scholarly journals Predicting Falls in People with Multiple Sclerosis: Fall History Is as Accurate as More Complex Measures

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Michelle H. Cameron ◽  
Emily Thielman ◽  
Rajarshi Mazumder ◽  
Dennis Bourdette
Keyword(s):  
Multiple Sclerosis ◽  
Fall Risk ◽  
Area Under The Curve ◽  
Dynamic Posturography ◽  
Balance Confidence ◽  
The Past ◽  
Injurious Falls ◽  
Fall Prediction ◽  
Disability Status ◽  
Physical Tests

Background.Many people with MS fall, but the best method for identifying those at increased fall risk is not known.Objective.To compare how accurately fall history, questionnaires, and physical tests predict future falls and injurious falls in people with MS.Methods.52 people with MS were asked if they had fallen in the past 2 months and the past year. Subjects were also assessed with the Activities-specific Balance Confidence, Falls Efficacy Scale-International, and Multiple Sclerosis Walking Scale-12 questionnaires, the Expanded Disability Status Scale, Timed 25-Foot Walk, and computerized dynamic posturography and recorded their falls daily for the following 6 months with calendars. The ability of baseline assessments to predict future falls was compared using receiver operator curves and logistic regression.Results.All tests individually provided similar fall prediction (area under the curve (AUC) 0.60–0.75). A fall in the past year was the best predictor of falls (AUC 0.75, sensitivity 0.89, specificity 0.56) or injurious falls (AUC 0.69, sensitivity 0.96, specificity 0.41) in the following 6 months.Conclusion.Simply asking people with MS if they have fallen in the past year predicts future falls and injurious falls as well as more complex, expensive, or time-consuming approaches.

scholarly journals Gait Difficulties and Postural Instability in Adrenoleukodystrophy

2021 ◽  
Vol 12 ◽  
Author(s):  
Neha P. Godbole ◽  
Reza Sadjadi ◽  
Madeline A. DeBono ◽  
Natalie R. Grant ◽  
Daniel C. Kelly ◽  
...  
Keyword(s):  
Postural Control ◽  
Fall Risk ◽  
Postural Instability ◽  
Walk Test ◽  
Expanded Disability Status Scale ◽  
Dynamic Posturography ◽  
Computerized Dynamic Posturography ◽  
Disability Status ◽  
Males And Females ◽  
Functional Gait

Background: Gait and balance difficulties are among the most common clinical manifestations in adults with X-linked adrenoleukodystrophy, but little is known about the contributions of sensory loss, motor dysfunction, and postural control to gait dysfunction and fall risk.Objective: To quantify gait and balance deficits in both males and females with adrenoleukodystrophy and evaluate how environmental perturbations (moving surfaces and visual surrounds) affect balance and fall risk.Methods: We assessed sensory and motor contributions to gait and postural instability in 44 adult patients with adrenoleukodystrophy and 17 healthy controls using three different functional gait assessments (25 Foot Walk test, Timed Up and Go, and 6 Minute Walk test) and computerized dynamic posturography.Results: The median Expanded Disability Status Scale score for the patient cohort was 3.0 (range 0.0–6.5). Both males and females with adrenoleukodystrophy showed impairments on all three functional gait assessments relative to controls (P < 0.001). Performance on walking tests and Expanded Disability Status Scale scores correlated with incidence of falls on computerized dynamic posturography, with the 25 Foot Walk being a moderately reliable predictor of fall risk (area under the ROC curve = 0.7675, P = 0.0038).Conclusion: We demonstrate that gait difficulties and postural control deficits occur in patients with adrenoleukodystrophy, albeit at an older age in females. Postural deficits were aggravated by eyes closed and dynamic conditions that rely on vestibular input, revealing challenges to the interplay of motor, sensory and vestibular circuitry in adrenoleukodystrophy.

scholarly journals Phototest for neurocognitive screening in multiple sclerosis

2016 ◽  
Vol 10 (1) ◽  
pp. 12-18
Author(s):  
Joana Pinto ◽  
Emanuela Lopes ◽  
Gerly Gonçalves ◽  
Ângela Silva ◽  
Carnero-Pardo ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Neurological Disorders ◽  
Area Under The Curve ◽  
Naming Task ◽  
Cognitive Test ◽  
Neurocognitive Impairments ◽  
Disability Status ◽  
Different Types ◽  
Fatigue Severity ◽  
Healthy Participants

