Clinical manifestation and perceived symptoms of walking-related performance fatigability in persons with multiple sclerosis

Geel, Fanny Van; Bielen, Hanne; Theunissen, Kyra; Moumdjian, Lousin; Nieuwenhoven, Johan Van; Wijmeersch, Bart Van; Meesen, Raf; Ramari, Cintia; Feys, Peter

doi:10.1097/mrr.0000000000000457

Cited by 7 publications

(8 citation statements)

References 21 publications

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“…Multiple sclerosis (MS) is a chronic inflammatory autoimmune disease, and its characteristic pathological change is multiple demyelinating plaques in the central nervous system (Compston and Coles, 2008;Lakin et al, 2021). The patient's immune system attacks nerve tissue, causing neurological damage, followed by the development of clinical symptoms such as fatigue, spasticity, balance problems, cognitive impairment, and mood changes (Goldenberg, 2012;Valentine et al, 2021;Van Geel et al, 2021;Cochrane et al, 2021). MS is more common in young adults and is one of the most common causes of neurological disability in young adults.…”

Section: Introductionmentioning

confidence: 99%

Effects of repetitive transcranial magnetic stimulation in multiple sclerosis: A systematic review and meta-analysis

Chen

Yin

et al. 2022

Multiple Sclerosis and Related Disorders

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This study aims to quantitatively evaluate and summarize the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in the treatment of patients with multiple sclerosis (MS). Methods: The PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, CBM, CNKI and Wanfang databases were searched for randomized controlled trails (RCTs) from their inception through July 10, 2021. RCTs that met the inclusion and exclusion criteria were included in the study, and RevMan software was used for meta-analysis. Outcome indicators included scores on the fatigue severity scale (FSS), modified Ashworth scale (MAS) and the H/M amplitude ratio of the Soleus H reflex. When p < 0.05, the difference was considered significant. Results: A total of 10 articles were included in this study, with 8 of them in the quantitative synthesis. The metaanalysis showed that the short-term effect of rTMS treatment for the MAS was better than that of the control treatment (95% CI: − 1.27 to − 0.25, p = 0.004); and compared with the control group, the effect of rTMS treatment for the H/M ratio showed a significant effect (95% CI: − 0.12 to − 0.03, p = 0.002); while the treatment effect for the FSS was not significant (95% CI: − 4.87 to 1.28, p = 0.25). Conclusion: Our results provide preliminary evidence for the treatment of patients with MS by rTMS, especially for improving spasticity, but further research is needed to evaluate its effects on fatigue.

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Section: Introductionmentioning

confidence: 99%

Effects of repetitive transcranial magnetic stimulation in multiple sclerosis: A systematic review and meta-analysis

Chen

Yin

et al. 2022

Multiple Sclerosis and Related Disorders

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“…6 Walking fatigability is caused by MS-related symptoms such as increased spasticity, lower knee flexor/extensor muscle strength of the weakest leg, and impairments in balance. 6,8,9 In recent years, studies have defined walking fatigability through different methods, such as investigating the dynamics of walking speed 10,11 or the gait speed trajectory, 12 minute-by-minute, in the 6MWT. Another clinical definition very well used is the decrease of at least 10% in distance walked toward the end of the 6MWT, 13 affecting up to 50% of moderate-to-severe disabled pwMS.…”

Section: Introductionmentioning

confidence: 99%

“…2,3 Walking impairments are caused by many factors, such as spasticity, lower limb muscle weakness and/or loss in gait automaticity. [4][5][6] In addition, fatigue in MS is also multifactorial and complex, including fatigability (ie, a decrease in performance in a given task) being an essential component of this symptom. 7 Within the fatigability construct, walking fatigability has been increasingly investigated at the activity level of the International Classification of Functioning, Disability, and Health (ICF) identified during prolonged walking protocols such as the 6-minute walking test (6MWT).…”

Section: Introductionmentioning

confidence: 99%

“…7 Within the fatigability construct, walking fatigability has been increasingly investigated at the activity level of the International Classification of Functioning, Disability, and Health (ICF) identified during prolonged walking protocols such as the 6-minute walking test (6MWT). 6 Walking fatigability is caused by MS-related symptoms such as increased spasticity, lower knee flexor/extensor muscle strength of the weakest leg, and impairments in balance. 6,8,9 In recent years, studies have defined walking fatigability through different methods, such as investigating the dynamics of walking speed 10,11 or the gait speed trajectory, 12 minute-by-minute, in the 6MWT.…”

Section: Introductionmentioning

confidence: 99%

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Between-Day Reliability of the Gait Characteristics and Their Changes During the 6-Minute Walking Test in People With Multiple Sclerosis

