Symptom variability, affect and physical activity in ambulatory persons with multiple sclerosis: Understanding patterns and time-bound relationships

Kasser, Susan L.; Goldstein, Amanda; Wood, Phillip K.; Sibold, Jeremy

doi:10.1016/j.dhjo.2016.10.006

Cited by 25 publications

(28 citation statements)

References 52 publications

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“…Consistent with previous research 32,34,35 , these data show that in ambulatory people with MS, symptoms are not static, but are experienced dynamically. Fatigue emerged as the most variable symptom, with a high ratio of within- to between-person variability, and the greatest change from wake to bed time.…”

Section: Discussionsupporting

confidence: 91%

“…In this study, we examined within-person variability and diurnal patterns in pain, fatigue, depressed mood, and cognitive function over 7 days. Based on previous findings 32,34,35 , we hypothesized that fatigue and depressed mood would demonstrate relatively higher levels of within-person variability compared to other symptoms and that all symptoms would exhibit a diurnal increase in severity throughout the day. We explored whether age, sex, MS subtype, MS duration, work status, and education level were related to different diurnal symptom patterns.…”

mentioning

confidence: 99%

“…Studies that examined daily symptoms in MS have shown significant within-person variability in fatigue and depressed mood, with less variability for pain intensity 32,33 , significant individual differences in diurnal fluctuations in fatigue 34 , and significant daily fatigue fluctuations that are more related to physical exertion in those with compared to those without MS 35 . While these studies provide initial evidence as to daily symptom variability in MS, they are somewhat limited by small sample sizes 32,33,35 and a focus on fatigue 33,34 . Greater understanding of the variability of MS symptoms could provide insight into how symptoms are experienced in daily life, inform approaches to measuring symptoms, and optimize behavioral and pharmacological treatments for symptoms in MS.…”

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confidence: 99%

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Ecological Momentary Assessment of Pain, Fatigue, Depressive, and Cognitive Symptoms Reveals Significant Daily Variability in Multiple Sclerosis

Kratz

Murphy

Braley

2017

Archives of Physical Medicine and Rehabilitation

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Objective To describe the daily variability and patterns of pain, fatigue, depressed mood, and cognitive function in persons with multiple sclerosis (MS). Design Repeated-measures observational study of seven consecutive days of home monitoring, including ecological momentary assessment (EMA) of symptoms. Multilevel mixed models were used to analyze data. Setting General community. Participants Ambulatory adults (N=107) with MS recruited through [Masked] and surrounding community. Interventions Not applicable. Main Outcome Measure(s) EMA measures of pain, fatigue, depressed mood, and cognitive function rated on a 0–10 scale, collected five times a day for seven days. Results Cognitive function and depressed mood exhibited more stable within-person patterns compared to pain and fatigue, which varied considerably within-person. All symptoms increased in intensity across the day (all p<0.02) with fatigue showing the most substantial increase. Notably, this diurnal increase varied by sex and age; women showed a continuous increase from wake to bedtime, whereas fatigue plateaued after 7PM for men (wake-bed B=1.04, p=0.004). For the oldest subgroup, diurnal increases were concentrated to the middle of the day compared to younger subgroups, which showed an earlier onset of fatigue increase and sustained increases until bed time (wake-3pm B=0.04, p=0.01; wake-7pm B=0.03, p=0.02). Diurnal patterns of cognitive function varied by education; those with advanced college degrees showed a more stable pattern across the day, with significant differences compared to those with bachelor-level degrees in the evening (wake-7pm B=−0.47, p=0.02; wake-bed B=−.45, p=0.04). Conclusions Findings suggest that chronic symptoms in MS are not static, even over a short time frame; rather, symptoms –fatigue and pain in particular - vary dynamically across and within days. Incorporation of EMA methods should be considered in the assessment of these chronic MS symptoms to enhance assessment and treatment strategies.

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Section: Discussionsupporting

confidence: 91%

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confidence: 99%

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confidence: 99%

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Ecological Momentary Assessment of Pain, Fatigue, Depressive, and Cognitive Symptoms Reveals Significant Daily Variability in Multiple Sclerosis

Kratz

Murphy

Braley

2017

Archives of Physical Medicine and Rehabilitation

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“…Another issue to consider is that patient-related factors, such as medications and comorbidities, can influence clinical outcome measurement findings by contributing to measurement error. Many people with MS using medications and have co-morbidities and symptoms such as fatigue, which may change over a period of several weeks or even days [82][83]. These factors are likely to affect outcome measures, both in test-retest reliability studies and clinical trials.…”

Section: Discussionmentioning

confidence: 99%

Walking measures to evaluate assistive technology for foot drop in multiple sclerosis: A systematic review of psychometric properties

2018

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“…ultiple Sclerosis (MS) is an immunemediated disease that attacks axons surrounded by myelin in the Central Nervous System (CNS), destroys the myelinated axon in variable degrees, which leads to physical disabilities [1][2][3]. MS is associated with a wide spectrum of sensory, motor, and psychological disorders.…”

Section: Introductionmentioning

confidence: 99%

Interleukin 6 but not Interleukin 8 Might be an Indicator of Multiple Sclerosis Progression from Relapse Remitting to Secondary Progressive Status

et al. 2020

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Background: Multiple Sclerosis (MS) is the most common chronic inflammatory disease of the white matter of the Central Nervous System (CNS). Proinflammatory cytokine network such as interleukin-6 (IL-6) has a role in the initiation of a destructive immune response in CNS and the progression of the disease. This study aimed to evaluate the comparative levels of IL-6 and IL-8 in MS patients and healthy controls and also to assess any fluctuation in IL-6 and IL-8 levels in MS progression. Materials and Methods: This case-control study recruited a total of 183 subjects, including 103 MS patients and 80 sex-and age-matched healthy controls. MS patients included 51 Relapsing Remitting MS (RRMS), 25 secondary progressive MS (SPMS), 27 Primary Progressive MS (PPMS), and Progressive Relapsing MS (PRMS). Clinical findings were collected, and serum levels of IL-6, IL-8, and 25-hydroxyl vitamin D3 (25(OH)D3) were determined with ELISA. Results: The mean serum level of IL-6 was significantly higher in MS patients than healthy controls (23.8±2.1 vs. 15.6±2.7 pg/mL, P=0.043). MS patients with SPMS had more prominent IL-6 levels than RRMS or PPMS (P=0.008). However, IL-8 levels did not show a significant change either in the patients compared with the controls or in the different forms of MS. MS was more prone to progressive form in male patients. Mean 25(OH)D3 level was significantly lower in MS patients than the controls. Meanwhile, the mean 25(OH)D3 level was surprisingly higher in MS patients with SPMS. Conclusion: The increased serum level of IL-6 in more advanced MS status, SPMS, suggests that IL-6 but not IL-8 might be a prognostic marker for the disease deterioration. Besides, the tendency for MS to progress to worse stages in affected men is an important finding that needs further clarification.

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Symptom variability, affect and physical activity in ambulatory persons with multiple sclerosis: Understanding patterns and time-bound relationships

Cited by 25 publications

References 52 publications

Ecological Momentary Assessment of Pain, Fatigue, Depressive, and Cognitive Symptoms Reveals Significant Daily Variability in Multiple Sclerosis

Ecological Momentary Assessment of Pain, Fatigue, Depressive, and Cognitive Symptoms Reveals Significant Daily Variability in Multiple Sclerosis

Walking measures to evaluate assistive technology for foot drop in multiple sclerosis: A systematic review of psychometric properties

Interleukin 6 but not Interleukin 8 Might be an Indicator of Multiple Sclerosis Progression from Relapse Remitting to Secondary Progressive Status

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