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

2006 ◽  
Vol 12 (5) ◽  
pp. 594-598 ◽  
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.

The patient's perception of a (reliable) change in the Multiple Sclerosis Functional C omposite

2004 ◽  
Vol 10 (1) ◽  
pp. 55-60 ◽  
Author(s):  
E LJ Hoogervorst ◽  
N F Kalkers ◽  
G R Cutter ◽  
B MJ Uitdehaag ◽  
C H Polman
Keyword(s):  
Multiple Sclerosis ◽  
Longitudinal Data ◽  
Functional Impairment ◽  
Outpatient Clinic ◽  
Cross Sectional ◽  
Reliable Change ◽  
Perceived Disability ◽  
Disability Scale ◽  
Patient’S Perception

Objective: To prospectively character ize the relation between two-year changes in functional impairment as measured by the Multiple Sclerosis Functio nal C omposite (MSFC) and changes in patient perceived disability as measured by the Guy’s Neurological Disability Scale (GNDS). Methods: O ne hundred and eighty-eight patients with multiple sclerosis (MS) were recruited at our outpatient clinic. Impairment and disability were assessed using the MSFC and G NDS at baseline and follow-up. Longitudinal correlations were studied between changes in MSFC and GNDS and their corresponding components. We also studied changes in G NDS in relation to what can be classified as a reliable change in MSFC; for example, 20% change in each MSFC component or a change of 0.5 in total MSFC score. In addition, we studied the change in total number of GNDS subcategories with a score of 3 or higher in relation to the predefined MSFC changes, these subcategories being indicative of the requirement for help by another person. Results: Despite good cross-sectional correlations between MSFC and GNDS, no significant correlation was found between longitudinal changes in MSFC and GNDS. A nalysing the change in GNDS in relation to the predefined MSFC changes shows that G NDS changes are nicely rank ordered when more stringent definitions of reliable change were applied. In addition, analysing the number of G NDS subcategories scored 3 or higher indicate that there is a profile of worsening on the MSFC being associated with increase in the amount of help required from others. Conclusion: O ur longitudinal data suggest that a reliable change is associated with a likewise change in patient perceived disability, the smallest reliable change being identified by at least 20% change in each MSFC component.

Factor structure of Guy’s Neurological Disability Scale in a sample of Dutch patients with multiple sclerosis

2011 ◽  
Vol 17 (12) ◽  
pp. 1498-1503 ◽  
Author(s):  
LB Mokkink ◽  
DL Knol ◽  
BMJ Uitdehaag
Keyword(s):  
Multiple Sclerosis ◽  
Factor Structure ◽  
General Factor ◽  
Cronbach’S Alpha ◽  
Neurological Disability ◽  
Structural Validity ◽  
Cronbach's Alpha ◽  
Disability Scale ◽  
Scale Scores ◽  
Item Factor Analysis

Background: Guy’s Neurological Disability Scale (GNDS) is designed to assess disability (i.e. activity limitations) in patients with multiple sclerosis. It contains 12 functional domains, each indicating a level of disability. Four domain scores and a total score can be calculated. Objective: The aim of this study was to evaluate the structural validity of the GNDS in a Dutch population who were definitely diagnosed as having multiple sclerosis. Methods: Data of 974 patients were available. The structural validity of the GNDS was evaluated by confirmatory item factor analysis (CIFA). Two first-order models and two bifactor models were investigated. Results: The best fitted model was a bifactor model with a general factor underlying all items, and 10 items loading on 3 group factors. Cronbach’s alpha on the general factor (0.78) and on the group factor spinal-plus (0.74) were satisfying. Cronbach’s alpha on the group factors mental (0.56) and bulbar (0.48) were low. Reliability based on CIFA was 0.85. Conclusion: Results showed a clear factor structure of the GNDS. It justifies the use of the total score of the GNDS. In addition, three sub-scale scores could be used.

scholarly journals Patients experiences with multiple sclerosis disease-modifying therapies in daily life – a qualitative interview study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anna Sippel ◽  
Karin Riemann-Lorenz ◽  
Jutta Scheiderbauer ◽  
Ingo Kleiter ◽  
Rebecca Morrison ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Decision Making ◽  
Daily Life ◽  
Interview Study ◽  
Disease Modifying Therapies ◽  
Qualitative Interview Study ◽  
Relapsing Remitting ◽  
Disease Modifying ◽  
Remitting Multiple Sclerosis ◽  
Relapsing Remitting Multiple Sclerosis

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.

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

2020 ◽  
Vol 17 (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.

