as in fatigue impact and mental health compared with controls. In addition, the exerciser subgroup showed greater improvement than controls in self-selected walking speed.

Conclusions

A less intensive, more accessible approach to health promotion based on telephone counseling and motivational interviewing shows promise and merits further study.     

The contribution of cognition and spasticity to driving performance in multiple sclerosis

Marcotte TD, Rosenthal TJ, Roberts E, Lampinen S, Scott JC, Allen RW, Corey-Bloom J. The contribution of cognition and spasticity to driving performance in multiple sclerosis.

Objective

To examine the independent and combined impact of cognitive dysfunction and spasticity on driving tasks involving high cognitive workload and lower-limb mobility in persons with multiple sclerosis (MS).

Design

Single-visit cohort study.

Setting

Clinical research center.

Participants

Participants included 17 drivers with MS and 14 referent controls. The group with MS exhibited a broad range of cognitive functioning and disability. Of the 17 patients with MS, 8 had significant spasticity in the knee used to manipulate the accelerator and brake pedals (based on the Modified Ashworth Scale).

Interventions

Not applicable.

Main Outcome Measures

A brief neuropsychologic test battery and 2 driving simulations. Simulation 1 required participants to maintain a constant speed and lane position while attending to a secondary task. Simulation 2 required participants to adjust their speed to accelerations and decelerations of a lead car in front of them.

Results

Patients with MS showed greater variability in lane position (effect size, g=1.30), greater difficulty in maintaining a constant speed (g=1.25), and less ability to respond to lead car speed changes (g=1.85) compared with controls. Within the MS group, in a multivariate model that included neuropsychologic and spasticity measures, cognitive functioning was the strongest predictor of difficulty in maintaining lane position during the divided attention task and poor response time to lead car speed changes, whereas spasticity was associated with reductions in accuracy of tracking the lead car movements and speed maintenance.

Conclusions

In this preliminary study, cognitive and physical impairments associated with MS were related to deficits in specific components of simulated driving. Assessment of these factors may help guide the clinician regarding the types of driving behaviors that would put patients with MS at an increased risk for an automobile crash.     

Reliability of the Dynamic Gait Index in individuals with multiple sclerosis

McConvey J, Bennett SE. Reliability of the Dynamic Gait Index in individuals with multiple sclerosis.

Objectives

To determine if the Dynamic Gait Index (DGI) is a reliable tool for assessing balance in people with multiple sclerosis (MS) and to determine the validity of the DGI by using the 6.1-m timed walk.

Design

Instrument reliability test: physical therapists viewed a videotape of 10 subjects with MS performing the DGI and scored their gait by using DGI criteria. Two weeks after the first session, therapists’ viewed the videotape again and scored subjects’ gait to establish interrater reliability.

Setting

Hospital-based outpatient rehabilitation clinic.

Participants

Eleven physical therapists and 10 people with MS.

Interventions

Not applicable.

Main outcome measures

Total DGI scores and each of the 8 DGI items were compared between and within raters (physical therapists). Time to walk 6.1m was compared with the total DGI score to examine concurrent validity.

Results

Interrater reliability for total DGI scores was .983, with each of the 8 items ranging from .910 to .976 (intraclass correlation coefficient, P<.05). Intrarater reliability for total DGI scores ranged between .760 and .986 (Pearson bivariate analysis, P<.05). An inverse relationship of −.801 (Pearson bivariate analysis, P<.01) existed between the total DGI scores and the 6.1-m walk.

Conclusions

The DGI is a reliable functional assessment tool that correlated inversely with timed walk, showing its concurrent validity.     

Effective rehabilitation interventions and participation among people with multiple sclerosis: An overview of reviews

