Understanding the Deterioration of Gait, Postural Control, Lower Limb Strength and Perceived Fatigue Across the Disability Spectrum of People with Multiple Sclerosis
Abstract
:1. Introduction
2. Experimental Section
2.1. Participants
2.2. Experimental Procedures
2.2.1. Balance and Core Stability Test
2.2.2. Gait Speed and Functional Mobility Tests
2.2.3. Lower Limb Strength Tests
2.2.4. Walking Endurance
2.3. Data Reduction
2.4. Statistical Analysis
3. Results
3.1. Differences between Disability Stages
3.2. Relative Weight Analysis
4. Discussion
4.1. The Decline of Physical Parameters in the Early Stages of the Disease (HC vs. MS1)
4.2. The Decline of Physical Parameters in Mildly Impaired PwMS (MS1 vs. MS2)
4.3. The Decline of Physical Parameters in Moderately Impaired PwMS (MS2 vs. MS3)
4.4. Perceived Fatigue across the Different Cohorts of PwMS
4.5. Relative Weight Analyses
4.6. Limitations
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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HC | MS1 | MS2 | MS3 | F | p | |
---|---|---|---|---|---|---|
Age (years) | 40.23 ± 8.15 | 36.70 ± 7.33 | 44.96 ± 7.77 * | 44.65 ± 8.03 * | 5.24 | 0.002 |
Height (m) | 165.34 ± 7.79 | 167.73 ± 9.68 | 163.57 ± 7.68 | 166.25 ± 10.64 | 0.32 | 0.812 |
Body mass (kg) | 66.99 ± 14.05 | 67.41 ± 10.07 | 64.21 ± 11.49 | 65.84 ± 15.17 | 0.81 | 0.494 |
EDSS | - | 1.10 ± 0.60 | 2.83 ± 0.51 | 5.08 ± 1.00 | 150.28 | <0.001 |
Disease Duration (years) | 6.15 ± 4.31 | 9.96 ± 5.30 | 11.60 ± 6.91 * | 5.02 | 0.010 | |
Female/Male (n) | 18/4 | 16/4 | 20/3 | 13/7 | ||
MS Type (n) | ||||||
Relapsing remitting | - | 20 | 21 | 13 | ||
Secondary progressive | - | - | 1 | 6 | ||
Primary progressive | - | - | 1 | 1 | ||
Disease-modifying drugs (n) | ||||||
Alemtuzumab | - | 1 | 2 | 1 | ||
Azathioprine | - | 0 | 1 | 0 | ||
Dimethyl-fumarate | - | 0 | 3 | 1 | ||
Fingolimod | - | 1 | 6 | 3 | ||
Interferon-beta | - | 4 | 4 | 2 | ||
Natalizumab | - | 7 | 1 | 2 | ||
Ocrelizumab | - | 0 | 1 | 1 | ||
Rituximab | - | 0 | 1 | 3 | ||
Teriflunomide | - | 2 | 2 | 0 | ||
Glatiramer acetate | - | 2 | 2 | 2 | ||
None | - | 3 | 0 | 5 | ||
Fampridine (n) | - | 0 | 0 | 6 |
Effect Size (Hedge’s g) | Percentage Differences | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
HC | MS1 | MS2 | MS3 | F | p | HC vs. MS1 | MS1 vs. MS2 | MS2 vs.MS3 | HC vs. MS1 | HC vs. MS2 † | HC vs. MS3 †† | |
Walk endurance, gait speed functional mobility | ||||||||||||