Multiple Sclerosis (MS) is one of the most common neurological disorders. Cognitive dysfunction is considered a clinical marker of MS, where approximately half of patients with MS have cognitive impairment. Objective : The Phototest (PT) is a brief cognitive test with high diagnostic sensitivity, accuracy and cost-effectiveness for detecting cognitive deterioration. Our aim was to test the utility of the PT as a neurocognitive screening instrument for MS. Methods : The study enrolled 30 patients with different types of MS from an outpatient clinic as well as 19 healthy participants. In conjunction with the PT, the Montreal Cognitive Assessment (MoCA), Barthel Index (BI), Expanded Disability Status Scale (EDSS), and Fatigue Severity Scale (FSS) were administered. Results : The MS group obtained significantly lower results on all domains of the PT, except for the naming task. The PT showed good concurrent validity with the MoCA. In direct comparison to the MoCA, PT showed a greater area under the curve and higher levels of sensitivity and specificity for MS neurocognitive impairments. A cut-off score of 31 on the Phototest was associated with sensitivity of 100% and specificity of 76.7%. Conclusion : The PT is a valid, specific, sensitive and brief test that is not dependent on motor functions. The instrument could be an option for neurocognitive screening in MS, especially in identifying cases for further neuropsychological assessment and intervention.

scholarly journals Impact of the first COVID-19 pandemic wave on the Scottish Multiple Sclerosis Register population

2020 ◽  
Vol 5 ◽  
pp. 276
Author(s):  
Peter M. Fernandes ◽  
Martin O'Neill ◽  
Patrick K.A. Kearns ◽  
Sinforosa Pizzo ◽  
Chrissie Watters ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Alert System ◽  
Risk Of Death ◽  
The Past ◽  
Disease Modifying Therapy ◽  
Disability Status ◽  
Scottish Population ◽  
Clinical Diagnoses ◽  
The Impact ◽  
Pandemic Wave

Background: The impact of the coronavirus disease 2019 (COVID-19) pandemic on people with multiple sclerosis (MS) is a major current concern, in particular the risk of death. Here we describe the impact of the first wave of COVID-19 infections (Mar 2020-July 2020) on the Scottish MS Register (SMSR) population, a cohort of 4702 individuals with MS, all newly diagnosed in the past decade. Methods: We established a clinician alert system, linking the SMSR with the Electronic Communication of Surveillance in Scotland (ECOSS). This allows identification of patients within this cohort who had a positive SARS-CoV-2 PCR test. The SMSR was also linked to death records from National Records Scotland. Results: Of 4702 people with MS, 246 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) PCR tests were performed, of which 17 were positive. The proportion of positive tests were similar to the general Scotland population (Observed PCR confirmed cases = 17, expected = 17.5, O/E = 0.97, 95% CI: 0.60 – 1.56, p=.90). Between 1st March – 31st July 2020 12 individuals on the SMSR died, 5 of which were linked to COVID-19 (1 PCR confirmed, 4 clinical diagnoses without PCR confirmation). This number of COVID-19-related deaths was higher than expected (observed deaths = 5, expected deaths = 1.2, O/E = 4.03, 95% CI = 1.48 – 8.94, p=.01). All COVID-19-related deaths in the SMSR occurred in individuals with advanced disability (Expanded Disability Status Scale ≥7), and no deaths occurred in patients receiving disease modifying therapy (DMT) therapies. Conclusion: In this nationally comprehensive cohort of MS patients diagnosed in Scotland within the past 10 years, we observed similar rates of PCR-confirmed SARS-CoV-2 infection compared to the general Scottish population, but a small number of excess COVID-19 related deaths. These deaths occurred in individuals with advanced disability who were not receiving DMTs.

scholarly journals Use of a Short Version of the Activities-specific Balance Confidence Scale in Multiple Sclerosis

2019 ◽  
Vol 21 (1) ◽  
pp. 15-21
Author(s):  
Tyler A. Wood ◽  
Douglas A. Wajda ◽  
Jacob J. Sosnoff
Keyword(s):  
Multiple Sclerosis ◽  
Internal Consistency ◽  
Fall Risk ◽  
Convergent Validity ◽  
Internal Consistency Reliability ◽  
Self Report ◽  
Balance Confidence ◽  
Patient Reported ◽  
Good Internal Consistency ◽  
Abc Scale