Multiple sclerosis (MS) is the most common cause of non-traumatic disability in people aged 10–65 years. Evidence exists for the effectiveness of multidisciplinary rehabilitation and exercise. However, the effectiveness of other rehabilitation approaches in MS needs further evaluation. The purposes were to systematically synthesise and evaluate knowledge on effectiveness of rehabilitation interventions and determinants for participation among persons with MS (pwMS) to inform clinical guidelines on rehabilitation. Joanna Briggs Institute methodology was used. PubMed, Embase, CINAHL, PsycINFO and Web of Science were searched for reviews, systematic reviews, meta-analyses, and meta-syntheses published 2009–2019. All types of rehabilitation interventions provided to pwMS at any time and in all settings were eligible. Two reviewers independently screened and extracted data. The most recently published reviews on mixed and specific modalities were included. The findings were reported in a narrative summary and a mixed-method analysis. Among 108 eligible reviews, 6 qualitative or mixed-method reviews and 66 quantitative were included (total pwMS > 90,000). This overview provides solid evidence for effectiveness of a spectrum of modalities. Among the modalities, there was strong evidence for the effectiveness of multidisciplinary, cognitive and exercise approaches, physiotherapy, and occupational therapy including full body training on functioning and participation outcomes. Employment significantly influenced quality of life; thus, vocational rehabilitation should be initiated early. The healthcare professionals should identify personal factors including relations and coping, and the rehabilitation process should involve partners or close family. The mixed-method analysis revealed insufficient consensus between the perspectives of pwMS on their rehabilitation and reported effects indicating that further research should target the experiences of pwMS. Further, results showed that rehabilitation should be patient-centred, focus on the complexity of needs, and be organised and performed by an experienced multidisciplinary team. Evidence-based rehabilitation should be initiated early after pwMS are diagnosed and follow international guidelines.Database registrationPROSPERO ID: CRD42020152422.     

多发性硬化合并不宁腿综合征12例临床分析

目的探讨多发性硬化（MS）患者合并不宁腿综合征（RLS）的临床特点,且进一步研究MS患者合并RLS的相关因素。方法选取确诊的70例MS患者,根据是否合并RLS分为伴RLS组和单纯MS组,比较两组患者的MS发病年龄、病程及神经功能损害严重程度（EDSS评分）等临床资料;分析RLS症状严重程度与EDSS的关系。结果70例MS患者中12例合并RLS,发生率为17．1％（12／70）。伴RLS组患者发病年龄为（47．6±10．0）岁,单纯MS组为（40．1±10．4）岁,两组比较差异有统计学意义（t=2．29,P=0．030）;病程分别为（12．6±6．8）、（8．2±6．6）年,两组比较差异有统计学意义（t=2．10,P=0．039）;EDSS评分分别为（4．5±2．5）、（2．5±2．0）分,两组比较差异有统计学意义（t=3．02,P=0．004）。RLS严重程度评分与EDSS评分无相关性（r=0．45,P=0．15）。结论RLS在MS患者中发病率较高,MS发病年龄越大,病程越长,神经功能损害越严重,发生RLS的可能性越大。     

A prospective evaluation of balance, gait, and strength to predict falling in women with multiple sclerosis

Kasser SL, Jacobs JV, Foley JT, Cardinal BJ, Maddalozzo GF. A prospective evaluation of balance, gait, and strength to predict falling in women with multiple sclerosis.

Objective

To identify measures of balance, gait, and strength that predict falls in women with multiple sclerosis (MS).

Design

This prospective study followed participants for 1 year.

Setting

University research laboratories.

Participants

A convenience sample of women with MS (N=99).

Interventions

Not applicable.

Main Outcome Measures

Balance was assessed with the limits of stability (LOS) test and the Sensory Organization Test. Peak force, torque, and power of knee flexors and extensors as well as hip abductors and adductors were also measured. Temporal-spatial parameters of gait were measured by an instrumented walkway system. For 1 year after baseline assessments, the participants reported their falls. Participants were then classified based on the number of reported falls for use in logistic regression models to predict either people with at least 1 fall or people with at least 2 falls (recurrent fallers).

Results

A total of 159 falls were reported by 48% of the participants. Expanded Disability Status Scale scores, leaning forward to the LOS, and standing sway within a visually referenced surround significantly predicted people with at least 1 fall as well as recurrent fallers. Stance-phase asymmetries and base-of-support width during gait, as well as the force and power produced during leg extension or flexion additionally predicted recurrent fallers. The models' overall predictive accuracy ranged from 69% to 85%.

Conclusions

This prospective study confirmed the prevalence and multifactorial nature of falls in this MS sample. In addition to advancing disease status, impaired forward LOS and visually dependent sway (as well as gait asymmetries and leg flexor-extensor weakness for recurrent fallers) predict future falls in women with MS.