scholarly journals Outcome measures used in trials on gait rehabilitation in multiple sclerosis: A systematic literature review

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257809
Author(s):  
L. Santisteban ◽  
M. Teremetz ◽  
J. Irazusta ◽  
P. G. Lindberg ◽  
A. Rodriguez-Larrad
Keyword(s):  
Multiple Sclerosis ◽  
Outcome Measures ◽  
Comprehensive Evaluation ◽  
Step Length ◽  
International Classification Of Functioning ◽  
Gait Rehabilitation ◽  
Timed Up And Go ◽  
Spatiotemporal Parameter ◽  
Spatiotemporal Parameters ◽  
Levels Of Functioning

Background Multiple Sclerosis (MS) is associated with impaired gait and a growing number of clinical trials have investigated efficacy of various interventions. Choice of outcome measures is crucial in determining efficiency of interventions. However, it remains unclear whether there is consensus on which outcome measures to use in gait intervention studies in MS. Objective We aimed to identify the commonly selected outcome measures in randomized controlled trials (RCTs) on gait rehabilitation interventions in people with MS. Additional aims were to identify which of the domains of the International Classification of Functioning, Disability and Health (ICF) are the most studied and to characterize how outcome measures are combined and adapted to MS severity. Methods Pubmed, Cochrane Central, Embase and Scopus databases were searched for RCT studies on gait interventions in people living with MS according to PRISMA guidelines. Results In 46 RCTs, we identified 69 different outcome measures. The most used outcome measures were 6-minute walking test and the Timed Up and Go test, used in 37% of the analyzed studies. They were followed by gait spatiotemporal parameters (35%) most often used to inform on gait speed, cadence, and step length. Fatigue was measured in 39% of studies. Participation was assessed in 50% of studies, albeit with a wide variety of scales. Only 39% of studies included measures covering all ICF levels, and Participation measures were rarely combined with gait spatiotemporal parameters (only two studies). Conclusions Selection of outcome measures remains heterogenous in RCTs on gait rehabilitation interventions in MS. However, there is a growing consensus on the need for quantitative gait spatiotemporal parameter measures combined with clinical assessments of gait, balance, and mobility in RCTs on gait interventions in MS. Future RCTs should incorporate measures of fatigue and measures from Participation domain of ICF to provide comprehensive evaluation of trial efficacy across all levels of functioning.

Toward a Consensus on Rehabilitation Outcomes in MS: Gait and Fatigue

2009 ◽  
Vol 11 (2) ◽  
pp. 67-78 ◽  
Author(s):  
Brian Hutchinson ◽  
Susan J. Forwell ◽  
Susan Bennett ◽  
Theodore Brown ◽  
Herb Karpatkin ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Outcome Measures ◽  
Consensus Conference ◽  
Timed Up And Go ◽  
Assessment Battery ◽  
Rehabilitation Professionals ◽  
Rehabilitation Outcomes ◽  
Dynamic Gait Index ◽  
Dynamic Gait

A multidisciplinary consensus conference was held on November 28–29, 2007, by the Consortium of Multiple Sclerosis Centers (CMSC) to determine the most appropriate outcome measures for gait and fatigue in people with multiple sclerosis (MS). The goals of this conference were to 1) improve understanding of gait and fatigue outcome measures being used by rehabilitation professionals treating people with MS; 2) establish consensus on outcome measures; and 3) establish consensus on required follow-up for transfer of this knowledge to rehabilitation professionals. The consensus conference and this document are the initial steps toward achieving the stated goals. Although many measures of fatigue exist, it was recommended that a global outcome measure for fatigue be developed that would 1) include a screen for the functional ramifications of fatigue for activities and participation; 2) be quick and easy to administer; 3) demonstrate psychometric integrity for MS; and 4) examine fatigue over a continuum of the MS disease course. In addition, it was recommended that an assessment battery for fatigue be developed. With respect to gait outcome measures, it was agreed that the following tools should be included in a preliminary chart for use in a clinical setting: the Timed 25-Foot Walk, Timed Up and Go test, Dynamic Gait Index, 6-Minute Walk, and self-reported 12-item Multiple Sclerosis Walking Scale. The global outcome fatigue measure and assessment battery are currently being developed, and work on a detailed gait outcome measures chart and additional research on commonly used gait outcome measures are in progress.