Abstract Background: Multiple sclerosis (MS) is a neurologic disease that results in balance and mobility impairments that are associated with elevated fall risk. One common patient-reported outcome measure of balance is the 16-item Activities-specific Balance Confidence (ABC) scale. The ABC scale is valid and reliable in assessing balance confidence in people with MS. However, a shorter, six-question version of the ABC scale, the ABC-6 scale, has been proposed to save time in a clinical setting. Thus, we assessed the convergent validity and internal consistency reliability of the ABC-6 scale in people with MS. Methods: A total of 221 participants were included in this secondary analysis to compare the ABC-6 scale with the ABC scale. Convergent validity and internal consistency reliability were applied to participants based on fall history and physiological fall risk. Results: Statistical analysis indicated a main effect of group of the ABC and ABC-6 scales (P < .001). Both scales showed good to very good internal consistency (Cronbach α range, 0.832–0.975) and good reliability (intraclass correlation coefficient score range, 0.888–0.941). Furthermore, both versions had moderate convergent validity. Sensitivity ranged from 30% to 97%, and specificity ranged from 64% to 100% across groups tested. Conclusions: The ABC and ABC-6 scales demonstrated good internal consistency reliability and moderate convergent validity in predicting balance confidence in people with MS. However, poor sensitivity of both versions in distinguishing between MS groups at risk for falls may call into question the usefulness of this self-report measure.

scholarly journals Risk factors for fingolimod-induced lymphopenia in multiple sclerosis

2018 ◽  
Vol 4 (1) ◽  
pp. 205521731875969 ◽  
Author(s):  
Ryohei Ohtani ◽  
Masahiro Mori ◽  
Tomohiko Uchida ◽  
Akiyuki Uzawa ◽  
Hiroki Masuda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multiple Sclerosis ◽  
Interferon Beta ◽  
Disease Duration ◽  
Area Under The Curve ◽  
Absolute Lymphocyte Count ◽  
Medication History ◽  
Disability Status ◽  
History Of ◽  
One Year

Background Lymphopenia is a well-known adverse event of fingolimod, a disease-modifying drug for multiple sclerosis (MS). Objectives The objective of this paper is to investigate risk factors for predicting fingolimod-induced lymphopenia in MS by frequent hematological monitoring. Methods We retrospectively reviewed data of fingolimod-treated MS patients. Data assessed were sex, age, disease duration, medication history, body mass index, all attacks, Kurtzke’s Expanded Disability Status Scale score, and absolute lymphocyte count (ALC) within two days before initiating fingolimod (baseline), on the day after first administration (day 2), and at least every other month after initiating fingolimod therapy. Results Of 41 MS patients, marked lymphopenia (ALC <200/µl) was confirmed in 12 patients (lymphopenia group) within one year. A significantly more frequent history of treatment with any interferon-beta and lower median baseline ALC was observed in the lymphopenia group than in the non-lymphopenia group ( n = 29) (91.7% vs. 44.8%; p = 0.006 and 1469/µl vs. 1879/µl; p = 0.005). An ALC of ≤952/μl on day 2 was the most responsible risk factor for predicting marked lymphopenia (sensitivity, 92%; specificity, 76%; area under the curve, 0.823; p < 0.001). Conclusions Low baseline ALC and treatment history with any interferon-beta were risk factors for fingolimod-induced lymphopenia, possibly predicted from ALC on day 2.

scholarly journals Fear of Falling Is Associated with Recurrent Falls in People with Multiple Sclerosis

2015 ◽  
Vol 17 (4) ◽  
pp. 164-170 ◽  
Author(s):  
Rajarshi Mazumder ◽  
William E. Lambert ◽  
Thuan Nguyen ◽  
Dennis N. Bourdette ◽  
Michelle H. Cameron
Keyword(s):  
Multiple Sclerosis ◽  
Goodness Of Fit ◽  
Fear Of Falling ◽  
Fit Indices ◽  
The Past ◽  
Recurrent Falls ◽  
Disability Status ◽  
Confirmatory Factor ◽  
Risk Factors For Falls ◽  
Fit Index

Background: People with multiple sclerosis (MS) fall frequently, and there are few clinically valid tools to measure the risk factors for falls. We assessed the unidimensionality of the 7-item Falls Efficacy Scale–International (FES-I), a measure of fear of falling, and determined whether the 7-item FES-I is associated with recurrent falls in people with MS. Methods: Falls were counted prospectively for 6 months using fall calendars in 58 people with MS (age, 18–50 years; Expanded Disability Status Scale score, 0–6). The FES-I was administered at baseline, and its unidimensionality was assessed by confirmatory factor analysis. The relationship between FES-I score and future falls, after adjusting for recurrent falls in the past year, was assessed by logistic regression. Results: Fifty-four participants who completed all assessments were included in the analysis. Goodness-of-fit indices confirmed a single-factor solution for the 7-item FES-I (discrepancy χ2, P = .101; Tucker-Lewis index, 0.953; comparative fit index, 0.969; root mean square error of approximation, 0.098). There was a significant association between fear of falling and falls in the following 3 months, independent of recurrent falls in the past year (odds ratio = 1.22, 95% confidence interval, 1.04–1.43, P = .016). Conclusions: The 7-item FES-I demonstrates good construct validity, allowing the total score to be used as a measure of fear of falling in people with MS. Fear of falling, as measured by the 7-item FES-I, is associated with future recurrent falls independent of past recurrent falls in people with MS.

