Understanding walking activity in multiple sclerosis: step count, walking intensity and uninterrupted walking activity duration related to degree of disability

AbstractRestrictions in the access to healthcare facilities during COVID-19 pandemic have raised the need for remote monitoring of chronic medical conditions, including multiple sclerosis (MS). In order to enable the continuity of care in these circumstances, many telemedicine applications are currently tested. While physicians’ preferences are commonly investigated, data regarding the patients’ point of view are still lacking. We built a 37 items web-based survey exploring patients’ propensity, awareness, and opinions on telemedicine with the aim to evaluate the sustainability of this approach in MS. Analysing 613 questionnaires out of 1093 that were sent to persons with MS followed at the Multiple Sclerosis Center of Tor Vergata University, Rome, we found that more than half of respondents (54%) were open to having a televisit. Propensity toward telemedicine significantly depended on having a higher income (p = 0.037), living farther from the center (p = 0.038), using computer and tablet (p = 0.010) and using the Internet for other remote activities (p < 0.001), conversely it was not influenced by any specific disease characteristics (i.e. degree of disability). The main advantages and disadvantages of televisit reported by participants were respectively saving time (70%) and impossibility to measure physical parameters (71%). Although the majority of respondents are in favour of televisit, so far this approach is restricted to those displaying better socioeconomic conditions and higher familiarity with technology. Implications of the study are that telemedicine platforms should be better tailored to patients’ demands in order to spread the use of telemedicine, to enhance usability and to increase patients’ adherence.

Intervention Mediators in a Randomized Controlled Trial to Increase Physical Activity and Fatigue Self-management Behaviors Among Adults With Multiple Sclerosis

Annals of Behavioral Medicine ◽

10.1093/abm/kaz033 ◽

2019 ◽

Author(s):

Matthew Plow ◽

Robert W Motl ◽

Marcia Finlayson ◽

Francois Bethoux

Keyword(s):

Physical Activity ◽

Multiple Sclerosis ◽

Goal Setting ◽

Self Efficacy ◽

Outcome Expectations ◽

Step Count ◽

Self Management ◽

Post Test ◽

The Impact

Abstract Background People with multiple sclerosis (MS) often experience fatigue, which is aggravated by inactivity. Identifying mediators of changes in physical activity (PA) and fatigue self-management (FSM) behaviors could optimize future interventions that reduce the impact of MS fatigue. Purpose To examine the effects of telephone-delivered interventions on Social Cognitive Theory constructs and test whether these constructs mediated secondary outcomes of PA and FSM behaviors. Methods Participants with MS (n = 208; Mean age = 52.1; Female = 84.6%) were randomized into contact–control intervention (CC), PA-only intervention, and PA+FSM intervention. Step count (Actigraphy) and FSM behaviors as well as self-efficacy, outcome expectations, and goal setting for PA and FSM were measured at baseline, post-test (12 weeks), and follow-up (24 weeks). Path analyses using bias-corrected bootstrapped 95% confidence intervals (CI) determined whether constructs at post-test mediated behaviors at follow-up when adjusting for baseline measures. Results Path analysis indicated that PA-only (β = 0.50, p < .001) and PA+FSM interventions (β = 0.42, p < .010) had an effect on goal setting for PA, and that PA + FSM intervention had an effect on self-efficacy for FSM (β = 0.48, p = .011) and outcome expectations for FSM (β = 0.42, p = .029). Goal setting for PA at post-test mediated the effects of PA-only (β = 159.45, CI = 5.399, 371.996) and PA + FSM interventions (β = 133.17, CI = 3.104, 355.349) on step count at follow-up. Outcome expectations for FSM at post-test mediated the effects of PA + FSM intervention on FSM behaviors at follow-up (β = 0.02, CI = 0.001, 0.058). Conclusions Goal setting for PA and outcome expectations for FSM may be important constructs to target in telephone-delivered interventions designed to reduce the impact of MS fatigue. Trial registration Clinicaltrials.gov (NCT01572714)

Correlation between fatigue and self-esteem in patients with multiple sclerosis

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2009000500007 ◽

2009 ◽

Vol 67 (3b) ◽

pp. 818-821 ◽

Cited By ~ 6

Author(s):

Yára Dadalti Fragoso ◽

Érika Oliveira da Silva ◽

Alessandro Finkelsztejn

Keyword(s):

Multiple Sclerosis ◽

Severe Depression ◽

Self Esteem ◽

Socioeconomic Level ◽

Mild Depression ◽

Degree Of Disability ◽

Severe Anxiety ◽

The Way

OBJECTIVE: To assess the possible association of fatigue with self-esteem in multiple sclerosis (MS) patients. METHOD: Thirty patients were prospectively assessed. None of them presented moderate or severe depression or anxiety and their degree of disability was low (EDSS<3.5). They had been clinically stable for at least three months and had been receiving the same medication for at least six months. Socioeconomic level was assessed. Severity of fatigue and self-esteem were evaluated using specific, validated scales. Patients with moderate to severe anxiety and/or depression were excluded. RESULTS: Low self-esteem correlated with fatigue (p=0.01), but not with any other variables, such as age, gender, EDSS, MS duration, number of relapses, mild depression and/or anxiety. CONCLUSION: Greater severity of fatigue in MS correlates with low self-esteem, thus suggesting that this chronic complaint that affects so many patients can interfere with the way in which they see and value themselves.