6MWT | 863.4 ± 145.4 | 746.6 ± 220.1 | 558.7 ± 125.6 | 322.3 ± 135.2 | 45.62 | <0.001 | 0.62 | 1.05 * | 1.78 * | 13.5 ± 25.5 | 35.3 ± 14.5 | 62.7 ± 15.7 |
T25FW | 2.50 ± 0.32 | 2.70 ± 0.38 | 3.24 ± 0.50 | 6.41 ± 1.67 | 86.74 | <0.001 | 0.55 | 1.19 * | 2.61 * | 7.8 ± 15.1 | 29.6 ± 20.0 | 156.3 ± 66.7 |
TUG | 4.70 ± 0.55 | 5.10 ± 0.58 | 5.86 ± 0.97 | 10.32 ± 2.54 | 71.09 | <0.001 | 0.69 | 0.91 * | 2.34 * | 8.4 ± 12.4 | 24.5 ± 20.6 | 119.3 ± 53.9 |
Whole-body balance, core stability and dizziness | ||||||||||||
TSWL | 7.94 ± 1.85 | 10.92 ± 3.03 | 14.99 ± 4.96 | 25.91 ± 8.29 | 46.43 | <0.001 | 1.18 * | 0.96 * | 1.64 * | 37.5 ± 38.1 | 88.8 ± 62.5 | 226.4 ± 104.4 |
TSSL | 7.22 ± 1.74 | 9.09 ± 2.17 | 12.77 ± 4.13 | 20.45 ± 7.30 | 36.17 | <0.001 | 0.94 * | 1.07 * | 1.31 * | 25.9 ± 30.1 | 76.9 ± 57.2 | 183.2 ± 101.1 |
US | 8.35 ± 3.22 | 10.79 ± 3.56 | 15.45 ± 5.40 | 23.91 ± 10.75 | 23.78 | <0.001 | 0.71 | 0.96 * | 1.00 * | 29.2 ± 42.6 | 85.1 ± 64.7 | 186.5 ± 128.7 |
DHI | - | 23.08 ± 20.01 | 32.09 ± 19.26 | 47.70 ± 17.20 | 8.26 | 0.001 | - | 0.47 | 0.75 * | - | - | - |
Knee strength | ||||||||||||
EXTWL | 1.90 ± 0.35 | 1.74 ± 0.39 | 1.43 ± 0.38 | 1.22 ± 0.46 | 12.41 | <0.001 | 0.43 | 0.77 | 0.50 | 8.7 ± 20.7 | 24.7 ± 20.1 | 35.9 ± 24.1 |
EXTSL | 2.03 ± 0.37 | 1.92 ± 0.38 | 1.61 ± 0.37 | 1.55 ± 0.35 | 8.54 | <0.001 | 0.30 | 0.79 * | 0.18 | 5.7 ± 18.8 | 20.6 ± 18.2 | 23.8 ± 17.3 |
FLXWL | 0.91 ± 0.21 | 0.80 ± 0.21 | 0.65 ± 0.21 | 0.37 ± 0.24 | 24.37 | <0.001 | 0.54 | 0.69 | 1.24 * | 12.4 ± 22.7 | 28.3 ± 22.7 | 58.9 ± 25.8 |
FLXSL | 1.01 ± 0.21 | 0.94 ± 0.18 | 0.80 ± 0.16 | 0.61 ± 0.22 | 16.81 | <0.001 | 0.33 | 0.81 | 0.97 * | 6.6 ± 18.1 | 20.7 ± 16.1 | 39.3 ± 21.7 |
Hip strength | ||||||||||||
ADDWL | 2.32 ± 0.93 | 1.67 ± 0.58 | 1.42 ± 0.38 | 1.36 ± 0.38 | 12.25 | <0.001 | 0.82 * | 0.49 | 0.17 | 28.2 ± 24.9 | 38.7 ± 16.4 | 41.4 ± 16.2 |
ADDSL | 2.62 ± 1.07 | 1.97 ± 0.57 | 1.61 ± 0.40 | 1.59 ± 0.42 | 11.00 | <0.001 | 0.73 | 0.74 | 0.03 | 24.7 ± 21.7 | 38.6 ± 15.1 | 39.2 ± 16.2 |
ABDWL | 2.70 ± 0.95 | 1.89 ± 0.48 | 1.64 ± 0.39 | 1.39 ± 0.51 | 17.93 | <0.001 | 1.04 * | 0.58 | 0.53 | 29.9 ± 17.7 | 39.4 ± 14.6 | 48.6 ± 19.0 |
ABDSL | 3.10 ± 0.94 | 2.18 ± 0.50 | 1.81 ± 0.43 | 1.79 ± 0.52 | 20.43 | <0.001 | 1.18 * | 0.78 | 0.04 | 29.7 ± 16.0 | 41.6 ± 14.0 | 42.2 ± 16.7 |
Perceived fatigue | ||||||||||||
MFIS | - | 40.55 ± 15.29 | 44.83 ± 12.01 | 40.95 ± 14.97 | 0.620 | 0.54 | - | 0.31 | −0.28 | - | - | - |
