Does gait bout definition influence the ability to discriminate gait quality between people with and without multiple sclerosis during daily life?

Abstract Background Besides coping with a disease with many uncertainties, people with relapsing-remitting multiple sclerosis face complex decisions concerning disease-modifying therapies (DMTs). In an interview study, we aimed to assess patients’ experiences with DMTs. Methods Problem-centred interviews were conducted with 50 people with relapsing-remitting multiple sclerosis in Germany using maximum variation sampling and covering all licensed DMTs. Data were analysed thematically using deductive and inductive categories. Results 47 of 50 patients had treatment with at least one of the approved DMTs. The main themes were: (1) starting a DMT, (2) switching to another DMT, (3) discontinuing a DMT, and (4) multiple sclerosis without starting a DMT. Different intercorrelated factors influenced the decision-making processes for or against a DMT. Individual experiences with DMTs in daily life contained the effort in administration, success, and failure of DMTs, coping strategies and well-being without DMTs. The decision-making process for or against a DMT and the use of those treatments can be understood as a constant, continually shifting process, complicated by different factors, which change over time. Experiences with DMTs were characterized by attempts to handle uncertainty and to (re)gain control and integrate adaptivity into one’s life. Conclusions The study provides a rich and nuanced amount of patients’ experiences with DMTs. The findings demonstrate the importance for practitioners to look at current life circumstances of patients with multiple sclerosis when recommending a DMT and to promote and enable patients to make informed decisions.

Download Full-text

Laboratory versus daily life gait characteristics in patients with multiple sclerosis, Parkinson’s disease, and matched controls

Journal of NeuroEngineering and Rehabilitation ◽

10.1186/s12984-020-00781-4 ◽

2020 ◽

Vol 17 (1) ◽

Cited By ~ 1

Author(s):

Vrutangkumar V. Shah ◽

James McNames ◽

Martina Mancini ◽

Patricia Carlson-Kuhta ◽

Rebecca I. Spain ◽

...

Keyword(s):

Multiple Sclerosis ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Neurological Disease ◽

Inertial Sensors ◽

Daily Life ◽

Area Under The Curve ◽

Gait Characteristics ◽

Discrete Moment ◽

Healthy Control

Abstract Background and purpose Recent findings suggest that a gait assessment at a discrete moment in a clinic or laboratory setting may not reflect functional, everyday mobility. As a step towards better understanding gait during daily life in neurological populations, we compared gait measures that best discriminated people with multiple sclerosis (MS) and people with Parkinson’s Disease (PD) from their respective, age-matched, healthy control subjects (MS-Ctl, PD-Ctl) in laboratory tests versus a week of daily life monitoring. Methods We recruited 15 people with MS (age mean ± SD: 49 ± 10 years), 16 MS-Ctl (45 ± 11 years), 16 people with idiopathic PD (71 ± 5 years), and 15 PD-Ctl (69 ± 7 years). Subjects wore 3 inertial sensors (one each foot and lower back) in the laboratory followed by 7 days during daily life. Mann–Whitney U test and area under the curve (AUC) compared differences between PD and PD-Ctl, and between MS and MS-Ctl in the laboratory and in daily life. Results Participants wore sensors for 60–68 h in daily life. Measures that best discriminated gait characteristics in people with MS and PD from their respective control groups were different between the laboratory gait test and a week of daily life. Specifically, the toe-off angle best discriminated MS versus MS-Ctl in the laboratory (AUC [95% CI] = 0.80 [0.63–0.96]) whereas gait speed in daily life (AUC = 0.84 [0.69–1.00]). In contrast, the lumbar coronal range of motion best discriminated PD versus PD-Ctl in the laboratory (AUC = 0.78 [0.59–0.96]) whereas foot-strike angle in daily life (AUC = 0.84 [0.70–0.98]). AUCs were larger in daily life compared to the laboratory. Conclusions Larger AUC for daily life gait measures compared to the laboratory gait measures suggest that daily life monitoring may be more sensitive to impairments from neurological disease, but each neurological disease may require different gait outcome measures.

