REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium; UMSC, Hasselt/Pelt, Belgium.
REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium; UMSC, Hasselt/Pelt, Belgium; Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey.
Mult Scler Relat Disord. 2024 Nov;91:105909. doi: 10.1016/j.msard.2024.105909. Epub 2024 Sep 25.
Distance walking fatigability (DWF) in people with multiple sclerosis (pwMS) is defined as a decrease in the distance walking over time. However, declines in gait quality (i.e., gait quality fatigability- GQF) may occur independently or alongside DWF.
i) to investigate how walking fatigability manifests and its prevalence in pwMS; ii) to describe the temporal pattern of the changes of specific gait characteristics during the 6-minute walking test (6MWT) METHODS: Eighty-eight pwMS (EDSS 4[0-6.5], 49[21-70] years) and 47 healthy controls (HC- 46[25-60] years) performed the 6MWT wearing inertial measurement units. Gait characteristics (stride length, sensor-based gait speed, cadence, double support, step duration, stance phase, step duration asymmetry, step duration variability, foot-strike, toe-off, and leg circumduction) and walking distance were recorded in 1-minute intervals. A fatigability index was calculated by comparing the last and first minute of the 6MWT to identify abnormal worsening based on cutoff scores. The manifestation of walking fatigability was counted. The temporal pattern of worsening of gait characteristics during the 6MWT was examined in pwMS exceeding the cutoff values, compared to pwMS without abnormal changes and HC, using a two-way ANOVA (group vs. minutes) RESULTS: Thirty-five pwMS presented both DWF and GQF, 2 presented isolated DWF, 27 presented isolated GQF, and 24 presented non-walking fatigability. PwMS having GQF presented worsening in gait characteristics (cadence, step duration, step duration variability, or toe-off angle) from minute 2 onwards of the 6MWT, while HCs and pwMS without abnormal changes stabilized gait from minute 2 towards the end of the 6MWT.
Walking fatigability in pwMS manifests not only as a decrease in walking distance but also as changes in gait quality. Understanding changes in gait characteristics during walking can help tailor rehabilitation interventions.
多发性硬化症（pwMS）患者的步行疲劳（DWF）定义为随着时间的推移步行距离减少。然而，步态质量的下降（即步态质量疲劳性-GQF）可能独立于 DWF 发生或与之同时发生。
i）调查 pwMS 中步行疲劳的表现及其患病率；ii）描述 6 分钟步行测试（6MWT）期间特定步态特征变化的时间模式。
88 名 pwMS（EDSS 4[0-6.5]，49[21-70]岁）和 47 名健康对照者（HC-46[25-60]岁）在穿着惯性测量单元的情况下进行 6MWT。在 1 分钟间隔内记录步态特征（步长、基于传感器的步行速度、步频、双支撑、步长持续时间、站立相、步长持续时间不对称性、步长持续时间变异性、足触地、足离地和腿部回旋）和步行距离。通过比较 6MWT 的最后 1 分钟和第 1 分钟来计算疲劳指数，以根据截值分数识别异常恶化。计算了行走疲劳的表现次数。在 pwMS 中超过截值的情况下，使用双向 ANOVA（组 vs. 分钟）检查了 6MWT 期间步态特征恶化的时间模式，与 pwMS 中没有异常变化的和 HC 进行了比较。
35 名 pwMS 表现出 DWF 和 GQF，2 名 pwMS 表现出孤立的 DWF，27 名 pwMS 表现出孤立的 GQF，24 名 pwMS 表现出非行走疲劳。表现出 GQF 的 pwMS 从 6MWT 的第 2 分钟开始出现步态特征（步频、步长、步长变异性或足离地角度）恶化，而 HC 和没有异常变化的 pwMS 从第 2 分钟开始稳定步态直到 6MWT 结束。
pwMS 中的行走疲劳不仅表现为行走距离的减少，还表现为步态质量的变化。了解行走过程中步态特征的变化可以帮助定制康复干预措施。