Assessing upper limb function in multiple sclerosis

2014 ◽  
Vol 20 (7) ◽  
pp. 775-784 ◽  
Author(s):  
Ilse Lamers ◽  
Peter Feys
Keyword(s):  
Multiple Sclerosis ◽  
Outcome Measures ◽  
Upper Limb ◽  
International Classification Of Functioning ◽  
Limb Function ◽  
Upper Limb Function ◽  
High Prevalence ◽  
Upper Limb Dysfunction

The need to fully assess upper limb function in multiple sclerosis (MS) has become increasingly clear with recent studies revealing a high prevalence of upper limb dysfunction in persons with MS leading to increased dependency and reduced quality of life. It is important that clinicians and researchers use tailored outcome measures to systematically describe upper limb (dys)function and evaluate potential deterioration or improvement on treatment. This topical review provides a comprehensive summary of currently used upper limb outcome measures in MS, classified according to the levels of the International Classification of Functioning (ICF). The clinical utility, strengths, weaknesses and psychometric properties of common upper limb outcome measures are discussed. Based on this information, recommendations for selecting appropriate upper limb outcome measures are given. The current shortcomings in assessment which need to be addressed are identified.

scholarly journals Core outcome measures for exercise studies in people with multiple sclerosis: recommendations from a multidisciplinary consensus meeting

2014 ◽  
Vol 20 (12) ◽  
pp. 1641-1650 ◽  
Author(s):  
Lorna Paul ◽  
Susan Coote ◽  
Jean Crosbie ◽  
Diane Dixon ◽  
Leigh Hale ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Multiple Sclerosis ◽  
Outcome Measures ◽  
Qualitative Evaluation ◽  
Consensus Meeting ◽  
International Consensus ◽  
Timed Up And Go ◽  
Impact Scale ◽  
Meta Analyses

Evidence shows that exercise is beneficial for people with multiple sclerosis (MS); however, statistical pooling of data is difficult because of the diversity of outcome measures used. The objective of this review is to report the recommendations of an International Consensus Meeting for a core set of outcome measures for use in exercise studies in MS. From the 100 categories of the International Classification of Function Core Sets for MS, 57 categories were considered as likely/potentially likely to be affected by exercise and were clustered into seven core groups. Outcome measures to address each group were evaluated regarding, for example, psychometric properties. The following are recommended: Modified Fatigue Impact Scale (MFIS) or Fatigue Severity Scale (FSS) for energy and drive, 6-Minute Walk Test (6MWT) for exercise tolerance, Timed Up and Go (TUG) for muscle function and moving around, Multiple Sclerosis Impact Scale (MSIS-29) or Multiple Sclerosis Quality of Life-54 Instrument (MSQoL54) for quality of life and body mass index (BMI) or waist-hip ratio (WHR) for the health risks associated with excess body fat. A cost effectiveness analysis and qualitative evaluation should be included where possible. Using these core measures ensures that future meta-analyses of exercise studies in MS are more robust and thus more effectively inform practice.

Gait Parameters of Older Adults according to Their Fall History and Functional Capacity While Walking at Different Speeds

Gerontology ◽  
2021 ◽  
pp. 1-12
Author(s):  
Letícia Pophal da Silva ◽  
Natália Boneti Moreira ◽  
Paulo Barbosa de Freitas ◽  
Gleber Pereira ◽  
André Luiz Felix Rodacki
Keyword(s):  
Older Adults ◽  
Functional Capacity ◽  
Walking Speed ◽  
Principal Component ◽  
Step Length ◽  
Community Dwelling ◽  
Timed Up And Go ◽  
Gait Parameters ◽  
Spatiotemporal Parameters ◽  
Walking Speeds

