The rate of force relaxation scaling factor is highly sensitive to detect upper and lower extremity motor deficiencies in mildly affected people with multiple sclerosis.

BACKGROUND: The motor symptoms affecting upper and lower extremity functioning in people with multiple sclerosis (PwMS) are considered the cardinal symptoms of multiple sclerosis. There is still a need for outcome measures that can sensitively evaluate these symptoms. We aimed to investigate the sensitivity of the isometric outcomes (maximum force; Fmax, maximum rate of force development; RFDmax, rate of force development scaling factor; RFD-SF, and rate of force relaxation scaling factor; RFR-SF) and standard clinical tests (9-hole peg test; 9HPT and timed 25-feet walk test; T25FW) in detecting the upper and lower extremity motor deficiencies in PwMS and also in a subgroup of mildly affected PwMS whose performance in standard clinical tests were similar to controls. METHODS: Twenty-nine PwMS (age: 47.9 (8.6) years, relapsing-remitting type, expanded disability status scale: 2.5 (1.5)) and their age- and gender-matched controls completed an identical testing protocol in the upper (grip force muscles) and lower (knee extensors) extremities. For each extremity, we assessed Fmax, RFDmax, RFD-SF, and RFR-SF. Additionally, participants completed standard clinical tests for the evaluation of upper- (9HPT) and lower-extremity (T25FW) function. Comparisons were made between controls and PwMS 1) using all study participants and 2) including only mildly affected PwMS whose performance in standard functional tests was comparable to controls. Independent sample t-tests were utilized to compare groups, with a p-value set at 0.01 to correct for multiple comparisons. P-values and effect sizes were used to evaluate the sensitivity of the outcome measures in detecting group differences. RESULTS: Our results indicate that most isometric outcomes and standard functional tests were sensitive in detecting motor deficiencies in both upper and lower extremities between groups (p<0.001). Among participants, 16 PwMS in 9HPT and 11 PwMS in T25FW demonstrated performance similar to that of the control group (9HPT: 18.85 (2.20) s vs 17.81 (2.19) s; p=0.19) and (T25FW: 3.60 (0.42) s vs 3.58 (0.29) s; p=0.92). The results of the comparisons between mildly affected PwMS and their controls indicate that RFR-SF is the only sensitive isometric outcome to detect differences between groups in the upper (-8.24 (0.76) 1/s vs -8.93 (0.6) 1/s; p=0.008) and lower extremity (-5.86 (1.13) 1/s vs -7.71 (1.11) 1/s; p<0.001). CONCLUSION: The rate of force relaxation scaling factor, which assesses the ability to rapidly relax muscle forces after quick contractions, demonstrates high sensitivity in detecting motor deficiencies in PwMS, even when the current standard clinical outcomes fail to detect these differences. Our findings emphasize the importance of future randomized controlled trials focusing on rehabilitative and therapeutic interventions that specifically target muscle force relaxation to enhance motor functioning in PwMS.

Isometric tests to evaluate upper and lower extremity functioning in people with multiple sclerosis: reliability and validity.

BACKGROUND: Both upper and lower extremity motor symptoms are common in people with multiple sclerosis (PwMS) and there is a need to develop objective, reliable, and valid outcome measures. The aim of this study was to evaluate the reliability and external validity of the standard and novel isometric tests in the assessment of neuromuscular functioning in both upper (grip force; GF) and lower (knee extensors; KE) extremities in PwMS. METHODS: Twenty-nine relapsing-remitting PwMS (Expanded Disability Status Scale (EDSS)<6) completed isometric and functional tests in upper (grip force) and lower (knee extension) extremity in two separate visits. Isometric testing included maximum force (maxF), maximum rate of force development (maxRFD), and our recently developed novel brief force pulse protocol (BFP). The dependent variables of BFP included rate of force development and relaxation scaling factors (RFD-SF and RFR-SF), which quantifies an individual's ability to scale the rates of force development and relaxation with the magnitude of force pulse produced. PwMS also completed functional tests of upper (9-hole peg (9HPT), finger tapping (FTT)) and lower extremity (25-ft walk test (T25WT), timed up and go (TUG), 5-time sit-to-stand (5StS), and Multiple Sclerosis Spasticity Scale (MSSS-88)). RESULTS: Most isometric outcome measures had high reliability (ICCs>0.87 and CVs<12%). In GF, both RFD-SF and RFR-SF had significant associations with 9HPT and FTT (r's between 0.49-0.55, p<0.05). In KE, while maxF, maxRFD, and RFD-SF were moderately correlated to some of the functional tests, the strongest correlations were observed for the RFR-SF (T25FW, r=0.71; TUG, r=0.60; 5StS, r=0.47; MSSS-88, r=0.60, and EDSS, r=0.71). Multiple linear regression analysis indicated that RFD-SF is the only predictor for 9HPT and RFR-SF is the only predictor of walking speed among the studied variables. CONCLUSIONS: BFP protocol provides highly reliable and relevant outcome measures to evaluate both upper and lower extremity functioning in PwMS. Specifically, the ability to relax muscle forces quickly after a quick force production highly contributes to walking speed in PwMS.