Energy cost of exercise in multiple sclerosis patients with low degree of disability

Multiple Sclerosis Journal ◽

10.1177/135245859600200307 ◽

1996 ◽

Vol 2 (3) ◽

pp. 161-167 ◽

Cited By ~ 25

Author(s):

C Tantucci ◽

M Massucci ◽

R Piperno ◽

V Grassi ◽

CA Sorbini

Keyword(s):

Multiple Sclerosis ◽

Minute Ventilation ◽

Respiratory Muscles ◽

Metabolic Cost ◽

Mild Degree ◽

Cardiorespiratory Response ◽

Low Degree ◽

Mild Disability ◽

Degree Of Disability ◽

Multiple Sclerosis Patients

In 10 patients (five females) suffering from multiple sclerosis with mild degree of disability, (EDSS ranging from 0 to 2) and in 10 age and sex matched control subjects we investigated lung function, respiratory muscles strength and cardiorespiratory response to incremental exercise in order to assess the metabolic cost of exercise. In the absence of any impairment of lung volumes and flows and in-and expiratory maximal mouth pressures, at peak of exercise oxygen consumption (VO2max=1886 ± 145 ml/min) and workload (Wmax = 137 ± 9.8 watts) were slightly diminished in patients, as compared with controls (VO2max = 2246 ± 196 ml/min and Wmax = 164 ± 14.7 watts). These findings were associated with an increased heart rate (HR) and reduced oxygen pulse (VO2/HR) at the same workloads. During the whole exercise, however, the slope of the linear relationship between VO2 and work exhibited by the patients, amounting to 9.9 ± 0.6 ml/min/watt, was similar to that of the controls (10.9 ± 0.42 ml/min/watt). Incidentally, both at rest and during exercise, the patients showed a significantly greater minute ventilation (due to a faster respiratory rate, associated with an augmented dead space (P<0.05). We conclude that an increase of metabolic cost of exercise does not occur in multiple sclerosis patients with mild disability, suggesting a lack or a low degree of spasticity and/or ataxia elicited by the effort Thus, their exertional capacity appears to be limited mainly by a poor training. The tachypnea observed in these patients at rest and during exercise was unexpected and the reason for adopting such a pattern of breathing is unclear.

The Significance of HLA DRB1*1501 and Oligoclonal Bands in Multiple Sclerosis: Clinical Features and Disability

Medicina ◽

10.3390/medicina47070052 ◽

2011 ◽

Vol 47 (7) ◽

pp. 368 ◽

Cited By ~ 4

Author(s):

Renata Balnytė ◽

Daiva Rastenytė ◽

Ingrida Ulozienė ◽

Dalia Mickevičienė ◽

Erika Skrodenienė ◽

...

Keyword(s):

Multiple Sclerosis ◽

Clinical Features ◽

Clinical Symptoms ◽

Oligoclonal Bands ◽

Disability Score ◽

Mcdonald Criteria ◽

Disability Status ◽

Igg Index ◽

Degree Of Disability ◽

A Prospective Study

The aim of the present study was to determine the value of immunogenetic risk factors and to estimate their relationship with the clinical features and disability status of patients with multiple sclerosis in a Lithuanian population. Materials and Methods. This was a prospective study of 80 patients with multiple sclerosis. The diagnosis of multiple sclerosis was based on the revised McDonald criteria. Oligoclonal bands (OCBs) of immunoglobulin G (IgG) were tested using isoelectric focusing and IgG specific immunofixation. HLA DRB1 alleles were genotyped using polymerase chain reaction. Results. Of all patients, 55% were positive for OCBs and 56% for HLA DRB1*1501. OCBpositive patients with multiple sclerosis had higher EDSS scores than their OCB-negative counterparts at onset of the disease (3.93±1.21 and 3.36±0.96 points, respectively; P=0.02) and during the last visit (4.31±2.06 and 3.09±1.98 points, respectively; P=0.009). The mean relapse rate was higher in the OCB-positive group compared with OCB-negative group (1.45±0.69 and 0.58±0.64, respectively; P=0.001). OCB-positive patients had higher IgG index compared with OCB-negative patients (P=0.0001). No relationship was found between HLA DRB1*1501 antigen status and the clinical features or EDSS score, and presence or absence of OCB in the present subset of patients with multiple sclerosis. Conclusions. The presence of oligoclonal bands in the cerebrospinal fluid of the patients with multiple sclerosis was associated with the greater number of exacerbations, higher degree of disability, and higher IgG index. There were no significant associations between the presence of HLA DRB1*1501 allele and the clinical symptoms, course of disease, or disability score.

