Knee flexor strength and balance control impairment may explain declines during prolonged walking in women with mild multiple sclerosis

Ramari, Cintia; Moraes, Andréa Gomes; Tauil, Carlos Bernardo; Glehn, Felipe von; Motl, Robert W.; David, Ana Cristina de

doi:10.1016/j.msard.2018.01.024

Cited by 23 publications

(15 citation statements)

References 23 publications

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“…No studies included patients based on a minimum of disability level; however, 7 out of 26 studies 13,16,17,26,38,40,41 had an upper limit for EDSS, which therefore may have led to a slight underestimation of deficits in the MS group. Healthy controls were matched for age and gender and for education level in 16 out of 26 studies.…”

Section: Methodological Considerations and Future Perspectivesmentioning

confidence: 99%

“…No studies included patients based on a minimum of disability level; however, 7 out of 26 studies 13,16,17,26,38,40,41 2), the CIS group presented deficits in line with or greater than the calculated mean deficit, indicating that the deficits are present even prior to the clinical MS diagnosis. This is in line with results from studies on biomarkers of neurodegeneration showing elevated levels of neurofilament light-chain as long as 6 years before clinical diagnosis.…”

Section: Methodological Considerations and Future Perspectivesmentioning

confidence: 99%

“…Bethune et al 37 Case-control Pediatric MS 1 a (0-6) 3.4 ± 3.5 33 9 Bonnet et al 28 Case-control RRMS 2.24 a (0-5. Pitteri et al 33 Case-control RRMS 2 a (0-4)/1 a (0-3) 0.5 ± 0.25/0.5 ± 0.17 14/36 7, 8, 9, 10, 11 Planche et al 42 Case-control CIS/RRMS 1.5 a (0-3.5) 0.97 ± 0.49 19 8, 9 Ramari et al 16 Case-control RRMS 2.5 a (1-3) 4.9 ± 3.9 28 1, 4, 6 Schulz et al 34 Case deficit is of clinical relevance, as the reported minimal threshold for clinical relevance is a change of 20% change in time for the 25-foot walk test (T25FWT) "within a person." 20 However, data from Heesen et al 22 and Green et al 23 show that patients rate walking function as one of the most important bodily functions.…”

Section: Physical Impairmentsmentioning

confidence: 99%

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Time matters: Early-phase multiple sclerosis is accompanied by considerable impairments across multiple domains

et al. 2020

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Impairments across multiple domains are a disabling consequence of multiple sclerosis (MS). Originating from preventive medical strategies, the “time matters”-perspective has become a focal point when treating MS. In particular, early detection of physical and cognitive deficits, along with deficits in patient-reported outcomes seems crucial to further optimize both pharmacological and non-pharmacological MS treatment strategies. Therefore, this topical review investigates the level of impairments across multiple domains (physical function, cognitive function, and patient-reported outcomes) in the early stage of MS (⩽5 years since diagnosis, including clinically isolated syndrome (CIS)), when compared to matched healthy controls. Even at early disease stages, studies show impairments corresponding to 8%–34% and small-to-large numerical effect sizes (0.35–2.85) in MS/CIS patients across domains. This evidence call for early screening programs along with early interventions targeting the multiple impaired domains. This further highlights the importance of preventive initiatives preserving and/or restoring physical and cognitive reserve capacity if possible.

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Section: Methodological Considerations and Future Perspectivesmentioning

confidence: 99%

Section: Methodological Considerations and Future Perspectivesmentioning

confidence: 99%

Section: Physical Impairmentsmentioning

confidence: 99%

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Time matters: Early-phase multiple sclerosis is accompanied by considerable impairments across multiple domains

et al. 2020

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“…Van Geel et al assessed the day-to-day reliability of Δ6MW, confirming consistent deceleration patterns in MS patients on two separate days ( 8 ). Ramari et al demonstrated that in females with mild MS, knee flexor strength and balance are linked to the deceleration pattern in the 6MW test ( 9 ). Using temporally more continuous data collected by wearable sensors, Shema-Shiratzky et al also demonstrated significant deterioration in cadence, stride regularity, and gait complexity among MS patients during 6MW tests ( 10 ).…”