Introduction: It is believed that functional capacity and fall history are factors capable of influencing the gait parameters of older adults. Thus, the objective of this study was to verify whether gait parameters of community-dwelling older adults differ according to their functional capacity and fall history when walking at self-selected walking speed (SSWS) and fast walking speed (FWS) using principal component analysis (PCA). Methods: Two hundred ninety-five participants (82.3% women and 17.7% men) were allocated in four groups according to their fall history and functional capacity: non-fallers with higher functional capacity (NFHFC, n = 94; 69.3 ± 5.5 years), non-fallers with lower functional capacity (NFLFC, n = 114; 72.0 ± 8.1 years), fallers with higher functional capacity (FHFC, n = 29; 70.0 ± 6.0 years), and fallers with lower functional capacity (FLFC, n = 58; 72.5 ± 8.2 years). Fall history, anthropometric data, functional capacity by short physical performance battery and mobility by Timed Up and Go (TUG), and spatiotemporal gait parameters were evaluated. Results: Data analysis indicated that FLFC presented the lowest scores, especially in the Five Times Sit-to-Stand Test and TUG. The PCA showed that the first principal component (PC1) explained the most substantial amount of the data variability in both walking speeds (SSWS and FWS), predominantly including temporal parameters. PC2 composed by spatial outcomes (stride and step length and walking speed) showed the highest effect size. PC1 and PC2 were able to differentiate functional status, regardless of fall history. Conclusions: Functional capacity showed great importance when analyzing gait parameters at different walking speeds (SSWS and FWS), regardless of fall history. Older adults with high functional capacity demonstrate better performance during gait. Besides, spatiotemporal parameters are the main factors explaining gait variability, both in SSWS and FWS.

scholarly journals Real-World Goal Setting and Use of Outcome Measures According to the International Classification of Functioning, Disability and Health: A European Survey of Physical Therapy Practice in Multiple Sclerosis

2020 ◽  
Vol 17 (13) ◽  
pp. 4774 ◽  
Author(s):  
Kamila Řasová ◽  
Patrícia Martinková ◽  
Bernadita Soler ◽  
Jenny Freeman ◽  
Davide Cattaneo ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Physical Therapy ◽  
Outcome Measures ◽  
Goal Setting ◽  
Real World ◽  
International Classification Of Functioning ◽  
European Regions ◽  
Disability And Health ◽  
Northern Regions

Goal setting is a core component of physical therapy in multiple sclerosis (MS). It is unknown whether and to what extent goals are set at different levels of the International Classification of Functioning, Disability and Health (ICF), and whether, and to which, standardized outcome measures are used in real life for evaluation at the different ICF levels. Our aim was to describe the real-world use of goal setting and outcome measures in Europe. An online cross-sectional survey, completed by 212 physical therapists (PTs) specialized in MS from 26 European countries, was conducted. Differences between European regions and relationships between goals and assessments were analyzed. PTs regularly set goals, but did not always apply the Specific, Measurable, Achievable, Realistic, Timed (SMART) criteria. Regions did not differ in the range of activities assessed, but in goals set (e.g., Western and Northern regions set significantly more goals regarding leisure and work) and outcome measures used (e.g., the Berg Balance Scale was more frequently used in Northern regions). Quality of life was not routinely assessed, despite being viewed as an important therapy goal. Discrepancies existed both in goal setting and assessment across European regions. ICF assists in understanding these discrepancies and in guiding improved health-care for the future.

scholarly journals Leg Spasticity and Ambulation in Multiple Sclerosis

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Swathi Balantrapu ◽  
Jacob J. Sosnoff ◽  
John H. Pula ◽  
Brian M. Sandroff ◽  
Robert W. Motl
Keyword(s):  
Multiple Sclerosis ◽  
Rating Scale ◽  
Free Living ◽  
Timed Up And Go ◽  
Temporal Parameters ◽  
Multiple Measures ◽  
Point Rating Scale ◽  
Spatiotemporal Parameters ◽  
Walking Velocity ◽  
Minute Walk

