Effects of COVID-19 “Sheltering in Place” on Activity in People With Multiple Sclerosis

Block, Valerie J; Bove, Riley; Gelfand, Jeffrey M.; Cree, Bruce A.C.

doi:10.1212/cpj.0000000000000982

Cited by 8 publications

(5 citation statements)

References 9 publications

(12 reference statements)

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“…The cause is likely multifactorial. During the pandemic, many PwNID were no longer able to access resources such as community centers, gyms, public transportation, home care and rehabilitative services ( Block et al., 2021 ; Lebrasseur et al., 2021 ), and there may have been interruptions with access to infusion therapies for the 54.6% of patients who reported current infusion DMT therapy (Supplemental Table 4). These restrictions would likely have a greater adverse effect on those with pre-existing physical limitations.…”

Section: Discussionmentioning

confidence: 99%

Worsening physical functioning in patients with neuroinflammatory disease during the COVID-19 pandemic

Levit¹,

Cohen²,

Dahl³

et al. 2022

Multiple Sclerosis and Related Disorders

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To quantify changes in psychological wellbeing and physical function as reported by people with neurological inflammatory disease (PwNID) during the COVID-19 pandemic. Methods: 1134 PwNID and 868 control participants were recruited through five major academic medical centers in the Northeast/Mid-Atlantic U.S. beginning in April 2020. Participants completed serial surveys throughout the COVID-19 pandemic that aimed to quantify mood symptoms and physical function, analyzed cross-sectionally with a smaller cohort analyzed longitudinally. Results: Throughout the pandemic, depression scores were not significantly different between PwNID and controls, although a higher proportion of PwNID reported clinically significant depression at study entry. Depression scores did not worsen over time for either group. Loneliness was the strongest predictor of worse depression, along with older age, male gender in both PwNID and controls, as well as lack of disease modifying therapy use, and disease duration in PwNID only. In contrast, physical disability worsened significantly over time for both PwNID and controls. Age, DMT status and comorbid health conditions emerged as significant predictors of physical function. Conclusions: Depressive symptoms remained consistent for both PwNID and controls throughout the COVID-19 pandemic, but physical function worsened significantly over time for both groups. This is particularly impactful for PwNID, who have higher baseline levels of physical disability, and underscores the importance of reinstituting services and interventions that facilitate exercise and reconditioning for this population.

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Section: Discussionmentioning

confidence: 99%

Worsening physical functioning in patients with neuroinflammatory disease during the COVID-19 pandemic

Levit¹,

Cohen²,

Dahl³

et al. 2022

Multiple Sclerosis and Related Disorders

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“…Numerically, there did seem to be a slightly higher percentage of participants with progression in recent years, suggesting perhaps true change brought about by the pandemic. Reports on the effects of restricted outings on patient function during the pandemic are mixed: some but not all patients experienced clinically meaningful decreases in ambulatory activity 30 and physical function. 31 While some patients reported isolation and worse mood, others enjoyed the respite.…”

Section: Discussionmentioning

confidence: 99%

Remote Observational Research for Multiple Sclerosis

Bove

Poole

Cuneo

et al. 2023

Neurol Neuroimmunol Neuroinflamm

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Background and ObjectivesProspective, deeply phenotyped research cohorts monitoring individuals with chronic neurologic conditions, such as multiple sclerosis (MS), depend on continued participant engagement. The COVID-19 pandemic restricted in-clinic research activities, threatening this longitudinal engagement, but also forced adoption of televideo-enabled care. This offered a natural experiment in which to analyze key dimensions of remote research: (1) comparison of remote vs in-clinic visit costs from multiple perspectives and (2) comparison of the remote with in-clinic measures in cross-sectional and longitudinal disability evaluations.MethodsBetween March 2020 and December 2021, 207 MS cohort participants underwent hybrid in-clinic and virtual research visits; 96 contributed 100 “matched visits,” that is, in-clinic (Neurostatus-Expanded Disability Status Scale [NS-EDSS]) and remote (televideo-enabled EDSS [tele-EDSS]; electronic patient-reported EDSS [ePR-EDSS]) evaluations. Clinical, demographic, and socioeconomic characteristics of participants were collected.ResultsThe costs of remote visits were lower than in-clinic visits for research investigators (facilities, personnel, parking, participant compensation) but also for participants (travel, caregiver time) and carbon footprint (p< 0.05 for each). Median cohort EDSS was similar between the 3 modalities (NS-EDSS: 2, tele-EDSS: 1.5, ePR-EDSS: 2, range 0.6.5); the remote evaluations were each noninferior to the NS-EDSS within ±0.5 EDSS point (TOST for noninferiority,p< 0.01 for each). Furthermore, year to year, the % of participants with worsening/stable/improved EDSS scores was similar, whether each annual evaluation used NS-EDSS or whether it switched from NS-EDSS to tele-EDSS.DiscussionAltogether, the current findings suggest that remote evaluations can reduce the costs of research participation for patients, while providing a reasonable evaluation of disability trajectory longitudinally. This could inform the design of remote research that is more inclusive of diverse participants.

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“…Furthermore, studies on remote activity monitoring showed that relatively small sample sizes were needed to detect a clinically meaningful difference in STEPS between treatment groups. 16,17 The objective of this study was to evaluate the association of structural central nervous system (CNS) pathology (MR imaging) with physical ambulatory disability (STEPS). The primary hypothesis was that spinal cord atrophy is a relevant anatomic substrate for STEPS, and therefore, spinal cord areas as well as brain deep and cortical GM volumes would correlate with STEPS.…”

Section: Association Of Daily Physical Activity With Brain Volumes An...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association of daily physical activity with brain volumes and cervical spinal cord areas in multiple sclerosis

et al. 2022

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Background: Remote activity monitoring has the potential to evaluate real-world, motor function, and disability at home. The relationships of daily physical activity with spinal cord white matter and gray matter (GM) areas, multiple sclerosis (MS) disability and leg function, are unknown. Objective: Evaluate the association of structural central nervous system pathology with ambulatory disability. Methods: Fifty adults with progressive or relapsing MS with motor disability who could walk >2 minutes were assessed using clinician-evaluated, patient-reported outcomes, and quantitative brain and spinal cord magnetic resonance imaging (MRI) measures. Fitbit Flex2, worn on the non-dominant wrist, remotely assessed activity over 30 days. Univariate and multivariate analyses were performed to assess correlations between physical activity and other disability metrics. Results: Mean age was 53.3 years and median Expanded Disability Status Scale (EDSS) was 4.0. Average daily step counts (STEPS) were highly correlated with EDSS and walking measures. Greater STEPS were significantly correlated with greater C2-C3 spinal cord GM areas (ρ = 0.39, p = 0.04), total cord area (TCA; ρ = 0.35, p = 0.04), and cortical GM volume (ρ = 0.32, p = 0.04). Conclusion These results provide preliminary evidence that spinal cord GM area is a neuroanatomical substrate associated with STEPS. STEPS could serve as a proxy to alert clinicians and researchers to possible changes in structural nervous system pathology.

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Effects of COVID-19 “Sheltering in Place” on Activity in People With Multiple Sclerosis

Cited by 8 publications

References 9 publications

Worsening physical functioning in patients with neuroinflammatory disease during the COVID-19 pandemic

Worsening physical functioning in patients with neuroinflammatory disease during the COVID-19 pandemic

Remote Observational Research for Multiple Sclerosis

Association of daily physical activity with brain volumes and cervical spinal cord areas in multiple sclerosis

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