DelMastro Heather M, Wall Tracy, McPartland Deirdre J, Plaia Erik S, Trimble Naomi J, Ruiz Jennifer A, Harris Katherine, Gromisch Elizabeth S
Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, CT; Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT.
Department of Physical Therapy, School of Health Sciences at Quinnipiac University, North Haven, CT.
Arch Phys Med Rehabil. 2025 Aug;106(8):1207-1216. doi: 10.1016/j.apmr.2025.01.001. Epub 2025 Jan 10.
To determine whether hip flexion (HF), extension (HE), abduction (HA), knee flexion (KF) and extension (KE), and ankle plantarflexion (APF) and dorsiflexion maximum voluntary contraction (MVC) differentiates between nonfall and fall history in persons with multiple sclerosis (PwMS) after accounting for age, gender, fatigue, disability, and disease duration.
Secondary analysis of a cross-sectional study.
Community-based comprehensive MS center.
A total of 172 PwMS who completed a 1-time visit.
Not applicable.
Lower limb (LL) MVC was measured for each muscle group as isometric peak torque (Newton-meter: Nm) of both limbs (Strongest: S; Weakest: W) using a Biodex Dynamometer and normalized by body weight (Nm/kg). Falls in the past 6 months were retrospectively collected and participants were classified as nonfall history (0 falls [nonfallers]; n=78) or fall history (≥1 falls [fallers]; n=94). Fall history was further categorized as occasional (1-2 falls [occasional fallers]; n=51) and recurrent (≥3 falls [recurrent fallers]; n=43).
Overall differences between participants with and without a fall history were noted on both limbs, with post-hoc analyses showing that those with a fall history had significantly lower strength (P<.05) on all LL-W and HF-S, HE-S, HA-S, KF-S, and APF-S. When separated out by fall frequency, recurrent fallers had diminished strength on all LL-W and HF-S, HE-S, HA-S, and APF-S, whereas occasional fallers exhibited reductions on HA-W, KE-W, and KF-W compared with nonfallers. Recurrent and occasional fallers differed on HE-W.
All LL-W and aspects of LL-S differentiated between fallers and nonfallers, with further differences observed when fall history was separated by frequency. These findings provide the necessary information to clinicians to inform their plans of care to address falls in MS and provide education on the importance of maintaining LL strength.
在考虑年龄、性别、疲劳、残疾和病程的情况下，确定髋关节屈曲（HF）、伸展（HE）、外展（HA）、膝关节屈曲（KF）和伸展（KE）以及踝关节跖屈（APF）和背屈最大自主收缩（MVC）是否能区分多发性硬化症患者（PwMS）的无跌倒史和有跌倒史情况。
横断面研究的二次分析。
基于社区的综合性MS中心。
总共172名完成一次就诊的PwMS。
不适用。
使用Biodex测力计测量每个肌肉群的下肢（LL）MVC，作为双下肢（最强：S；最弱：W）的等长峰值扭矩（牛顿米：Nm），并按体重（Nm/kg）进行标准化。回顾性收集过去6个月内的跌倒情况，参与者被分类为无跌倒史（0次跌倒[无跌倒者]；n = 78）或有跌倒史（≥1次跌倒[跌倒者]；n = 94）。跌倒史进一步分为偶尔跌倒（1 - 2次跌倒[偶尔跌倒者]；n = 51）和反复跌倒（≥3次跌倒[反复跌倒者]；n = 43）。
在双下肢均观察到有跌倒史和无跌倒史参与者之间的总体差异，事后分析表明，有跌倒史者在所有LL - W以及HF - S、HE - S、HA - S、KF - S和APF - S上的力量显著较低（P <.05）。按跌倒频率分开后，反复跌倒者在所有LL - W以及HF - S、HE - S、HA - S和APF - S上的力量减弱，而偶尔跌倒者与无跌倒者相比，在HA - W、KE - W和KF - W上力量降低。反复跌倒者和偶尔跌倒者在HE - W上存在差异。
所有LL - W以及LL - S的各个方面都能区分跌倒者和无跌倒者，当按频率区分跌倒史时观察到了进一步的差异。这些发现为临床医生提供了必要信息，以指导他们针对MS患者跌倒问题的护理计划，并就维持下肢力量的重要性提供教育。