Explained Variance (%, Adjusted R2) | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Total | 1st PF | 2nd PF | 3rd PF | 4th PF | 5th PF | 6th PF | 7th PF | 8th PF | 9th PF | ||
6MWT | 71.0 | Predictor | FLXWL | FLXSL | TSWL | TSSL | EXTWL | ABDSL | DHI | EXTSL | ABDWL |
Mean | 16.4 | 14.8 | 7.7 | 7.0 | 6.4 A | 4.9 | 4.9 | 4.5 | 4.3 | ||
(95% CI) | (10.6–22.7) | (9.1–21.7) | (3.6–12.3) | (2.9–13.2) | (2.7–10.9) | (1.4–9.3) | (1.4–9.9) | (1.6–8.4) | (1.3–7.6) | ||
T25FW | 60.6 | Predictor | FLXWL | TSWL | FLXSL | US | EXTWL | ||||
Mean | 18.8 | 18.2 | 11.6 | 7.4 | 4.6 A,B | ||||||
(95% CI) | (7.8–31.3) | (7.9–34.5) | (5.3–20.2) | (1.9–17.4) | (1.5–9.7) | ||||||
TUG | 61.7 | Predictor | FLXWL | TSWL | US | FLXSL | EXTWL | DHI | |||
Mean | 16.8 | 13.3 | 11.3 | 9.4 | 5.7 A | 5.2 A | |||||
(95% CI) | (6.5–28.9) | (4.9–27.7) | (4.1–22.8) | (3.5–14.9) | (1.6–11.4) | (1.2–11.6) |
Main Target | Complementary Activities | |
---|---|---|
MS1 | Balance exercises Hip strength exercises | Lower limb resistance training Core stability |
MS2 | Comprehensive program. Lower limb resistance training Balance and core stability exercises | Knee flexors resistance exercises Increased work out on the weakest leg Functional mobility task |
MS3 | Knee flexors resistance exercises Increased work out on the weakest leg Balance exercises Gait and functional mobility tasks | Core stability exercises Hip strength exercises |
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Moreno-Navarro, P.; Gomez-Illán, R.; Carpena-Juan, C.; P. Sempere, Á.; Vera-Garcia, F.J.; Barbado, D. Understanding the Deterioration of Gait, Postural Control, Lower Limb Strength and Perceived Fatigue Across the Disability Spectrum of People with Multiple Sclerosis. J. Clin. Med. 2020, 9, 1385. https://doi.org/10.3390/jcm9051385
Moreno-Navarro P, Gomez-Illán R, Carpena-Juan C, P. Sempere Á, Vera-Garcia FJ, Barbado D. Understanding the Deterioration of Gait, Postural Control, Lower Limb Strength and Perceived Fatigue Across the Disability Spectrum of People with Multiple Sclerosis. Journal of Clinical Medicine. 2020; 9(5):1385. https://doi.org/10.3390/jcm9051385
Chicago/Turabian StyleMoreno-Navarro, Pedro, Ramón Gomez-Illán, Carmen Carpena-Juan, Ángel P. Sempere, Francisco J. Vera-Garcia, and David Barbado. 2020. "Understanding the Deterioration of Gait, Postural Control, Lower Limb Strength and Perceived Fatigue Across the Disability Spectrum of People with Multiple Sclerosis" Journal of Clinical Medicine 9, no. 5: 1385. https://doi.org/10.3390/jcm9051385