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Background and Purpose: The symptom of fatigue impairs function in people with multiple sclerosis (MS). Choosing appropriate measures to assess fatigue is challenging. The purpose of this article is to report the findings of a systematic review of patient-reported fatigue measures for people with MS. Methods: PubMed, CINAHL, and Embase databases were searched through January 2020 using terms related to fatigue and MS. Studies were included if the sample size was 30 or more or smaller samples if adequately powered, and if information about measurement characteristics (ie, test-retest reliability, content validity, responsiveness, interpretability, or generalizability) of the measure(s) could be extracted. Study quality was appraised with the 2-point COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. Data about measurement characteristics, psychometrics, and clinical utility were extracted and results were synthesized. Results: Twenty-four articles met inclusion criteria with information about 17 patient-reported fatigue measures. No studies had critical methodologic flaws. Measurement characteristic data were not available for all measures. Clinical utility varied in time to complete and fatigue domains assessed. Discussion and Conclusions: Five measures had data pertaining to all properties of interest. Of these, only the Modified Fatigue Impact Scale (MFIS) and Fatigue Severity Scale (FSS) had excellent reliability, responsiveness data, no notable ceiling/floor effects, and high clinical utility. We recommend the MFIS for comprehensive measurement and the FSS for screening of subjective fatigue in people with MS. [ABSTRACT FROM AUTHOR]

Background and Purpose: This study's purpose was to investigate the reliability, validity, and responsiveness of the Patient-Specific Functional Scale (PSFS) for measuring mobility-related goals in people with multiple sclerosis (MS). Methods: Data from 32 participants with MS who underwent 8 to 10 weeks of rehabilitation were analyzed (Expanded Disability Status Scale scores 1.0-7.0). For the PSFS, participants identified 3 mobility-related areas where they had difficulty and rated them at baseline, 10 to 14 days later (before starting intervention), and immediately after intervention. Test-retest reliability and response stability of the PSFS were calculated using the intraclass correlation coefficient (ICC2,1) and minimal detectable change (MDC95), respectively. Concurrent validity of the PSFS was determined with the 12-item Multiple Sclerosis Walking Scale (MSWS-12) and the Timed 25-Foot Walk Test (T25FW). PSFS responsiveness was determined using Cohen's d , and minimal clinically important difference (MCID) was calculated based on patient-reported improvements on a Global Rating of Change (GRoC) scale. Results: The PSFS total score demonstrated moderate reliability (ICC2,1 = 0.70, 95% CI: 0.46 to 0.84) and the MDC was 2.1 points. At baseline, the PSFS was fairly and significantly correlated with the MSWS-12 (r = −0.46, P = 0.008) but not with the T25FW. Changes in the PSFS were moderately and significantly correlated with the GRoC scale (ρ = 0.63, P < 0.001), but not with MSWS-12 or T25FW changes. The PSFS was responsive (d = 1.7), and the MCID was 2.5 points or more to identify patient-perceived improvements based on the GRoC scale (sensitivity = 0.85, specificity = 0.76). Discussion and Conclusions: This study supports the use of the PSFS as an outcome measure in people with MS to assess mobility-related goals. Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A423). [ABSTRACT FROM AUTHOR]

BACKGROUND: Backward walking (BW) interventions have improved gait and balance in persons with stroke, cerebral palsy, and Parkinson disease but have not been studied in persons with multiple sclerosis (MS). We examined the feasibility of a BW intervention and how it affected strength, balance, and gait vs forward walking (FW) in persons with MS. METHODS: Sixteen persons with MS with a Patient-Determined Disease Steps (PDDS) scale score of 3 to 5 (gait impairment-late cane) were randomized to the FW (n = 8) or BW (n = 8) group. Participants did 30 minutes of FW or BW on a treadmill 3 times per week for 8 weeks (24 visits). Enrollment, adherence rate, and safety were tracked. The Timed Up and Go test, Six-Spot Step Test, single-leg stance, and abbreviated Activities-specific Balance Confidence scale were used to measure balance. Hip and knee flexion and extension strength (isometric peak torque), gait speed, and spatiotemporal gait parameters were measured. A 2x2 factorial multivariate analysis of covariance was used to examine changes in strength, balance, and gait, with the PDDS scale score as the covariate. RESULTS: Treatment adherence rate was 99.7%, with no safety concerns. After controlling for baseline differences in disability (PDDS scale score; P = .041), the BW group improved dominant hip flexion strength preintervention to postintervention compared with the FW group (F1,13 = 9.03; P = .010). No other significant differences were seen between groups. CONCLUSIONS: This was the first study to look at BW as an intervention in persons with MS. Based on its feasibility, safety, and significant finding, BW should be studied in a larger, definitive trial in the future. [ABSTRACT FROM AUTHOR]