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

2021 ◽  
Vol 84 ◽  
pp. 108-113
Author(s):  
Vrutangkumar V. Shah ◽  
James McNames ◽  
Graham Harker ◽  
Carolin Curtze ◽  
Patricia Carlson-Kuhta ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Daily Life ◽  
Gait Quality

Motor cortex excitability and fatigue in multiple sclerosis: a transcranial magnetic stimulation study

2005 ◽  
Vol 11 (3) ◽  
pp. 316-321 ◽  
Author(s):  
J Liepert ◽  
D Mingers ◽  
C Heesen ◽  
T Bäumer ◽  
C Weiller
Keyword(s):  
Multiple Sclerosis ◽  
Transcranial Magnetic Stimulation ◽  
Motor Cortex ◽  
Magnetic Stimulation ◽  
Primary Motor Cortex ◽  
Motor Task ◽  
Time Interval ◽  
Membrane Excitability ◽  
Motor Cortex Excitability ◽  
Fatigue Severity

We investigated electrophysiological correlates of fatigue in patients with multiple sclerosis (MS). Transcranial magnetic stimulation (TMS) was used to explore motor excitability in three groups of subjects: MS patients with fatigue (MS-F), MS patients without fatigue (MS-NF) and healthy control subjects. All participants had to perform a fatiguing hand-grip exercise. TMS was performed prior to and after the exercise. Prior to the motor task, MS-F patients had less inhibition in the primary motor cortex compared to both other groups. Postexercise, intracortical inhibition was still reduced in the MS-F patients compared to the MS-NF patients. In MS-F patients the postexercise time interval for normalization of the motor threshold was correlated with the fatigue severity. We conclude that MS patients with fatigue have an impairment of inhibitory circuits in their primary motor cortex. The results also indicate that fatigue severity is associated with an exercise-induced reduction of membrane excitability.

Anti-myelin antibodies predict the clinical outcome after a first episode suggestive of MS

2007 ◽  
Vol 13 (9) ◽  
pp. 1086-1094 ◽  
Author(s):  
V. Tomassini ◽  
L. De Giglio ◽  
M. Reindl ◽  
P. Russo ◽  
I. Pestalozza ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Brain Mri ◽  
First Episode ◽  
Time Interval ◽  
Serum Samples ◽  
Double Positive ◽  
Baseline Serum ◽  
Patients At Risk ◽  
In Cis

The aim of this study was to test the contribution of anti-myelin antibodies in predicting conversion from clinically isolated syndrome (CIS) to multiple sclerosis (MS) when considering either Poser's or McDonald's diagnostic criteria. Fifty-one patients with CIS and abnormal brain MRI were imaged monthly for six months and then at 12, 18, 24, 36 months. At baseline serum samples testing antibodies against myelin oligodendrocyte glycoprotein (anti-MOG) and myelin basic protein (anti-MBP) were collected. During the 36-month follow-up, 26 (51%) patients developed a relapse thus becoming clinically definite MS (CDMS) according to Poser's criteria; 46 (90.2%) patients converted to MS according to McDonald's criteria. Out of 51 patients, 28 (54.9%) had either double or single positivity for anti-myelin antibodies. Antibody status significantly predicted MS according to Poser's criteria ( P = 0.004), but did not according to the McDonald's criteria. When compared to antibody negative patients, the risk of developing a relapse was 8.9 (95% CI: 2.7—29.8; P < 0.001) for anti-MBP positive (anti-MBP+) patients and 1.5 (95% CI: 0.4—5.4; P = 0.564) for those anti-MOG positive (anti-MOG+); double positive patients (ie, anti-MBP+/anti-MOG+) had a risk of relapse's occurrence equal to 3.4 (95% CI: 1.1—10.2; P = 0.031). Also, the antibody status predicted the median time span from CIS to CDMS, that was of 36 months in the anti-MOG-/anti-MBP- group, 33 months in the anti-MOG+/anti-MBP- group, 24 months in the anti-MOG+/anti-MBP+ group and 12 months in the anti-MOG-/anti-MBP+ patients ( P = 0.003 by ANOVA). Our data support the prognostic value of anti-myelin antibodies in CIS patients at risk of CDMS, with positive patients showing shorter time interval to relapse occurrence than negative patients. Multiple Sclerosis 2007; 13: 1086—1094. http://msj.sagepub.com

scholarly journals Validation of the Guy's Neurological Disability Scale as a screening tool for cognitive impairment in multiple sclerosis

2019 ◽  
Vol 35 ◽  
pp. 272-275
Author(s):  
Ritsu Akatani ◽  
Norio Chihara ◽  
Hisatsugu Tachibana ◽  
Shusuke Koto ◽  
Hisatomo Kowa ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Impairment ◽  
Screening Tool ◽  
Neurological Disability ◽  
Disability Scale
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