scholarly journals Relationship between Expanded Disability Status Scale scores and the presence of temporomandibular disorders in patients with multiple sclerosis

2018 ◽  
Vol 12 (01) ◽  
pp. 144-148 ◽  
Author(s):  
Lucas Senra Correa Carvalho ◽  
Osvaldo José Moreira Nascimento ◽  
Luciane Lacerda Franco Rocha Rodrigues ◽  
Andre Palma Da Cunha Matta
Keyword(s):  
Multiple Sclerosis ◽  
Temporomandibular Disorders ◽  
Control Group ◽  
Expanded Disability Status Scale ◽  
Exact Test ◽  
Disability Status ◽  
Relapsing Remitting ◽  
Scale Scores ◽  
Axis I ◽  
Relapsing Remitting Multiple Sclerosis

ABSTRACTObjectives: The objectives of this study were to assess the prevalence of temporomandibular disorders (TMDs) in patients with relapsing-remitting multiple sclerosis (MS) and to investigate whether an association exists between the presence of TMD symptoms and the degree of MS-related disability. Materials and Methods: In all, 120 individuals were evaluated: 60 patients with a diagnosis of relapsing-remitting MS and 60 age- and sex-matched controls without neurological impairments. A questionnaire recommended by the European Academy of Craniomandibular Disorders for the assessment of TMD symptoms was administered. For those who answered affirmatively to at least one of the questions, the RDC/TMD Axis I instrument was used for a possible classification of TMD subtypes. The Expanded Disability Status Scale (EDSS) was the measure of the degree of MS-related disability. Statistical Analysis Used: Fisher’s exact test was used to analyze the data. ANOVA was used to detect significant differences between means and to assess whether the factors influenced any of the dependent variables by comparing means from the different groups. Results: The prevalence of TMD symptoms in patients with MS was 61.7% versus 18.3% in the control group (CG). A diagnosis of TMD was established for 36.7% in the MS group and 3.3% in the CG (P = 0.0001). There were statistically significant differences between degrees of MS-related disability and the prevalence of TMD (P = 0.0288). Conclusions: The prevalence of both TMD and TMD symptoms was significantly greater in the MS group. EDSS scores and TMD prevalence rates were inversely related.

scholarly journals Determinants of therapeutic lag in multiple sclerosis

2021 ◽  
pp. 135245852098130
Author(s):  
Izanne Roos ◽  
Emmanuelle Leray ◽  
Federico Frascoli ◽  
Romain Casey ◽  
J William L Brown ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Expanded Disability Status Scale ◽  
Disability Progression ◽  
Delayed Onset ◽  
Disease Characteristics ◽  
Disability Status ◽  
Male Sex ◽  
Pre Treatment ◽  
Patient Subgroups

Background: A delayed onset of treatment effect, termed therapeutic lag, may influence the assessment of treatment response in some patient subgroups. Objectives: The objective of this study is to explore the associations of patient and disease characteristics with therapeutic lag on relapses and disability accumulation. Methods: Data from MSBase, a multinational multiple sclerosis (MS) registry, and OFSEP, the French MS registry, were used. Patients diagnosed with MS, minimum 1 year of exposure to MS treatment and 3 years of pre-treatment follow-up, were included in the analysis. Studied outcomes were incidence of relapses and disability accumulation. Therapeutic lag was calculated using an objective, validated method in subgroups stratified by patient and disease characteristics. Therapeutic lag under specific circumstances was then estimated in subgroups defined by combinations of clinical and demographic determinants. Results: High baseline disability scores, annualised relapse rate (ARR) ⩾ 1 and male sex were associated with longer therapeutic lag on disability progression in sufficiently populated groups: females with expanded disability status scale (EDSS) < 6 and ARR < 1 had mean lag of 26.6 weeks (95% CI = 18.2–34.9), males with EDSS < 6 and ARR < 1 31.0 weeks (95% CI = 25.3–36.8), females with EDSS < 6 and ARR ⩾ 1 44.8 weeks (95% CI = 24.5–65.1), and females with EDSS ⩾ 6 and ARR < 1 54.3 weeks (95% CI = 47.2–61.5). Conclusions: Pre-treatment EDSS and ARR are the most important determinants of therapeutic lag.

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