Background: Walking dysfunction is reported by two-thirds of persons with multiple sclerosis (MS). Assistive devices are frequently recommended to improve walking; however, it is uncommon to consider their psychosocial impact, although many users abandon their assistive devices. The psychosocial impact, walking, balance, and fatigue associated with three assistive devices were compared to guide clinical decision making. Methods: Twenty-five persons with MS (median Expanded Disability Status Scale score, 4.0; range, 2.5-6.0) who reported walking difficulty were trained in the use of three assistive devices--a single-point cane (SPC), a four-point cane (FPC), and a trekking pole (TP)--at 1- to 2-week intervals, then used the assistive device for their usual activities. Outcome measures included the Psychosocial Impact of Assistive Devices Scale (PIADS), the 6-Minute Walk Test (6MWT), walking speed, cadence, stride length, stride time, the 12-item Multiple Sclerosis Walking Scale (MSWS-12), the Activities-specific Balance Confidence (ABC) scale, the 5-item Modified Fatigue Impact Scale (MFIS-5), and a visual analogue scale of fatigue (VAS-F). Results: The SPC and TP were more positive in the PIADS adaptability, competence, and self-esteem subscales. The SPC and TP resulted in higher 6MWT, walking speed, cadence, stride length, stride time, and MSWS-12 scores compared with the FPC. No differences were found in ABC scale, MFIS-5, or VAS-F scores. Conclusions: Participants reported more positive psychosocial impact, and walked faster and with higher quality, with the SPC and TP than with the FPC. Clinicians should consider suggesting an SPC or TP to patients who may benefit from assistive device use and for whom psychosocial impact is an important consideration. [ABSTRACT FROM AUTHOR]

Background/aims Diminished walking speed and endurance is commonly experienced by individuals with multiple sclerosis. Speed-intensive gait training has led to improvements in walking speed and endurance in other neurological populations; however, its effect in persons with multiple sclerosis is unknown. This pilot study examined the feasibility, safety and efficacy of speed-intensive gait training in a sample of people with multiple sclerosis. Methods A total of eight participants (five women, median Expanded Disability Status Scale 3.5) underwent a 6-week, twice weekly speed-intensive gait training programme. Walking speed and endurance, balance and fatigue were measured pre- and post-intervention. Results Speed-intensive gait training was feasible, with excellent adherence and safety. It proved effective, with improvements in walking speed (P=0.05), walking endurance (P=0.036) and balance (P=0.041) without an increase in fatigue. conclusions The intermittent design of speed-intensive gait training may enable individuals with multiple sclerosis to achieve higher training volumes than traditional models. Although further study is warranted, rehabilitation clinicians should consider adding speed-intensive gait training as an intervention to improve walking and balance in this patient group. [ABSTRACT FROM AUTHOR]

Background: Fatigue is a common but poorly understood phenomenon frequently seen in patients with neurologic diagnoses. The impact of fatigue on mobility in these patients can be significant, indicating that it can have a large effect on physical therapy management. There is little literature available to Physical Therapists to guide them toward appropriate strategies for examination, evaluation and management of patients with neurologic pathologies who present with limitations due to fatigue. Objectives: (1) To present clear definitions describing the subjective and objective components of fatigue and the impact they might have on mobility in patients with neurologic conditions; (2) To present a clinical reasoning framework that clinicians can utilize to examine, evaluate and treat fatigue in patients with neurologic conditions; (3) To provide examples of how the framework can be applied in clinical practice. Conclusions: Fatigue is common in patients with neurologic disorders and can impact physical therapy management. The clinical reasoning framework presented here can help clinicians provide appropriate examination, evaluation and treatment for use with patients with neurologic pathologies. [ABSTRACT FROM AUTHOR]

Background: This pilot study determined the feasibility of a specifically designed 8-week yoga program for people with moderate multiple sclerosis (MS)-related disability. We explored the program's effect on quality of life (QOL) and physical and mental performance. Methods: We used a single-group design with repeated measurements at baseline, postintervention, and 8-week follow-up. Feasibility was examined through cost, recruitment, retention, attendance, and safety. Outcomes included the Multiple Sclerosis Quality of Life Inventory (MSQLI), 12-item Multiple Sclerosis Walking Scale (MSWS-12), Timed 25-Foot Walk test (T25FW), 6-Minute Walk Test (6MWT), Nine-Hole Peg Test (NHPT), Five-Times Sit-to-Stand Test (FTSTS), Multidirectional Reach Test (MDRT), maximum expiratory pressure, and Paced Auditory Serial Addition Test-3" (PASAT-3"). Results: Fourteen participants completed the study. The program was feasible. There were significant main effects on the 36-item Short Form Health Status Survey Mental Component Summary (SF-36 MCS), Modified Fatigue Impact Scale (MFIS), Bladder Control Scale (BLCS), Perceived Deficits Questionnaire (PDQ), Mental Health Inventory (MHI), MSWS-12, T25FW, NHPT, PASAT-3", 6MWT, FTSTS, and MDRT-Back. Improvements were found on the SF-36 MCS, MFIS, BLCS, PDQ, MHI, and MSWS-12 between baseline and postintervention. The effect on PDQ persisted at follow-up. Improvements were found on the T25FW, NHPT, 6MWT, FTSTS, and MDRT-Back between baseline and postintervention that persisted at follow-up. The PASAT-3" did not change between baseline and postintervention but did between postintervention and follow-up. Conclusions: The yoga program was safe and feasible. Improvements in certain measures of QOL and performance were seen at postintervention and follow-up. [ABSTRACT FROM AUTHOR]