Trekking Poles to Aid Multiple Sclerosis Walking Impairment: An Exploratory Comparison of the Effects of Assistive Devices on Psychosocial Impact and Walking.

BACKGROUND: Walking dysfunction is reported by two-thirds of persons with multiple sclerosis (MS). Assistive devices are frequently recommended to improve walking; however, it is uncommon to consider their psychosocial impact, although many users abandon their assistive devices. The psychosocial impact, walking, balance, and fatigue associated with three assistive devices were compared to guide clinical decision making. METHODS: Twenty-five persons with MS (median Expanded Disability Status Scale score, 4.0; range, 2.5-6.0) who reported walking difficulty were trained in the use of three assistive devices-a single-point cane (SPC), a four-point cane (FPC), and a trekking pole (TP)-at 1- to 2-week intervals, then used the assistive device for their usual activities. Outcome measures included the Psychosocial Impact of Assistive Devices Scale (PIADS), the 6-Minute Walk Test (6MWT), walking speed, cadence, stride length, stride time, the 12-item Multiple Sclerosis Walking Scale (MSWS-12), the Activities-specific Balance Confidence (ABC) scale, the 5-item Modified Fatigue Impact Scale (MFIS-5), and a visual analogue scale of fatigue (VAS-F). RESULTS: The SPC and TP were more positive in the PIADS adaptability, competence, and self-esteem subscales. The SPC and TP resulted in higher 6MWT, walking speed, cadence, stride length, stride time, and MSWS-12 scores compared with the FPC. No differences were found in ABC scale, MFIS-5, or VAS-F scores. CONCLUSIONS: Participants reported more positive psychosocial impact, and walked faster and with higher quality, with the SPC and TP than with the FPC. Clinicians should consider suggesting an SPC or TP to patients who may benefit from assistive device use and for whom psychosocial impact is an important consideration.

Rate of force development and relaxation scaling factors are highly sensitive to detect upper extremity motor impairments in multiple sclerosis.

OBJECTIVE: Clinical assessment of upper extremity in multiple sclerosis is mainly limited to 9-hole peg test (9-HPT), which is commonly criticized due to its limited sensitivity. There is a need for sensitive outcome measures for the assessment of motor symptoms in individuals with multiple sclerosis (iMS). We evaluated our recently developed brief force pulse protocol to simultaneously quantify the motor control of hand function and neuromuscular quickness in iMS. Additionally, we compared the sensitivity of the studied outcome measures with 9-HPT in detecting the differences between iMS and controls. METHODS: Twelve iMS and 12 controls grasped a grip- (GF; perpendicular force) and load-force (LF; tangential force) measuring handle and produced around 100 isometric LF pulses to various submaximal levels by pushing down on it as quickly as possible, followed by quick relaxation. The GF-LF ratio quantified the motor control of hand function. The slopes of linear regressions between peak forces and corresponding peak rates of force development (rate of force development scaling factor; RFD-SF) and relaxation (rate of force relaxation scaling factor; RFR-SF) quantified the control of neuromuscular quickness. RESULTS: All of the selected variables were different between groups (all p-values < .05), and the effect sizes obtained from RFD-SF (d = 2.87) and RFR-SF (d = 1.93) were larger than the effect sizes obtained from 9-HPT (d = 1.07). CONCLUSION: Measures of neuromuscular quickness are more sensitive to detect disease related differences than 9-HPT and, therefore, can be used as a tool in clinical and rehabilitative settings to objectively evaluate therapeutic interventions and disease progression in iMS.

