Understanding the Deterioration of Gait, Postural Control, Lower Limb Strength and Perceived Fatigue Across the Disability Spectrum of People with Multiple Sclerosis.

Pedro Moreno-Navarro,Francisco J Vera-Garcia,Ángel P Sempere,Ramón Gomez-Illán,David Barbado,Carmen Carpena-Juan

doi:10.3390/jcm9051385

Pedro Moreno-Navarro, Francisco J Vera-Garcia + Show 4 more

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https://doi.org/10.3390/jcm9051385

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Abstract

Disability progression is a prominent feature of multiple sclerosis (MS). However, little is known about the extent to which physical condition parameters and perceived fatigue evolve during the disease. We analyzed how strength, balance, core stability and perceived fatigue differ among different cohorts of people with MS (PwMS) with different disability degrees and how these contribute to patients’ gait speed and functional mobility. Sixty-three PwMS divided into three groups according to the “Expanded Disability Status Scale” (MS1: EDSS ≤ 1.5; MS2: 2 ≤ EDSS ≤ 3.5; MS3: 4 ≤ EDSS ≤ 6) and 22 healthy controls (HC) participated in this study. MS1 showed lower balance and hip strength compared to HC. MS2 showed lower balance, core stability, gait speed, and functional mobility than MS1. MS3 showed lower gait speed, functional mobility, balance, and knee flexion strength than MS2. No between-group differences were observed in perceived fatigue. Relative weight analysis showed that strength, balance and core stability explained 60%–70% of the variance in gait speed and functional mobility. The decline of each parameter did not evolve at the same rate across the different stages of the disease, being knee flexion strength and balance the most influential factors in the disability progression. Overall, these results provide useful information to guide exercise prescription at different stages of MS.

Highlights

Multiple sclerosis (MS) is a neurodegenerative disease of the central nervous system characterized by a multifocal inflammation, demyelination, reactive gliosis, oligodendrocyte loss, and axonal degeneration [1]
The main findings were that the strength, balance and core stability deterioration observed across the MS groups seems to be different between physical parameters unlike perceived fatigue that shows no change between MS groups
The main point of attention regarding the comparison between the people with MS (PwMS) in the early stages of the disease (EDSS ≤ 1.5; patients with minimal or non-disability according to the neurological evaluation) and participants without the disease was that, MS1 seems to show slightly worse performance in most of the parameters (Table 2), significant differences were only found for balance (0.94 ≤ dg ≤ 1.18; 25.9% ≤ percentage differences (PD) ≤ 37.5%) and hip strength (0.73 ≤ dg ≤ 1.18; 24.7% ≤ PD ≤ 29.9%), mainly in the abductor muscles

Summary

Introduction

Multiple sclerosis (MS) is a neurodegenerative disease of the central nervous system characterized by a multifocal inflammation, demyelination, reactive gliosis, oligodendrocyte loss, and axonal degeneration [1]. Among the symptoms caused by the disease, balance and core stability disturbances [6], muscular weakness mainly in the lower limbs [7], and fatigue [8] stand out because they seem to play a prominent role in patients’ loss of functionality [9,10,11,12]. Based on this rationale, patient management programs should aim at improving those deficits that have the greatest impact on the patients’ disability progression. The extent to which each of these symptoms should be prioritized to optimize the rehabilitation process is still not clear

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