Norbye Anja Davis, Midgard Rune, Thrane Gyrd
Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
Department of Neurology, Molde Hospital, Møre and Romsdal Health Trust, Molde, Norway.
Physiother Res Int. 2020 Jan;25(1):e1799. doi: 10.1002/pri.1799. Epub 2019 Jul 9.
More than 80% of people with multiple sclerosis (MS) are affected by spasticity. Spasticity is known to reduce quality of life and contribute to additional symptoms, such as pain and reduced mobility, but the association between spasticity, balance, and mobility has not yet been established. Our aim was to examine whether a relationship exists between spasticity in the lower limbs, balance, and gait, as well as to explore the involvement of different muscle groups.
This study employed a cross-sectional design. Thirty patients with MS were included. The Modified Ashworth Scale (MAS) was used to examine spasticity in the ankle plantar flexors, knee extensors, and hip adductors. Balance was measured using the Mini-Balance Evaluation Systems Test, and gait with the 2-Minute Walk Test. The participants were tested once with no additional follow-up. Spearman's correlation, recursive partitioning, and linear regression analyses were used to explore the association.
A significant correlation between gait distance and spasticity in the ankle plantar flexors (ρ = -.69, p < .001) and knee extensors (ρ = -.45, p = .012) was observed. Balance significantly correlated with spasticity in ankle plantar flexors (ρ = -.69, p < .001), knee extensors (ρ = -.52, p = .003), and hip adductors (ρ = -.5, p = .005). The relationship between spasticity in ankle plantar flexors and hip adductors was significant, even from low levels of spasticity, whereas MAS score ≥ 2 was clinically correlated with a decrease in gait and balance function. Adjustments for sex, age, or years since diagnosis had only minor impact on the results.
This study indicates that spasticity in the lower limbs is clinically significantly associated with mobility in people with MS.
超过80%的多发性硬化症（MS）患者受痉挛影响。已知痉挛会降低生活质量并导致其他症状，如疼痛和活动能力下降，但痉挛、平衡和活动能力之间的关联尚未确立。我们的目的是研究下肢痉挛与平衡和步态之间是否存在关系，并探讨不同肌肉群的受累情况。
本研究采用横断面设计。纳入了30例MS患者。使用改良Ashworth量表（MAS）检查踝跖屈肌、膝伸肌和髋内收肌的痉挛情况。使用简易平衡评估系统测试测量平衡，使用2分钟步行测试测量步态。参与者仅接受一次测试，无额外随访。采用Spearman相关性分析、递归划分分析和线性回归分析来探讨关联。
观察到步态距离与踝跖屈肌（ρ = -0.69，p < 0.001）和膝伸肌（ρ = -0.45，p = 0.012）的痉挛之间存在显著相关性。平衡与踝跖屈肌（ρ = -0.69，p < 0.001）、膝伸肌（ρ = -0.52，p = 0.003）和髋内收肌（ρ = -0.5，p = 0.005）的痉挛显著相关。即使在低水平痉挛时，踝跖屈肌和髋内收肌的痉挛之间的关系也很显著，而MAS评分≥2与步态和平衡功能下降在临床上相关。对性别、年龄或诊断后年限进行调整对结果的影响很小。
本研究表明，下肢痉挛在临床上与MS患者的活动能力显著相关。
