Musculoskeletal Pain and Arthritis in MS and Other Types of Chronic Pain: Case Control Study

Abstract

Objective: To investigate the relationship between sense of autonomy and attitudes toward exercise and behavior in persons with MS. Design: Prospective cohort study. Setting: Academic medical center. Participants: 46 subjects (35 female) were solicited from clinical practices. Interventions: Not applicable. Main Outcome Measure(s): Two physical measures: grip strength dynamometry and the 2 minute walk test (2MWT);the Guys Neurological Disability Scale (GNDS), the Impact on Participation and Autonomy Questionnaire (IPA) and the Multidimensional Outcome Expectations for Exercise Scale (MOEES) previously validated in the ambulatory MS population. A medical history relevant to MS was elicited, and in the second part of the study, the subjects completed an exercise diary for 2 weeks. Results: 46 subjects (35 female) were recruited and enrolled. Mean GNDS score was 10.7 (7.1) for males and 12.1(9.4) for females, which were not significantly different. Bivariate correlation analyses showed significant relationship between GNDS and 2MWT (rZ -0.425, p <.003); GNDS and presence of pain or spasticity (r Z 0.452, p < .002; r Z 0.541, p < .001). The IPA subscales showed significant correlations with average daily pain rating: Autonomy Indoors (AI Scale) rZ 0.450; Family Role Scale (FR) rZ 0.463 and Autonomy Outdoors (AO Scale) r Z 0.453, all with p values less than .01. Social Role (SR) scale and pain rating showed rZ 0.365, pZ .013. The MOEES scale data evaluated by principal components analysis showedexcellent agreementwith published 3-subscale factormodel.TheSelfEvaluative (SELF) subscale showed significant correlation with average daily pain rating (Kendall’s tau-b, 0.247, pZ .036; Somer’s dZ 0.247, pZ .012). Grip dynamometrywas left hand: 30.9 kg (11.1) andR hand: 32.1 kg (12.1). Mean of exercise minutes per week (diary) was 219.5 (260.3). Log transformed data showed it to be normally distributed. Bivariate correlation analyses showed no significant correlation between reported exercise per week and the following measures: age, GNDS, IPA subscales, MOEES subscales, RH or LH Grip, 2 MWT. Conclusions: GNDS correlates well with walking distance, and presence of pain or spasticity. MOEES questionnaire 3 subscales appear valid, and Self-Evaluative scale correlates with pain score as well as physical measure (grip). Our hypothesized relationship between exercise performance (diary self-report) did not correlate with age, GNDS, MOEES, IPA or physical measures. Other factors must influence exercise behavior beyond those measured in this study.