Download Full-text

Quality of Daily-Life Gait: Novel Outcome for Trials that Focus on Balance, Mobility, and Falls

Sensors ◽

10.3390/s19204388 ◽

2019 ◽

Vol 19 (20) ◽

pp. 4388 ◽

Cited By ~ 3

Author(s):

Kimberley S. van Schooten ◽

Mirjam Pijnappels ◽

Stephen R. Lord ◽

Jaap H. van Dieën

Keyword(s):

Fall Risk ◽

Statistical Power ◽

Inertial Sensors ◽

Daily Life ◽

Gait Characteristics ◽

Technological Advances ◽

Gait Quality ◽

Intervention Trials ◽

Variance Estimates

Technological advances in inertial sensors allow for monitoring of daily-life gait characteristics as a proxy for fall risk. The quality of daily-life gait could serve as a valuable outcome for intervention trials, but the uptake of these measures relies on their power to detect relevant changes in fall risk. We collected daily-life gait characteristics in 163 older people (aged 77.5 ± 7.5, 107♀) over two measurement weeks that were two weeks apart. We present variance estimates of daily-life gait characteristics that are sensitive to fall risk and estimate the number of participants required to obtain sufficient statistical power for repeated comparisons. The provided data allows for power analyses for studies using daily-life gait quality as outcome. Our results show that the number of participants required (i.e., 8 to 343 depending on the anticipated effect size and between-measurements correlation) is similar to that generally used in fall prevention trials. We propose that the quality of daily-life gait is a promising outcome for intervention studies that focus on improving balance and mobility and reducing falls.

Download Full-text

Observational Study on Daily Life Practice in 15039 Patient with Multiple Sclerosis in France

Value in Health ◽

10.1016/j.jval.2016.09.463 ◽

2016 ◽

Vol 19 (7) ◽

pp. A426-A427

Author(s):

G Defer ◽

J de Seze ◽

M Clanet ◽

S Bouee ◽

L Courouve ◽

...

Keyword(s):

Multiple Sclerosis ◽

Observational Study ◽

Daily Life

Download Full-text

Clinical impact of 20% worsening on Timed 25-foot Walk and 9-hole Peg Test in multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458506070768 ◽

2006 ◽

Vol 12 (5) ◽

pp. 594-598 ◽

Cited By ~ 109

Author(s):

J J Kragt ◽

F AH van der Linden ◽

J M Nielsen ◽

B MJ Uitdehaag ◽

C H Polman

Keyword(s):

Multiple Sclerosis ◽

Daily Life ◽

Clinical Impact ◽

Time Interval ◽

Lower Extremity Function ◽

Perceived Disability ◽

Quantitative Measurements ◽

Disability Scale ◽

Life Functioning ◽

Clinical Meaning

Introduction: Quantitative tests of motor function, like the Timed 25-foot Walk (T25FW) and 9-hole Peg Test (9HPT), are increasingly being applied as outcome measures in multiple sclerosis (MS) clinical trials. The quantitative nature of the data has a favorable impact on responsiveness, but the clinical impact of the changes is uncertain. The goal of this study was to assess whether a change on T25FW and 9HPT does indeed have a clinical meaning. This was accomplished by comparing 20% changes on these quantitative measurements to concomitant changes on the Guy’s Neurological Disability Scale (GNDS), a scale which measures patient-perceived daily life disability. Methods: From a longitudinal database, we selected patients with at least two measurements of T25FW, 9HPT and GNDS with a minimal time interval of 350 days. In those patients who experienced at least a 20% change on T25FW or 9HPT, GNDS score changes were examined more closely. Results: Of 527 patients, 143 experienced a >20% worsening on their T25FW and 71 on their 9HPT, respectively. Patients with a 20% increase in T25FW or 9HPT had more GNDS worsening than patients without such an increase. GNDS worsening associated with an increase in T25FW was mainly due to an increase in perceived disability related to lower extremity function and fatigue; GNDS worsening associated with an increase in 9HPT was more diffuse with respect to domains involved. Conclusion: Worsening on T25FW or 9HPT has a clinical impact on disability, as perceived by MS patients during daily life functioning.

