IRCSS Fondazione Don Carlo Gnocchi, Via Capecelatro 66, 20148 Milano, Italy.
IRCSS Fondazione Don Carlo Gnocchi, Via Capecelatro 66, 20148 Milano, Italy.
Ann Phys Rehabil Med. 2022 Jan;65(1):101491. doi: 10.1016/j.rehab.2021.101491. Epub 2021 Nov 12.
Motor and cognitive disorders appear early in the course of multiple sclerosis (MS) and develop gradually over time.
To study the frequency and pattern of subtle functional disorders in people with MS (PwMS) with no overt signs of disability in an early phase of the disease and their association with walking impairments in daily activities.
In this cross-sectional study, we recruited PwMS with an Expanded Disability Status Scale (EDSS) score≤2.5 and disease duration≤5years. Participants were assessed with functional scales rating walking endurance (6-Min Walk Test), perceived walking ability (Twelve-item Multiple Sclerosis Walking Scale), balance (Fullerton Advanced Balance scale_short), manual dexterity (Nine Hole Peg Test), fatigue (Fatigue Severity Scale), and cognitive impairments (Brief International Cognitive Assessment).
About 90% of the 82 PwMS (mean [SD] EDSS score 1.5 [0.7] and disease duration 2.2 [1.7] years) showed endurance values below the expected score; almost 30% showed impairment, and for 57%, perceived walking ability score was abnormal. Balance was impaired in 48% of participants, as was manual dexterity (29%) and fatigue (24%), but only a few showed cognitive impairments. Only 11% of PwMS had no abnormal score on the scales used in the assessment. As compared with EDSS score 0 to 1.5, with EDSS score 2 to 2.5, performance was worse for endurance (difference±61.0m, P=0.016), perceived walking ability (-11 points, P=0.002), balance (+1.9 points, P=0.005), manual dexterity (-2.8 s, P=0.004), and fatigue (-1.3 points, P=0.013). Factors that predicted perceived walking ability were balance (B=-1.37, P<0.001) and fatigue (B=5.11, P<0.001) rather than endurance (B=-0.01, P=048).
Even PwMS with no clinical disability and classified as having "no problem walking" present walking and other functional deficits when assessed with specific functional tests. The addition of specific tools could better identify subtle motor and cognitive deficits. Finally, the assessment of balance disorders and fatigue is important to understand individuals' perceived walking impairments in daily activities.
运动和认知障碍在多发性硬化症（MS）的病程早期出现，并随着时间的推移逐渐发展。
研究早期疾病阶段无明显残疾迹象的多发性硬化症患者（PwMS）中微妙功能障碍的频率和模式及其与日常活动中行走障碍的关系。
在这项横断面研究中，我们招募了扩展残疾状态量表（EDSS）评分≤2.5 和病程≤5 年的 PwMS。参与者通过评估步行耐力（6 分钟步行测试）、感知步行能力（十二项多发性硬化症步行量表）、平衡（富尔顿高级平衡量表-短）、手灵巧性（九孔钉测试）、疲劳（疲劳严重程度量表）和认知障碍（简要国际认知评估）来进行评估。
约 90%的 82 名 PwMS（平均[标准差]EDSS 评分 1.5[0.7]和病程 2.2[1.7]年）表现出低于预期评分的耐力值；近 30%的人存在障碍，57%的人感知到的步行能力评分异常。48%的参与者平衡受损，手灵巧性（29%）和疲劳（24%）也是如此，但只有少数人表现出认知障碍。只有 11%的 PwMS 在评估中没有异常评分。与 EDSS 评分 0 至 1.5 相比，EDSS 评分 2 至 2.5 的患者在耐力方面表现更差（差异±61.0m，P=0.016），感知到的步行能力（-11 分，P=0.002），平衡（+1.9 分，P=0.005），手灵巧性（-2.8 秒，P=0.004）和疲劳（-1.3 分，P=0.013）。预测感知到的步行能力的因素是平衡（B=-1.37，P<0.001）和疲劳（B=5.11，P<0.001），而不是耐力（B=-0.01，P=0.48）。
即使是没有临床残疾且被归类为“行走无问题”的 PwMS，在使用特定的功能测试进行评估时，也会出现行走和其他功能障碍。添加特定工具可以更好地识别微妙的运动和认知障碍。最后，评估平衡障碍和疲劳对于理解个体在日常活动中的感知行走障碍很重要。