Feasibility and Impact of an 8-Week Integrative Yoga Program in People with Moderate Multiple Sclerosis-Related Disability: A Pilot Study.

BACKGROUND: This pilot study determined the feasibility of a specifically designed 8-week yoga program for people with moderate multiple sclerosis (MS)-related disability. We explored the program's effect on quality of life (QOL) and physical and mental performance. METHODS: We used a single-group design with repeated measurements at baseline, postintervention, and 8-week follow-up. Feasibility was examined through cost, recruitment, retention, attendance, and safety. Outcomes included the Multiple Sclerosis Quality of Life Inventory (MSQLI), 12-item Multiple Sclerosis Walking Scale (MSWS-12), Timed 25-Foot Walk test (T25FW), 6-Minute Walk Test (6MWT), Nine-Hole Peg Test (NHPT), Five-Times Sit-to-Stand Test (FTSTS), Multidirectional Reach Test (MDRT), maximum expiratory pressure, and Paced Auditory Serial Addition Test-3″ (PASAT-3″). RESULTS: Fourteen participants completed the study. The program was feasible. There were significant main effects on the 36-item Short Form Health Status Survey Mental Component Summary (SF-36 MCS), Modified Fatigue Impact Scale (MFIS), Bladder Control Scale (BLCS), Perceived Deficits Questionnaire (PDQ), Mental Health Inventory (MHI), MSWS-12, T25FW, NHPT, PASAT-3″, 6MWT, FTSTS, and MDRT-Back. Improvements were found on the SF-36 MCS, MFIS, BLCS, PDQ, MHI, and MSWS-12 between baseline and postintervention. The effect on PDQ persisted at follow-up. Improvements were found on the T25FW, NHPT, 6MWT, FTSTS, and MDRT-Back between baseline and postintervention that persisted at follow-up. The PASAT-3″ did not change between baseline and postintervention but did between postintervention and follow-up. CONCLUSIONS: The yoga program was safe and feasible. Improvements in certain measures of QOL and performance were seen at postintervention and follow-up.

Survey of US Patients with Multiple Sclerosis: Comparison of the New Electronic Interferon Beta-1b Autoinjector (BETACONNECT™) With Mechanical Autoinjectors.

INTRODUCTION: Patients with multiple sclerosis (MS) generally undergo long-term treatment with disease-modifying therapies (DMTs). In the US, patients taking glatiramer acetate, interferon beta-1a, or interferon beta-1b, typically use a mechanical autoinjector. Recent survey results have shown that using an electronic autoinjector, such as BETACONNECT™ (Bayer Pharma AG) for interferon beta-1b/Betaseron® (Bayer Pharma AG) may reduce injection discomfort and increase patient satisfaction with treatment. The aim of the current survey was to assess patient perceptions of BETACONNECT compared with mechanical autoinjectors using a survey integrated with demonstrations and simulated injections with BETACONNECT. METHODS: Patients with MS currently using mechanical autoinjectors for glatiramer acetate/Copaxone® (Teva Pharmaceuticals USA, Inc.), interferon beta-1a/Rebif® (EMD Serono Inc.), or interferon beta-1b/Extavia® (Novartis Pharmaceuticals Corp.), participated in a 60-min in-person interview. Patients rated the importance of 18 ideal autoinjector attributes, and the performance of their current autoinjectors across these attributes. BETACONNECT was demonstrated and patients performed simulated injections with BETACONNECT before rating it across the same attributes. Patient overall autoinjector preference was assessed. RESULTS: Ninety patients completed the survey: 63 were using autoinjectors for Copaxone, 25 for Rebif, and 2 for Extavia. BETACONNECT scored higher than mechanical autoinjectors across all 18 attributes. The top attributes of an ideal autoinjector were the injection process is easy overall, easy to push the button to start the injection, and autoinjector is comfortable to hold during injections. Unique BETACONNECT features most valued by patients were the built-in dwell time, self-check function, greater ability to customize injections, adjustment of injection speed, low injection noise, and automatic needle retraction. Overall, 75 out of 90 patients (83%) expressed a preference for BETACONNECT over their current autoinjector. CONCLUSION: BETACONNECT attributes and features were highly rated by patients, compared with both an ideal autoinjector and their current mechanical autoinjectors. These findings suggest that the use of BETACONNECT may increase patient satisfaction and potentially increase overall medication adherence. FUNDING: Bayer HealthCare Pharmaceuticals.