Effect of pregnancy and exclusive breastfeeding on multiple sclerosis relapse rate and degree of disability within two years after delivery

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2020.105829 ◽

2020 ◽

Vol 194 ◽

pp. 105829

Author(s):

Masoud Ghiasian ◽

Mohaddeseh Nouri ◽

Abdorreza Naser Moghadasi ◽

Mehran Ghaffari

Keyword(s):

Multiple Sclerosis ◽

Relapse Rate ◽

Exclusive Breastfeeding ◽

Multiple Sclerosis Relapse ◽

Degree Of Disability

Assessment of cognitive functions in patients with multiple sclerosis

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-021-00383-4 ◽

2021 ◽

Vol 57 (1) ◽

Author(s):

Tara A. Al-Falaki ◽

Farqad B. Hamdan ◽

Nawfal M. Sheaheed

Keyword(s):

Multiple Sclerosis ◽

Functional Disability ◽

Disease Duration ◽

Education Level ◽

Cognitive Changes ◽

Duration Of Illness ◽

Disability Status ◽

Visuospatial Learning ◽

Degree Of Disability ◽

Moca Score

Abstract Background About 40–70% of patients with multiple sclerosis (MS) develop cognitive impairment (CI) throughout their life. We aim to study the influence of MS on cognitive changes. This is a case–control study of fifty patients with MS who met the revised 2017 Mc Donald Criteria and fifty age- and sex-matched healthy subjects. The Expanded Disability Status Scale (EDSS) was used to assess the degree of disability, and the Montreal Cognitive Assessment (MoCA) scoring system was used to assess cognitive function. Results MS patients show low total MoCA score than the controls. Total MoCA scores were lower in patients with CI versus those with intact cognition. CI was higher in those with a longer duration of illness and a high EDSS. MoCA was positively correlated with education level but negatively with EDSS and disease duration. Conclusion MoCA scale has optimal psychometric properties for routine clinical use in patients with MS, even in those with mild functional disability. The longer the disease duration and the higher the EDSS, the lower the MoCA score and the higher the education level, the higher the MoCA score. As for the profile of cognitive dysfunction in patients with MS, the domains most frequently failed by the patients were memory, attention, visuospatial learning, and language.

Evaluation of Retinal Structure and Optic Nerve Function Changes in Multiple Sclerosis: Longitudinal Study with 1-Year Follow-Up

Neurology Research International ◽

10.1155/2021/5573839 ◽

2021 ◽

Vol 2021 ◽

pp. 1-10

Author(s):

Riwanti Estiasari ◽

Adisresti Diwyacitta ◽

Muhammad Sidik ◽

Ni Nengah Rida Ariarini ◽

Freddy Sitorus ◽

...

Keyword(s):

Multiple Sclerosis ◽

Optic Nerve ◽

Contrast Sensitivity ◽

Disease Duration ◽

Nerve Function ◽

P100 Latency ◽

Rnfl Thickness ◽

Degree Of Disability ◽

Retinal Structure

Background. Multiple sclerosis (MS) is an autoimmune disease characterized by inflammation and demyelination of the central nervous system which often involves the optic nerve even though only 20% of the patients experience optic neuritis (ON). Objective. This study aims to compare the retinal structure and optic nerve function between patients with MS and healthy controls (HCs), evaluate optic nerve alterations in MS over 1-year follow-up, and analyze its correlations with disease duration, number of relapses, degree of disability, and different subtypes. Methods. This is a prospective cohort study involving 58 eyes of MS patients. Optic nerve function was evaluated with best-corrected visual acuity (BCVA), contrast sensitivity, and P100 latency, while the retinal structure was evaluated from the GCIPL and RNFL thickness measured with optical coherence tomography (OCT) and fundus photography. Results. The MS group had lower BCVA ( p = 0.001 ), contrast sensitivity ( p < 0.001 ), mean GCIPL thickness ( p < 0.001 ), and mean RNFL thickness ( p < 0.001 ) than HC. At 6 and 12 months of observations, GCIPL and RNFL (nasal quadrant) of MS patients decreased significantly ( p = 0.007 and p = 0.004 , respectively). Disease duration and the number of relapses correlated with delayed P100 latency (r = −0.61, p < 0.001 and r = −0.46, p = 0.02 ). GCIPL and RNFL in the SPMS subtype were thinner than in RRMS. Conclusions. The retinal structure and optic nerve function of MS patients are worse than those of normal individuals. GCIPL and RNFL thinning occurs at 6 and 12 months but do not correlate with disease duration, the number of relapses, and degree of disability.