Inpatient Rehabilitation: Prediction of Changes in Sensorimotor Performance in Multiple Sclerosis: A Pilot Study

Abstract

Inpatient rehabilitation has been shown to be an effective intervention for sensorimotor performance in multiple sclerosis (MS) patients. So far, predictions of the rehabilitation outcomes are limited. The objective was to predict inpatient rehabilitation outcomes by changes in the Watzmann Severity Scale (WSS), a statistical estimation of the EDSS by sensorimotor capacity. Sensorimotor performance and physical activity during rehabilitation (by actigraphy) were assessed in a sample of 28 MS patients at a facility for neurorehabilitation. Daily changes in the WSS were predicted by a model of multiple linear regression. The resulting model had an R2adjusted of 0.48 (p < 0.01) and revealed five impacting factors (a reduction in the WSS represents an improvement): the number of steps (β-weight = 0.52, p < 0.01), the duration of nocturnal rest time (β-weight = 0.46, p = 0.01), the EDSS at entry (β-weight = 0.38, p = 0.03), a relapsing-remitting MS (β-weight = 0.37, p = 0.03), and the performance in a visuomotor pursuit task with time pressure (β-weight = −0.35, p = 0.04). One standard deviation improvement was predicted when the patient at admission yielded 6600 fewer steps per day, 94 min less rest per night, −2.7 points in the EDSS at entry, a relapsing-remitting MS, and a pursuit task performance that decreased by 2.2 standard deviations. Overall, the patients improved by −0.22 ± 0.51 WSS points during 19.3 ± 4.5 d of inpatient rehabilitation. Different potential explanations of the findings are discussed, one of which proposes that the results reflect an unhealthy lifestyle which, in addition to MS, would explain the higher predicted improvements by rehabilitation tackling both MS and the patients’ lifestyle.

Changes in thumb tapping rates and central motor conduction times are associated in persons with multiple sclerosis

“…The more is broken, the more can be restored would be supported by the impact of starting performance in model 1 (10,000 TAP and the interaction term) and in model 2 (10 s TAP). However, this seems to be contradicted by the impact of the EDSS in model 2, being in line with previously published evidence from inpatient rehabilitation (lower EDSS grades predicting better improvements in sensorimotor performance) [4]. The EDSS alone probably did not show a significant association with changes in CMCT due to its emphasis on gait in moderate and higher grades.…”

“…The EDSS alone probably did not show a significant association with changes in CMCT due to its emphasis on gait in moderate and higher grades. Since longer timespans since the first manifestations were associated with higher reductions in CMCT, the EDSS could potentially represent the factor coined unhealthy lifestyle (from a perspective of neuroplasticity) [4] and the initial tapping performance of the specific sensorimotor impairment of the respective upper limb. This would support the assumption of the more is broken, the more can be restored and would underline the impact of the central nervous milieu as will be discussed in the following.…”

“…Tapping tasks have been shown to be a valid tool to assess disease severity and progression in multiple sclerosis (MS) [1][2][3][4][5][6][7][8] (expect in [9]), at least when participants are asked for maximum performance [1]. Commonly used dexterity tasks like the box-and-block or nine-hole peg test [10] are well associated with tapping performance [6,8,11], whereas such dexterity tasks can show low reliability [10] (but an intraclass correlation of 0.90 in [12]).…”

The Association Between Actigraphy-Derived Behavioral Clusters and Self-Reported Fatigue in Persons With Multiple Sclerosis: Cross-sectional Study

“…Such a missing association could indicate either insufficient validity of self-reports or objective assessments or, alternatively, low sensitivity of self-reports or current approaches to objectively assess such psychological constructs. Especially when considering fatigue and fatigability (since they are commonly assessed or recognized by their consequence, which is a lack of activity), actigraphy could be a feasible measure to continuously gather objective data [9] and circumvent "assessing a snapshot of the person's feelings and current interpretation of subjective experience" [4]. When anticipating a certain intraindividual and interindividual variance of self-reports, as there can be a plethora of biases [10][11][12], cluster analyses of actigraphic data would have the potential to identify behavioral patterns and validate self-reports by treating a cluster of persons as one type of person.…”