Lamers Ilse, Cattaneo Davide, Chen Christine C, Bertoni Rita, Van Wijmeersch Bart, Feys Peter
I. Lamers, PhD, REVAL-Rehabilitation Research Center, BIOMED-Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan Building A, 3590 Diepenbeek, Belgium.
D. Cattaneo, PhD, Larice Lab, Don Carlo Gnocchi Foundation, Milan, Italy.
Phys Ther. 2015 Jan;95(1):65-75. doi: 10.2522/ptj.20130588. Epub 2014 Sep 4.
It is unknown how impairments caused by multiple sclerosis (MS) affect upper limb capacity, performance, and community integration.
The aim of this study was to investigate the extent to which impairments explained the variance in activity level and participation level measures of the International Classification of Functioning, Disability and Health (ICF) and the extent to which upper limb capacity measures explained perceived performance on the activity level in people with MS and different dexterity levels.
This was a cross-sectional study.
A total of 105 people with MS (median Expanded Disability Status Scale=6.5) were assessed with measures on the ICF body functions and structures level (strength, active range of motion of the wrist, tactile sensitivity, tremor, spasticity, and pain), activity level (Nine-Hole Peg Test [NHPT], Action Research Arm Test, and Manual Ability Measure-36 [MAM-36]), and participation level (Community Integration Questionnaire). The sample was divided into low- and high-dexterity subgroups on the basis of the median score on the NHPT.
In the total group, muscle strength, tactile sensitivity of the thumb, and intention tremor explained 53% to 64% of the variance in activity level measures. In the low-dexterity subgroup, muscle strength and active range of motion explained 43% to 71% of the variance in activity level measures. In the high-dexterity subgroup, only 35% of the variance in the MAM-36 was explained by muscle strength. Capacity measures (NHPT and Action Research Arm Test) were moderately to highly associated with perceived performance (MAM-36) in the low-dexterity subgroup.
Some outcome measures showed ceiling effects in people with MS and a high dexterity level.
Upper limb muscle strength is the most important impairment affecting capacity and perceived performance in daily life. Associations among outcome measures differ in people with MS and different dexterity levels.
尚不清楚多发性硬化症（MS）所导致的功能障碍如何影响上肢能力、表现及融入社会的程度。
本研究旨在调查功能障碍在多大程度上解释了《国际功能、残疾和健康分类》（ICF）中活动水平和参与水平指标的差异，以及上肢能力指标在多大程度上解释了不同灵活性水平的MS患者在活动水平上的实际表现。
这是一项横断面研究。
对总共105名MS患者（扩展残疾状态量表中位数 = 6.5）进行了ICF身体功能和结构水平（力量、手腕主动活动范围、触觉敏感度、震颤、痉挛和疼痛）、活动水平（九孔插板试验[NHPT]、动作研究手臂试验和手动能力测量-36[MAM-36]）以及参与水平（社区融入问卷）的评估。根据NHPT的中位数得分将样本分为低灵活性和高灵活性亚组。
在总样本组中，肌肉力量、拇指触觉敏感度和意向性震颤解释了活动水平指标中53%至64%的差异。在低灵活性亚组中，肌肉力量和主动活动范围解释了活动水平指标中43%至71%的差异。在高灵活性亚组中，肌肉力量仅解释了MAM-36中35%的差异。在低灵活性亚组中，能力指标（NHPT和动作研究手臂试验）与实际表现（MAM-36）呈中度至高度相关。
一些结果指标在MS患者和高灵活性水平人群中显示出天花板效应。
上肢肌肉力量是影响日常生活能力和实际表现的最重要功能障碍。MS患者和不同灵活性水平人群的结果指标之间的关联有所不同。