There is little literature examining the use of maximal strength training (MST) in people with multiple sclerosis (pwMS). This pretest-posttest study examined the effects of a MST program on strength, walking, balance, and fatigue in a sample of pwMS. Seven pwMS (median EDSS 3.0, IQR 1.5) participated in a MST program twice weekly for eight weeks. Strength was assessed with 1-repetition maximum (1RM) on each leg. Walking and balance were measured with the 6-Minute Walk Test (6MWT) and Berg Balance Scale (BBS), respectively. Fatigue was measured during each week of the program with the Fatigue Severity Scale (FSS). The program was well tolerated, with an attendance rate of 96.4%. Participants had significant improvements in right leg 1RM (t6=-6.032, P=0.001), left leg 1RM (t(6)=-5.388, P=0.002), 6MWT distance (t(6)=-2.572,P=0.042), and BBS score (Z=-2.371, P=0.018) after the MST intervention. There was no significant change in FSS scores (F(1,3.312)=2.411, P=0.092). Participants in the MST program experienced improved balance and walking without an increase in fatigue. This MST program may be utilized by rehabilitation clinicians to improve lower extremity strength, balance, and mobility in pwMS. [ABSTRACT FROM AUTHOR]

Despite the well-known benefits of using standardized outcome measures (OMs) in clinical practice, a variety of barriers interfere with their use. In particular, rehabilitation therapists lack sufficient knowledge in selecting appropriate OMs. The challenge is compounded when working with people with multiple sclerosis (MS) owing to heterogeneity of the patient population and symptom variability in individual patients. To help overcome these barriers, the American Physical Therapy Association appointed the Multiple Sclerosis Outcome Measures Task Force to review and make evidence-based recommendations for OM use in clinical practice, education, and research specific to people with MS. Sixty-three OMs were reviewed based on their clinical utility, psychometric properties, and a consensus evaluation of the appropriateness of use for people with MS. We sought to illustrate use of the recommendations for two cases. The first case involves a 43-year-old man with new-onset problems after an exacerbation. The second case pertains to an outpatient clinic interested in assessing the effectiveness of their MS rehabilitation program. For each case, clinicians identified areas that were important to assess and various factors deemed important for OM selection. Criteria were established and used to assist in OM selection. In both cases, the described processes narrowed the selection of OMs and assisted with choosing the most appropriate ones. The recommendations, in addition to the processes described in these two cases, can be used by clinicians in any setting working with patients with MS across the disability spectrum. [ABSTRACT FROM AUTHOR]

Background: Gait and walking impairment is a common finding in persons with multiple sclerosis (PwMS) and is often studied using a treadmill. However, studies in other neurologic conditions have questioned whether treadmill walking accurately represents overground walking. If it does not, it may be questionable whether gait research performed on a treadmill can be generalized to overground walking. Similarly, it may suggest that the use of a treadmill for clinical gait evaluation and intervention for PwMS may not be supported. Objectives: The purpose of this study is to examine whether treadmill walking speed is similar to overground walking speed in PwMS. We hypothesized that treadmill walking speed would not be significantly different from overground walking speed in PwMS. If our hypothesis is correct, it will suggest that clinicians can be confident that use of a treadmill for the examination and treatment of gait and walking dysfunction is representative of overground walking. If our hypothesis is not supported, however, it would suggest that clinicians who treat PwMS for gait and walking impairment should reconsider the use of a treadmill as a tool for evaluation and treatment. Methods: 19 people with MS (11 women and 8 men; median [IQR; range] Expanded Disability Status Scale score 4.5 [2.5; 2.0-6.5]) performed an overground 2-Minute Walk Test (2MWT) to determine their average walking speed, then were asked to walk at the same speed on a treadmill. Participants were given up to 10 minutes to familiarize themselves with the treadmill before trying to achieve their overground walking speed. Results: Pearson correlations were used to examine the relationship between predicted walking speed (PWS) (based on the mean walking speed during the 2MWT) and the actual walking speed (AWS) attained while on the treadmill. There was a positive correlation between AWS and PWS (r = 0.841 [r² = 0.707], n = 19, P = .000). 70.7% of the variance in PWS could be predicted by the AWS. This, however, leaves 29.3% of the variance unexplained. Conclusions: Although overground walking and treadmill walking may seem very similar, there are contextual differences in these activities that may limit generalizability between the two. Researchers should be cautious when generalizing outcomes in physical performance in PwMS measured during treadmill walking to expected performance in overground walking. Clinicians should also be cautious in expecting generalized training effects of treadmill walking on overground walking in PwMS. The walking techniques used on a treadmill may not be the same ones used for overground walking, and therefore treadmill walking may not generalize to overground walking. [ABSTRACT FROM AUTHOR]