Santinelli,

Ramari,

Poncelet

et al. 2024

Neurorehabil Neural Repair

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Background Gait characteristics and their changes during the 6-minute walking test (6MWT) in people with multiple sclerosis (pwMS) have been described in the literature, which one may refer to as walking fatigability in the body function level of the International Classification of Functioning, Disability, and Health. However, whether these metrics are reliable is unknown. Objective To investigate the between-day reliability of the gait characteristics and their changes in pwMS and healthy controls (HCs). Methods Forty-nine pwMS (EDSS 4.82 ± 1.22 and 54.7 ± 9.36 years) and 23 HCs (50.6 ± 6.1 years) performed the 6MWT, as fast as possible but safely while wearing Inertial Measurement Units. Gait characteristics were measured in the pace, rhythm, variability, asymmetry, kinematics, coordination, and postural control domains and were obtained in intervals of 1 minute during the 6MWT. In addition, gait characteristics change in the last minute compared with the first minute were calculated for all gait variables using a fatigability index (ie, distance walking index). The intraclass correlation coefficient (ICC), Bland–Altman Plots, and Standard error of measurement were applied to investigate reliability. Results Reliability of gait characteristics, minute-by-minute, and for their changes (ie, using the fatigability index) ranged from poor to excellent (pwMS: ICC 0.46-0.96; HC: ICC 0.09-0.97 and pwMS: ICC 0-0.72; HC: ICC 0-0.77, respectively). Conclusion Besides coordination, at least 1 variable of each gait domain showed an ICC of moderate or good reliability for gait characteristics changes in both pwMS and HC. These metrics can be incorporated into future clinical trials and research on walking fatigability. Clinical Trial Registration: NCT05412043.

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“…Walking-related fatigability limits the mobility of pwMS in daily life, and is prevalent in up to half of pwMS with moderate to severe impairments ( Leone et al, 2016 ). During the 6MWT, pwMS perceive more balance problems and gait impairments, and report overall higher state fatigue levels across minutes ( Van Geel et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

Interlimb Coordination Performance in Seated Position in Persons With Multiple Sclerosis: Reduced Amplitude Over 6 min and Higher Coordination Variability in Persons With Walking Fatigability

Goetschalckx

Geel

Meesen

et al. 2021

Front. Hum. Neurosci.

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Background: Walking fatigability is prevalent in MS and can be measured by a percentage distance decline during a 6-min walking test. Walking is characterized by an accurate and consistent interlimb antiphase coordination pattern. A decline in coordination each minute during a 6-min walking test is observed in persons with MS (pwMS). Measuring coordination during a 6-min seated coordination task with minimized balance and strength requirements, is assumed to examine a more fundamental interlimb antiphase coordination pattern in pwMS. This research aimed to answer the following research question: How does interlimb antiphase coordination pattern change during a seated coordination task in pwMS with walking fatigability (WF), non-walking fatigability (NWF) and Healthy Controls (HC)?Methods: Thirty-five pwMS and 13 HC participated. Interlimb coordination was assessed by a seated 6-min coordination task (6MCT) with the instruction to perform antiphase lower leg movements as fast as possible. Outcomes were Phase Coordination Index (PCI) and movement parameters (amplitude, frequency).Results: Mixed models revealed a significant effect of time for the the variability of generating interlimb movements, with a difference in mean values between WF and HC. A significant group∗time interaction effect was found for movement amplitude, represented by a significant decrease in movement amplitude in the WF group from minute 1 to the end of the task.Conclusion: The higher variability in interlimb coordination and decrease in movement amplitude over time during the 6MCT in the WF group could be an indicator of decreased control of fundamental antiphase coordination pattern in pwMS with walking fatigability.Clinical Trial Registration:www.clinicaltrials.gov, identifier NCT04142853 (registration date: October 29, 2019) and NCT03938558 (registration date: May 6, 2019).

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Clinical manifestation and perceived symptoms of walking-related performance fatigability in persons with multiple sclerosis

Cited by 7 publications

References 21 publications

Effects of repetitive transcranial magnetic stimulation in multiple sclerosis: A systematic review and meta-analysis

Effects of repetitive transcranial magnetic stimulation in multiple sclerosis: A systematic review and meta-analysis

Between-Day Reliability of the Gait Characteristics and Their Changes During the 6-Minute Walking Test in People With Multiple Sclerosis

Interlimb Coordination Performance in Seated Position in Persons With Multiple Sclerosis: Reduced Amplitude Over 6 min and Higher Coordination Variability in Persons With Walking Fatigability

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