Association between perceived fatigue and gait parameters measured by an instrumented treadmill in people with multiple sclerosis: a cross-sectional study

Abstract

BackgroundMultiple sclerosis (MS) is a multi-focal progressive disorder of the central nervous system often resulting in diverse clinical manifestations. Symptomatic fatigue is quite common in people with MS (PwMS), with prevalence as high as 85%. Nevertheless, it remains poorly understood and its association with walking capabilities unclear. Therefore, the objective of this investigation was to examine the relationship between symptomatic fatigue and spatio-temporal parameters of gait in PwMS based on an instrumented treadmill.MethodsOne hundred and twenty-four relapsing-remitting patients diagnosed with MS, 84 women and 40 men aged 42.6 (S.D = 11.9), participated in this investigation. A convenience sample of 25 apparently healthy subjects, 15 women and 10 men aged 40.3 (S.D = 11.1), served as controls. Gait spatiotemporal parameters were obtained using the Zebris FDM-T Treadmill (Zebris1 Medical GmbH, Germany). The Modified Fatigue Impact Scale (MFIS), a self-reported questionnaire, was used to determine the level of symptomatic fatigue in the MS study group. PwMS were divided into two groups: fatigued and non-fatigued.ResultsForty-four PwMS were classified as suffering from fatigue (mean MFIS = 52.0, S.D = 13.7); 80 were classified as non-fatigued (mean MFIS = 14.5, S.D = 14.5). Individuals in the fatigued group walked slower than those in the non-fatigued group; 1.7 (S.D = 2.4) vs. 2.4 (S.D = 1.0); P < 0.001, respectively. Moreover, fatigued patients took smaller steps, had a shorter stride length, prolonged stance, double support phase and a shorter single support phase compared to the non-fatigued group. In the total group, fatigue was significantly correlated with 10 (out of 14) spatiotemporal parameters of gait, however, correlation scores <0.40 were considered as weak correlations. According to step one of the linear logistic regression analysis, the temporal gait component was found to explain 5.1% of the variance related to symptomatic fatigue, R2 = 0.051, χ2 (1) = 6.511, P = 0.011. Step two of the model added the gait spatial component, thus increasing the explaining variance to 9.3%; R2 = 0.093, χ2 (2) = 12.12, P = 0.002. The asymmetry gait parameter did not contribute to the equation.ConclusionsPerceived fatigue is related to walking speed in PwMS, nevertheless its contribution to level of fatigue is limited.

Changes in spatiotemporal gait patterns during flat ground walking and obstacle crossing 1 year after bariatric surgery

“…In a study of 597 older adults, double limb support was the best predictor of fall risk [28]. Also, prolonged double limb support is linked with perceived fatigue [29] and increased energy expenditure [30] during walking. Thus, reduced double limb support may lead to a more active lifestyle following bariatric surgery.…”

Clinical Assessment of Fatigability in Multiple Sclerosis: A Shift from Perception to Performance

“…Scores on both the FSS and FIS correlate with disease severity as determined by the extended disability status scale (EDSS) in PwMS (19). However, the FSS and FIS do not adequately reflect functional status established by clinical outcome measures such as the 6-min walk test (20, 21), gait speed, or temporal and spatial components of gait kinematics (22). Questionnaires may have poor association with indices of whole muscle fatigue derived from isometric muscle testing (18).…”

“…Of key importance is designing tests which can best mimic functional requirements of daily living. Current functional exams of performance in MS are not strongly associated with fatigue as a trait characteristic (20–22). Tests which may hold promise include the Short Physical Performance Battery Protocol (28), Adult Myopathy Assessment Tool (29), and the Functional Capacity Test developed by Dalgas et al (30).…”

Orthotic and therapeutic effect of functional electrical stimulation on fatigue induced gait patterns in people with multiple sclerosis

“…Fatigue in people with MS typically exacerbates pre-existing deficits in gait, with fatigued individuals demonstrating slower walking speeds with associated shorter step lengths and prolonged periods of double support compared to non-fatigued individuals [17]. Moreover, signs of impaired neuromuscular control of gait mechanics have been associated with the severity of fatigue experienced by people with MS [18,19].…”