Abstract
BackgroundMultiple sclerosis (MS) is a multi-focal progressive disorder of the central nervous system often resulting in diverse clinical manifestations. Symptomatic fatigue is quite common in people with MS (PwMS), with prevalence as high as 85%. Nevertheless, it remains poorly understood and its association with walking capabilities unclear. Therefore, the objective of this investigation was to examine the relationship between symptomatic fatigue and spatio-temporal parameters of gait in PwMS based on an instrumented treadmill.MethodsOne hundred and twenty-four relapsing-remitting patients diagnosed with MS, 84 women and 40 men aged 42.6 (S.D = 11.9), participated in this investigation. A convenience sample of 25 apparently healthy subjects, 15 women and 10 men aged 40.3 (S.D = 11.1), served as controls. Gait spatiotemporal parameters were obtained using the Zebris FDM-T Treadmill (Zebris1 Medical GmbH, Germany). The Modified Fatigue Impact Scale (MFIS), a self-reported questionnaire, was used to determine the level of symptomatic fatigue in the MS study group. PwMS were divided into two groups: fatigued and non-fatigued.ResultsForty-four PwMS were classified as suffering from fatigue (mean MFIS = 52.0, S.D = 13.7); 80 were classified as non-fatigued (mean MFIS = 14.5, S.D = 14.5). Individuals in the fatigued group walked slower than those in the non-fatigued group; 1.7 (S.D = 2.4) vs. 2.4 (S.D = 1.0); P < 0.001, respectively. Moreover, fatigued patients took smaller steps, had a shorter stride length, prolonged stance, double support phase and a shorter single support phase compared to the non-fatigued group. In the total group, fatigue was significantly correlated with 10 (out of 14) spatiotemporal parameters of gait, however, correlation scores <0.40 were considered as weak correlations. According to step one of the linear logistic regression analysis, the temporal gait component was found to explain 5.1% of the variance related to symptomatic fatigue, R2 = 0.051, χ2 (1) = 6.511, P = 0.011. Step two of the model added the gait spatial component, thus increasing the explaining variance to 9.3%; R2 = 0.093, χ2 (2) = 12.12, P = 0.002. The asymmetry gait parameter did not contribute to the equation.ConclusionsPerceived fatigue is related to walking speed in PwMS, nevertheless its contribution to level of fatigue is limited.
Highlights
Multiple sclerosis (MS) is a multi-focal progressive disorder of the central nervous system often resulting in diverse clinical manifestations
Spatio-temporal gait findings Fatigued vs. Non-fatigued The mean gait velocity obtained from the instrumented treadmill for the study sample, was within the range for usual gait speed among people with MS (PwMS) [35]
The fatigued group exhibited a larger asymmetry between the right and left legs in 3 parameters; step length, single support and stance phase compared to the non-fatigued group
Summary
Multiple sclerosis (MS) is a multi-focal progressive disorder of the central nervous system often resulting in diverse clinical manifestations. Symptomatic fatigue is quite common in people with MS (PwMS), with prevalence as high as 85%. It remains poorly understood and its association with walking capabilities unclear. Symptomatic fatigue and walking capabilities are major challenges to the medical and rehabilitation management of persons with MS (PwMS). Both of these issues are quite common, with prevalence of fatigue as high as 85% [1] and impaired gait up to 75% [2]. Previous trials have reported a strong association between symptomatic fatigue with increased muscle fatigability [12] and impaired central muscle activation in PwMS [13]. Symptomatic fatigue has been found to be associated with cerebellar and brainstem involvement [14]
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