Abstract
ObjectiveTo address the disability impact on fine hand motor functions in patients with Multiple Sclerosis (MS) by quantitatively measuring finger opposition movements, with the aim of providing a new “score” integrating current methods for disability assessment.Methods40 MS patients (Expanded Disability Status Scale (EDSS): 0–7) and 80 healthy controls (HC) performed a repetitive finger-to-thumb opposition sequence with their dominant hand at spontaneous and maximal velocity, and uni- and bi-manually metronome-paced. A sensor-engineered glove was used to measure finger motor performance. Twenty-seven HC were tested twice, one month apart, to assess test-retest reliability.ResultsThe motor parameters showed a good reproducibility in HC and demonstrated significantly worse performance in MS patients with respect to HC. A multivariate model revealed that rate of movement in the spontaneous velocity condition and inter-hand interval (IHI), indicating bimanual coordination, contributed independently to differentiate the two groups. A finger motor impairment score based on these two parameters was able to discriminate HC from MS patients with very low EDSS scores (p<0.001): a significant difference was already evident for patients with EDSS = 0. Further, in the MS group, some motor performance parameters correlated with the clinical scores. In particular, significant correlations were found between IHI and EDSS (r = 0.56; p<0.0001), MS Functional Composite (r = −0.40; p = 0.01), Paced Auditory Serial Addition (r = −0.38; p = 0.02). No motor performance parameter correlated with Timed 25-Foot Walk.ConclusionsA simple, quantitative, objective method measuring finger motor performance could be used to define a score discriminating healthy controls and MS patients, even with very low disability. This sensitivity might be of crucial importance for monitoring the disease course and the treatment effects in early MS patients, when changes in the EDSS are small or absent.
Highlights
Strategies to improve the disability assessment in Multiple Sclerosis (MS) have been the focus of discussion of the International Conference on Disability Outcomes in MS (Washington DC, May 2011) [1]
A simple, quantitative, objective method measuring finger motor performance could be used to define a score discriminating healthy controls and MS patients, even with very low disability. This sensitivity might be of crucial importance for monitoring the disease course and the treatment effects in early MS patients, when changes in the Expanded Disability Status Scale (EDSS) are small or absent
The test-retest reliability resulted to be very high for RATE in the MV condition and inter-hand interval (IHI) in the 2 Hz_bim condition, with an Intraclass Correlation Coefficient (ICC) ranging from 71% to 75% for a single measurement and from 83% to 86% for the average of two measurements
Summary
Strategies to improve the disability assessment in Multiple Sclerosis (MS) have been the focus of discussion of the International Conference on Disability Outcomes in MS (Washington DC, May 2011) [1]. The Expanded Disability Status Scale (EDSS) [2] is commonly used as primary outcome measure in MS clinical trials, but its limitations are well known [3,4]. We propose to assess the disability impact on fine hand motor functions in MS by quantitatively measuring finger opposition movements, with the goal to re-balance the motor disability assessment enhancing upper limb evaluation. We demonstrated that patients with MS show general motor slowing and impaired bimanual coordination [9,10,11]. In this study we could expect to find out finger motor impairments in a large group of MS patients with respect to a group of healthy subjects, even in those patients considered with very low disability as mainly evaluated on the lower limb
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