Download Full-text

Daily-Life Gait Quality as Predictor of Falls in Older People: A 1-Year Prospective Cohort Study

PLoS ONE ◽

10.1371/journal.pone.0158623 ◽

2016 ◽

Vol 11 (7) ◽

pp. e0158623 ◽

Cited By ~ 58

Author(s):

Kimberley S. van Schooten ◽

Mirjam Pijnappels ◽

Sietse M. Rispens ◽

Petra J. M. Elders ◽

Paul Lips ◽

...

Keyword(s):

Cohort Study ◽

Older People ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Daily Life ◽

Gait Quality

Download Full-text

The Relationship Between Concerns About Falling and Daily Life Activity in Older Men and Women

Journal of Aging and Physical Activity ◽

10.1123/japa.2020-0516 ◽

2021 ◽

pp. 1-8

Author(s):

Zoe Yu Shiu ◽

Kim Delbaere ◽

Kimberley S. van Schooten

Keyword(s):

Daily Life ◽

Older Men ◽

Community Dwelling ◽

Cross Sectional ◽

Men And Women ◽

Daily Life Activities ◽

Gait Quality ◽

Risk Of Falls ◽

Objectively Measured ◽

Older Men And Women

Concerns about falling (CAF) affect daily life activities in older people; however, it is unclear whether gender moderates this relationship. The authors investigated the cross-sectional relationship between CAF and objectively measured physical activity (PA) and gait quality in 503 community-dwelling older men and women. About 448 people (age = 76.2 [SD 7.9] years, 296 females) contributed sufficient data on movement intensity, activity duration (bouts of walking, sitting, and standing), number of transitions between activities (sit-to-stand and sit-to-walk), number of steps and gait quality, quantified as walking speed, and sample entropy. Associations with the Iconographical Falls Efficacy Scale were tested. The authors found no significant moderation by gender. However, women participated in less PA than men and showed a more irregular walking pattern. Higher levels of CAF led to lower PA and poorer gait quality. Our findings suggest that prevention of CAF-related PA avoidance may be particularly important for women, who are less active and at higher risk of falls.

Download Full-text

Association between Daily-Life Gait Quality Characteristics and Physiological Fall Risk in Older People

Sensors ◽

10.3390/s20195580 ◽

2020 ◽

Vol 20 (19) ◽

pp. 5580

Author(s):

Sabine Schootemeijer ◽

Roel H.A. Weijer ◽

Marco J.M. Hoozemans ◽

Kimberley S. van Schooten ◽

Kim Delbaere ◽

...

Keyword(s):

Older People ◽

Fall Risk ◽

Walking Speed ◽

Risk Group ◽

Daily Life ◽

Risk Groups ◽

Sample Entropy ◽

Quality Characteristics ◽

Low Risk ◽

Gait Quality

Gait quality characteristics obtained from accelerometry during daily life are predictive of falls in older people but it is unclear how they relate to fall risk. Our aim was to test whether these gait quality characteristics are associated with the severity of fall risk. We collected one week of trunk accelerometry data from 279 older people (aged 65–95 years; 69.5% female). We used linear regression to investigate the association between six daily-life gait quality characteristics and categorized physiological fall risk (QuickScreen). Logarithmic rate of divergence in the vertical (VT) and anteroposterior (AP) direction were significantly associated with the level of fall risk after correction for walking speed (both p < 0.01). Sample entropy in VT and the mediolateral direction and the gait quality composite were not significantly associated with the level of fall risk. We found significant differences between the high fall risk group and the very low- and low-risk groups, the moderate- and very low-risk and the moderate and low-risk groups for logarithmic rate of divergence in VT and AP (all p ≤ 0.01). We conclude that logarithmic rate of divergence in VT and AP are associated with fall risk, making them feasible to assess the physiological fall risk in older people.

Download Full-text