Background. Spasticity of the legs is common in multiple sclerosis (MS), but there has been limited research examining its association with ambulatory outcomes.Objective. This study examined spasticity of the legs and its association with multiple measures of ambulation in persons with MS.Methods. The sample included 84 patients with MS. Spasticity of the legs was measured using a 5-point rating scale ranging between 0 (normal) and 4 (contracted). Patients completed the 6-minute walk (6 MW), timed 25 foot walk (T25FW), and timed up-and-go (TUG), and O2cost of walking was measured during the 6 MW. The patients undertook two walking trials on a GAITRite (CIR systems, Inc.) for measuring spatial and temporal parameters of gait. The patients completed the Multiple Sclerosis Walking Scale-12 (MSWS-12) and wore an accelerometer over a seven-day period.Results. 52% (n=44) of the sample presented with spasticity of the legs. Those with leg spasticity had significantly worse ambulation as measured by 6 MW (P=0.0001,d=-0.86), T25FW (P=0.003,d=0.72), TUG (P=0.001,d=0.84), MSWS-12 (P=0.0001,d=1.09), O2cost of walking (P=0.001,d=0.75), average steps/day (P<0.05,d=-0.45), and walking velocity (P<0.05,d=-0.53) and cadence (P<0.05,d=-0.46).Conclusion. Leg spasticity was associated with impairments in ambulation, including alterations in spatiotemporal parameters and free-living walking.

Digital Technology in Clinical Trials for Multiple Sclerosis: a systematic review. (Preprint)

2020 ◽  
Author(s):  
Marcello De Angelis ◽  
Luigi Lavorgna ◽  
Antonio Carotenuto ◽  
Martina Petruzzo ◽  
Roberta Lanzillo ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Trial ◽  
Clinical Trials ◽  
Outcome Measures ◽  
Digital Technology ◽  
Clinical Trial Design ◽  
Motor Rehabilitation ◽  
Robot Assisted ◽  
Future Directions ◽  
Treatment Side Effects

BACKGROUND Clinical trials in multiple sclerosis (MS) have leveraged the use of digital technology to overcome limitations in treatment and disease monitoring. OBJECTIVE To review the use of digital technology in concluded and ongoing MS clinical trials. METHODS In March 2020, we searched for “multiple sclerosis” and “trial” on pubmed.gov and clinicaltrials.gov using “app”, “digital”, “electronic”, “internet” and “mobile” as additional search words, separately. Overall, we included thirty-five studies. RESULTS Digital technology is part of clinical trial interventions to deliver psychotherapy and motor rehabilitation, with exergames, e-training, and robot-assisted exercises. Also, digital technology has become increasingly used to standardise previously existing outcome measures, with automatic acquisitions, reduced inconsistencies, and improved detection of symptoms. Some trials have been developing new patient-centred outcome measures for the detection of symptoms and of treatment side effects and adherence. CONCLUSIONS We will discuss how digital technology has been changing MS clinical trial design, and possible future directions for MS and neurology research.

The International Classification of Functioning, Disability, and Health (ICF) as a community participation model for people with multiple sclerosis: A hierarchical regression analysis

2020 ◽  
Vol 26 (2) ◽  
pp. 55-72
Author(s):  
Joseph Pfaller ◽  
Fong Chan ◽  
Kanako Iwanaga ◽  
Jia-Rung Wu ◽  
Stuart Rumrill ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Regression Analysis ◽  
Community Participation ◽  
International Classification Of Functioning ◽  
Self Management ◽  
Hierarchical Regression ◽  
Personal Factors ◽  
Disability And Health ◽  
The Relationship

AbstractMultiple sclerosis (MS) is a central nervous system disorder that impacts more than 400,000 people in the U.S. The disease results in multiple functional impairments that are diverse and varied across individuals. Additonally, MS has a profound impact on community participation which, like other rehabilitation outcomes, cannot be explained on the basis of functional limitations alone. The purpose of this study was to develop and evaluate a model of community participation for people living with MS using the World Health Organization (WHO) International Classification of Functioning, Disability, and Health (ICF) framework. The model focused on the roles that personal factors have as predictors of community participation, while also serving as mediators and moderators for the relationship between activity limitation and participation. Results from the hierarchical regression analysis indicated that demographic characteristics (i.e. MS type), personal factors (i.e. core self-evaluations (CSE), MS self-management, resilience, and social skills), and activity limitations accounted for 64% of the variance in participation. Further, mediation analysis indicated that CSE mediated the relationship between activity limitation and community participation. Finally, moderation analysis indicated an interaction effect between educational attainment and MS self-management. Implications for future research in rehabilitation and clinical application are discussed.

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