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OBJECTIVE: To summarize the literature on definitions, assessment protocols, and outcome measures for motor fatigability in patients with neurologic problems and investigates the known clinimetric properties according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria. DATA SOURCES: Two databases were consulted for studies published between January 2003 and November 2018 using the terms "motor fatigability," "nervous system disease," and "upper limb." STUDY SELECTION: Studies were included if they were (1) not older than 15 years; (2) written in English, German, or Dutch; (3) involved upper limbs of patients with neurologic disease; and (4) adequately described protocols using maximum voluntary contractions. DATA EXTRACTION: Thirty-three studies were included, describing 14 definitions, 37 assessment protocols, and 9 outcome measures. The following data were obtained: (1) author and publication year; (2) aim; (3) fatigability definition; (4) sample characteristics; (5) fatigability protocol; (8) measurement system; and (9) outcome measure. DATA SYNTHESIS: Protocols relating to body function level of the International Classification of Functioning (ICF) were most often performed in patients with multiple sclerosis (MS) including maximal or submaximal, isometric or concentric, and eccentric contractions of variable duration. For ICF activities level, most protocols included wheelchair-related tasks. Clinimetric properties were known in 2 included protocols. Test-retest reliability in patients with MS were moderate to excellent for the static fatigue index and moderate for the dynamic fatigue index. CONCLUSIONS: Based on physiology, recommendations are made for protocols and outcome measures for motor fatigability at the ICF body function level. For the ICF activities level, too little is known to make sound statements on the use of protocols in populations with neurologic disease. Clinimetric properties should be further investigated for populations with neurologic problems. ispartof: ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION vol:101 issue:5 pages:907-916 ispartof: location:United States status: published

Objective To provide an overview of applied upper limb outcome measures in multiple sclerosis (MS) according to the International Classification of Functioning, Disability and Health (ICF) levels and to review their psychometric properties in MS. Data Sources PubMed and Web of Knowledge. Study Selection Articles published until June 2013 were selected when written in English, published in the last 25 years, peer reviewed, including >5 persons with MS, and including standardized clinical upper limb outcome measures. Included articles were screened based on title/abstract and full text by 2 independent reviewers. In case of doubt, feedback from a third independent reviewer was obtained. Additionally, references lists were checked for relevant articles. Of the articles, 109 met the selection criteria and were included for data extraction. Data Extraction All reported clinical upper limb outcome measures were extracted from the included studies and classified according to the ICF levels by 2 independent reviewers. In addition, available psychometric properties (reliability, validity, responsiveness) in MS were summarized and discussed. Data Synthesis A diversity of outcome measures assessing impairments on the body functions and structures level (n=33), upper limb capacity (n=11), and performance (n=8) on the activity level were extracted from 109 articles. Hand grip strength and the nine-hole peg test (NHPT) were the most frequently used outcome measures. However, multiple outcome measures are necessary to encapsulate the multidimensional character of the upper limb function. The psychometric properties were insufficiently documented for most of the outcome measures, except for the NHPT. Conclusions The results of this review may help with the selection of appropriate outcome measures and may guide future research regarding the psychometric properties in MS.

Feys P, Helsen WF, Liu X, Lavrysen A, Nuttin B, Ketelaer P. Effects of vision and arm position on amplitude of arm postural tremor in patients with multiple sclerosis. Arch Phys Med Rehabil 2004;85:1031–3. Objectives To quantify the effects of vision and arm position on arm postural tremor, comparisons were made between flexed and extended arm positions performed with the eyes open and closed. Design Case-control study. Setting National multiple sclerosis (MS) center in Belgium. Participants Sixteen patients (32 arms) with MS who had intention tremor and 16 healthy controls (32 arms). Interventions Not applicable. Main outcome measure The amplitude of postural tremor was assessed by a magnetic position sensor attached to the index finger. Results The amplitude of postural tremor was not influenced by changes in visual condition or different arm positions. Both healthy controls and MS patients made more directional changes in the flexed, compared with the extended arm position. Conclusions The amplitude of the arm postural tremor in MS is independent of vision and arm position. Selecting 1 arm position is sufficient to assess postural tremor amplitude.

To quantify the effects of vision and arm position on arm postural tremor, comparisons were made between flexed and extended arm positions performed with the eyes open and closed.Case-control study.National multiple sclerosis (MS) center in Belgium.Sixteen patients (32 arms) with MS who had intention tremor and 16 healthy controls (32 arms).Not applicable.The amplitude of postural tremor was assessed by a magnetic position sensor attached to the index finger.The amplitude of postural tremor was not influenced by changes in visual condition or different arm positions. Both healthy controls and MS patients made more directional changes in the flexed, compared with the extended arm position.The amplitude of the arm postural tremor in MS is independent of vision and arm position. Selecting 1 arm position is sufficient to assess postural tremor amplitude.

Feys PG, Davies-Smith A, Jones R, Romberg A, Ruutiainen J, Helsen WF, Ketelaer P. Intention tremor rated according to different finger-to-nose test protocols: a survey. Arch Phys Med Rehabil 2003;84:79-82. Objectives: To investigate the dependence of intention tremor rating scores on different finger-to-nose test (FNT) protocols, varying in arm position and the time the finger has to be kept on the nose, and to examine their relevance to function. Design: Observational survey. Video recordings were made while patients performed the FNTs and functional tasks such as pouring water. Setting: Three European rehabilitation centers in Belgium, Finland, and England. Participants: Twenty-six multiple sclerosis patients with intention tremor (avg age, 44.1y). Interventions: Not applicable. Main Outcome Measure: Six examiners rated the degree of intention tremor by using the Fahn Tremor Rating Scale. Results: Interrater reliability for rating intention tremor during the FNTs was high ([kappa ]=.65[ndash ].74). Both the required arm position and time constraints affected the magnitude of intention tremor rating scores (mean rank, 2.27[ndash ]2.95) and their functional relevance ([rho ]=.70[ndash ].84). Intention tremor was scored the highest when the arm was lifted to 90[deg ] of abduction at the shoulder and the subject was required to stabilize the finger on the nose. However, its functional relevance was lower compared with a more [ldquo ]functionally[rdquo ] executed FNT. Conclusions: The rating of intention tremor during the FNT depends on test instructions. A standardized protocol is needed. [copy ] 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation