Simaitis Laura B, Gromisch Elizabeth S, Demeule Alyssa, Murphy Rhiannon, Palumbo Corinne, DelMastro Heather M
Department of Physical Therapy, Quinnipiac University, Hamden, Connecticut (L.B.S., A.D., R.M., C.P.); Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, Connecticut (E.S.G., H.M.D.); Department of Rehabilitation Medicine, Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut (E.S.G., H.M.D.); Department of Medical Sciences, Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut (E.S.G.); and Department of Neurology, University of Connecticut School of Medicine, Farmington, Connecticut (E.S.G.).
J Neurol Phys Ther. 2025 Jul 1;49(3):137-144. doi: 10.1097/NPT.0000000000000505. Epub 2024 Nov 25.
Background and Purpose: Lower limb (LL) weakness and gait impairment are prevalent among persons with multiple sclerosis (PwMS) and can impede functional independence and impact health-related quality of life (HR-QoL). The purpose of this study was to examine the mediation effect of walking speed and perceived walking ability on the relationship between LL weakness and HR-QoL in ambulatory PwMS.
Participants (n = 175) were PwMS in this secondary analysis of a cross-sectional study. Demographics, pain (visual analog scale), fatigue (5-item Modified Fatigue Impact Scale), LL strength (hip extensors [HE] and flexors [HF], knee extensors [KE] and flexors [KF], and ankle plantarflexors [APF] and dorsiflexors [ADF]), Timed 25-Foot Walk, 12-item MS Walking Scale, and HR-QoL (MS Impact Scale-Physical [MSIS-29-Phys] and Psychological [MSIS-29-Psych]) were collected. Bivariate and mediation analyses using Hayes' PROCESS were performed to determine if LL strength had an indirect effect through walking speed or perceived walking ability on physical and psychological HR-QoL while controlling for fatigue and pain.
There were significant ( P < 0.01) correlations for all strength measures with the MSIS-29-Phys and for HF, KE, KF, and APF with the MSIS-29-Psych. In the mediation analyses, LL strength indirectly influenced PwMS' MSIS-29-Phys through walking speed and perceived walking ability. There was only partial mediation between HE, HF, KF, ADF, and MSIS-29-Phy when walking speed was in the model. LL strength did not influence MSIS-29-Psych.
LL strength impacts physical HR-QoL through walking but does not indirectly affect PwMS' perceived psychological HR-QoL. These findings may prompt physical therapists to create individualized care plans that address LL weakness and walking impairments with the goal of promoting optimal outcomes and improving HR-QoL.
for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A504 ).
背景与目的：下肢（LL）无力和步态障碍在多发性硬化症患者（PwMS）中很常见，会妨碍功能独立性并影响健康相关生活质量（HR-QoL）。本研究的目的是探讨步行速度和感知步行能力在非卧床PwMS的LL无力与HR-QoL之间关系中的中介作用。
在这项横断面研究的二次分析中，参与者（n = 175）为PwMS。收集了人口统计学信息、疼痛（视觉模拟量表）、疲劳（5项改良疲劳影响量表）、LL力量（髋伸肌[HE]和屈肌[HF]、膝伸肌[KE]和屈肌[KF]、踝跖屈肌[APF]和背屈肌[ADF]）、定时25英尺步行、12项MS步行量表以及HR-QoL（MS影响量表-身体[MSIS-29-Phys]和心理[MSIS-29-Psych]）。使用Hayes的PROCESS进行双变量和中介分析，以确定在控制疲劳和疼痛的情况下，LL力量是否通过步行速度或感知步行能力对身体和心理HR-QoL产生间接影响。
所有力量测量指标与MSIS-29-Phys均存在显著（P < 0.01）相关性，HF、KE、KF和APF与MSIS-29-Psych存在显著相关性。在中介分析中，LL力量通过步行速度和感知步行能力间接影响PwMS的MSIS-29-Phys。当步行速度纳入模型时，HE、HF、KF、ADF与MSIS-29-Phy之间仅存在部分中介作用。LL力量不影响MSIS-29-Psych。
LL力量通过步行影响身体HR-QoL，但不会间接影响PwMS感知的心理HR-QoL。这些发现可能促使物理治疗师制定个性化护理计划，解决LL无力和步行障碍问题，以促进最佳结果并改善HR-QoL。
获取作者更多见解（见视频，补充数字内容1可在：http://links.lww.com/JNPT/A504 查看）。