Section: Introductionmentioning

confidence: 99%

Gait Speed Trajectory During the Six-Minute Walk Test in Multiple Sclerosis: A Measure of Walking Endurance

et al. 2021

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Background: The six-minute walk (6MW) test is a validated assessment method in Multiple Sclerosis (MS) research. While the total distance covered during six minutes (6MWTD) is often used as the standard measurement of gait capacity (i.e., the maximum distance one can achieve), we hypothesize that endurance (i.e., ability to maintain speed over a prolonged time) can be inferred by the gait speed trajectory (GST) during the 6MW test (6MWGST).Objective: To characterize group differences in 6MWGST between MS patients and healthy controls (HCs), and to assess information added by 6MWGST for discerning between MS patients and HCs.Methods: We performed a secondary data analysis on a cross-sectional cohort of 40 MS and 20 HC subjects with three repeated 6MW tests. We modeled 6MWGST using a linear mixed-effects model with time in minutes and replicated walks nested within individuals. We compared the discernibility of 6MWGST with that of conventional metrics using likelihood ratio tests and receiver operating characteristic (ROC) analysis on logistic regression models.Results: MS subjects showed a concave, quadratic GST during 6MW tests, slowing down more than the HC subjects, especially at the beginning of 6MW tests. Despite accelerating at the end of the 6MW, MS subjects were unable to attain or surpass their initial 6MW gait speeds. 6MWGST added useful information (p = 0.002) to the conventional metrics (e.g., 6MWTD) for discerning between MS and HC subjects, and increased the area under the ROC curve from 0.83 to 0.93 (p = 0.037).Conclusions: The distinctive 6MWGST pattern of MS patients provided increased discernibility compared with currently used gait metrics. Both gait capacity measured by the 6MWTD, and gait endurance measured by parameters of 6MWGST, are significant functional indicators for the MS population.

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“…MS patients have a broad variety of symptoms which differ greatly between individuals due to the severity of the condition [ 7 ]. Debilitation and fatigue are the most common symptoms of MS and can be followed by numbness in muscles, sensory impairment, spasticity, pain, depression, difficulties in balancing and vision, acute or chronic pain, tremor, and cognitive problems in concentration and memory [ 8 , 9 ]. Although many medications and interventions have been introduced to prevent the progression of neurological disability, many cases still meet the long-term course of multiple sclerosis [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Multiple sclerosis projection in Tehran, Iran using Bayesian structural time series

et al. 2021

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Background The prevalence of Multiple Sclerosis (MS) has been increasing worldwide and the highest prevalence ratio among Asian countries was reported in Iran. This study aims to estimate the increase in MS occurrence during more than three decades in Tehran and forecast the future condition of the disease using time series approaches for the next ten years. Methods The cross-sectional study was conducted from 1999 to 2019 based on records of MS cases from Iranian MS Society (IMSS) registry system. The prevalence was estimated using population data presented by the Statistical Centre of Iran. Through Bayesian Structural Time Series (BSTS) model, we want to predict the prevalence of familial and sporadic MS in the next ten years. . Results Among 22,421 cases with MS, 16,831 (75.1 %) were female and 5589 (24.9 %) were male. Female to male ratio was 3.0:1 and the number of familial MS cases were 2982 (13.3 %) of subjects. Female gender was less responsible for higher rate of MS in familial definition (beta = 0.020) in comparison to sporadic cases (beta = 0.034). Forecasting by BSTS revealed an increase in MS prevalence for the next ten years so that the prevalence rate for total, familial and sporadic MS respectively begins with 189.50 (183.94-195.14), 25.69 (24.97–26.45) and 163.74(159.06-168.57) in 2020 and ends with 220.84 (171.48-266.92), 30.79 (24.16–37.15), and 189.33(146.97-230.19) in 2029. Conclusions According to the findings, MS prevalence increased during three decades and it will increase over the next ten years. Tehran province is one of the regions with highest MS prevalence in Asia. The results of present study indicated that females are at higher risk for MS than males in both sporadic and familial MS.

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Knee flexor strength and balance control impairment may explain declines during prolonged walking in women with mild multiple sclerosis

Cited by 23 publications

References 23 publications

Time matters: Early-phase multiple sclerosis is accompanied by considerable impairments across multiple domains

Time matters: Early-phase multiple sclerosis is accompanied by considerable impairments across multiple domains

Gait Speed Trajectory During the Six-Minute Walk Test in Multiple Sclerosis: A Measure of Walking Endurance

Multiple sclerosis projection in Tehran, Iran using Bayesian structural time series

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