神经肌肉力量发展率可区分多发性硬化症患者的跌倒情况——一项探索性研究。
Neuromuscular rate of force development discriminates fallers in ambulatory persons with multiple sclerosis - an exploratory study.
机构信息
Exercise Biology, Department of Public Health, Aarhus University, Denmark.
Exercise Biology, Department of Public Health, Aarhus University, Denmark; The Danish MS Hospitals, Ry and Haslev, Denmark.
出版信息
Mult Scler Relat Disord. 2023 Jul;75:104758. doi: 10.1016/j.msard.2023.104758. Epub 2023 May 10.
BACKGROUND
Falls as well as fall-related injuries (e.g., bone fractures) are common in persons with multiple sclerosis (pwMS). Whilst some studies have identified lower extremity maximal muscle strength (Fmax) as one among several risk factors, no previous studies have investigated the association between rate of force development (RFD; ability to generate a rapid rise in muscle force) and falls in pwMS. Not only is RFD substantially compromised (and more so than Fmax) in pwMS, studies involving other neurodegenerative populations have shown that RFD - to a greater extent than Fmax - is crucial for counteracting unexpected perturbations and avoiding falling.
OBJECTIVE
To explore whether knee extensor RFD (and Fmax) can discriminate fallers from non-fallers in pwMS.
METHODS
Knee extensor neuromuscular function (comprising RFD and RFD (force developed in the interval 0-50 ms and 0-200 ms, respectively) as well as Fmax) of the weaker leg was assessed by isokinetic dynamometry. Falls were determined by 1-year patient recall, with pwMS subsequently being classified as non-fallers (0 falls), fallers (1-2 falls), or recurrent fallers (≥3 falls).
RESULTS
A total of n=53 pwMS were enrolled in the study, with n=24 classified as non-fallers (63% females, 48 years, EDSS 2.2), n=16 as fallers (88% females, 57 years, EDSS 3.3), and n=13 as recurrent fallers (46% females, 60 years, EDSS 4.2). Compared with non-fallers, neuromuscular function was reduced in both fallers (RFD -4.42 [-7.47;-1.37] Nmskg, -48%; RFD -1.45 [-2.98;0.07] Nmskg, -24%; Fmax -0.42 [-0.81;-0.03] Nmkg, -21%) and recurrent fallers (RFD -5.69 [-8.94;-2.43] Nmskg, -62%; RFD -2.26 [-3.89;-0.63] Nmskg, -38%; Fmax -0.38 [-0.80;0.03] Nmkg, -19%). Across all participants, associations were observed between RFD and falls (r = -0.46 [-0.67;-0.24], between RFD and falls (r = -0.34 [-0.59;-0.09]), and between Fmax and falls (r = -0.24 [-0.48;0.01]).
CONCLUSION
In this exploratory study, knee extensor neuromuscular function was able to discriminate fallers from non-fallers in pwMS, with RFD being superior to Fmax. Routine assessment of lower extremity neuromuscular function (RFD in particular) may be a helpful tool in identifying pwMS at future risk of falling.
背景
多发性硬化症（pwMS）患者经常会出现跌倒和跌倒相关损伤（例如骨折）。虽然一些研究已经确定下肢最大肌肉力量（Fmax）是几个风险因素之一，但以前的研究并未调查 pwMS 中与跌倒相关的力量发展速率（RFD；产生肌肉力量快速上升的能力）之间的关联。不仅 RFD 在 pwMS 中受到严重损害（比 Fmax 更严重），而且涉及其他神经退行性疾病人群的研究表明，RFD-比 Fmax 更重要-对于对抗意外干扰和避免跌倒至关重要。
目的
探讨膝伸肌 RFD（和 Fmax）是否可以区分 pwMS 中的跌倒者和非跌倒者。
方法
使用等速测力法评估较弱腿的膝伸肌神经肌肉功能（包括 RFD 和 RFD（分别为 0-50ms 和 0-200ms 时产生的力）以及 Fmax）。通过 1 年的患者回忆确定跌倒，随后将 pwMS 分类为非跌倒者（0 次跌倒）、跌倒者（1-2 次跌倒）或复发性跌倒者（≥3 次跌倒）。
结果
共有 53 名 pwMS 参加了这项研究，其中 24 名被归类为非跌倒者（63%为女性，年龄 48 岁，EDSS 2.2），16 名被归类为跌倒者（88%为女性，年龄 57 岁，EDSS 3.3），13 名被归类为复发性跌倒者（46%为女性，年龄 60 岁，EDSS 4.2）。与非跌倒者相比，跌倒者的神经肌肉功能均降低（RFD-4.42[-7.47;-1.37]Nmskg，-48%；RFD-1.45[-2.98;0.07]Nmskg，-24%；Fmax-0.42[-0.81;-0.03]Nmkg，-21%）和复发性跌倒者（RFD-5.69[-8.94;-2.43]Nmskg，-62%；RFD-2.26[-3.89;-0.63]Nmskg，-38%；Fmax-0.38[-0.80;0.03]Nmkg，-19%）。在所有参与者中，RFD 与跌倒之间存在相关性（r= -0.46[-0.67;-0.24]），RFD 与跌倒之间存在相关性（r= -0.34[-0.59;-0.09]），以及 Fmax 与跌倒之间存在相关性（r= -0.24[-0.48;0.01]）。
结论
在这项探索性研究中，膝伸肌神经肌肉功能能够区分 pwMS 中的跌倒者和非跌倒者，RFD 优于 Fmax。下肢神经肌肉功能（特别是 RFD）的常规评估可能是识别 pwMS 未来跌倒风险的有用工具。
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