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Walking ability, balance and accidental falls in persons with Multiple Sclerosis
Örebro University, School of Health and Medical Sciences.ORCID iD: 0000-0002-9760-3785
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

By using a pragmatic paradigm, different research methodologies were employed in this thesis. MS-related symptoms may be exaggerated due to heatsensitivity and it is supposed that cooling garments relieve the symptoms. The effects of wearing a Rehband® vest were evaluated in a sample of 42 persons with MS in a randomised controlled crossover study. Both objective and subjective statistically significant improvements were found when a cooled Rehband® vest was worn compared to the wearing of a room-tempered vest. Using a repeated-measures design, 10m and 30m timed walks and Timed Up and Go were studied in 42 persons with MS. Reproducibility was investigated within and between test points. High reproducibility was found both within (r=0.97–0.98) and between measure points (r=0.91–0.93). The correlation between the three tests was high (r=0.85). Differences at –23% to +40% were established as being needed to detect genuine changes. Severity of MS infl uenced the size of the differences, especially for the 30m timed walk test. The 12-item MS Walking Scale was translated and used in a cross-sectional study. Out of 81 persons with MS, 89–96% perceived limitations in standing or walking. The internal consistency of the scale was acceptable for nine items (0.69–0.84). The concurrent validity between the 12-item MS Walking Scale and the investigated objective tests was low: Berg Balance Scale (r=–0.368**), Four Square Step Test (r=0.338**) and Timed Up and Gocognitive (r=0.319*).

A prevalence of falling was found at 63% in a longitudinal cohort study with prospectively registered falls including 76 persons with MS. The odds of falling were fi ve fold when there was a reported need of using a walking aid indoors and outdoors and by 2.5 to 15.6 times while there was disturbed proprioception, depending on severity. The highest sensitivity was found for the Berg Balance Scale (94%) and the highest specifi city was found for the 12-item MS Walking Scale (82%). Positive predictive values at 70–83% were found for the Berg Balance Scale, Timed Up and Gocognitive, the Four Square Step Test and the 12-item MS Walking Scale. Finally, we explored and described factors that persons with MS perceive as related to accidental falls. A content analysis with a deductive approach was chosen. By conducting interviews, we found previously untargeted factors: divided attention, reduced muscular endurance, fatigue and heat-sensitivity. The content of the interviews also gave support to previously reported risk factors such as changes in gait pattern, walking disability, impaired proprioception and vision, and spasticity.

Place, publisher, year, edition, pages
Örebro: Örebro universitet , 2008. , 94 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 21
Keyword [en]
multiple sclerosis, cooling garment, gait, walking, balance, reliability, validity, accidental falls, prediction, ICF
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-2518ISBN: 978-91-7668-631-7 (print)OAI: oai:DiVA.org:oru-2518DiVA: diva2:136351
Public defence
2008-11-21, Wilandersalen, USÖ, M-huset, 701 85, Örebro, 09:00 (English)
Opponent
Supervisors
Available from: 2008-10-15 Created: 2008-10-15 Last updated: 2016-12-08Bibliographically approved
List of papers
1. Evaluation of a single session with cooling garment for persons with multiple sclerosis: a randomized trial
Open this publication in new window or tab >>Evaluation of a single session with cooling garment for persons with multiple sclerosis: a randomized trial
2006 (English)In: Disability and Rehabilitation: Assistive Technology, ISSN 1748-3107, Vol. 1, no 4, 225-233 p.Article in journal (Refereed) Published
National Category
Medical and Health Sciences Physiotherapy Nursing
Research subject
Medicine; Nursing Science
Identifiers
urn:nbn:se:oru:diva-3012 (URN)10.1080/09638280500493696 (DOI)
Available from: 2008-10-15 Created: 2008-10-15 Last updated: 2016-12-08Bibliographically approved
2. Clinical relevance using timed walk tests and 'timed up and go' testing in persons with multiple sclerosis
Open this publication in new window or tab >>Clinical relevance using timed walk tests and 'timed up and go' testing in persons with multiple sclerosis
2007 (English)In: Physiotherapy Research International, ISSN 1358-2267, E-ISSN 1471-2865, Vol. 12, no 2, 105-14 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND PURPOSE: One must understand the potentials and limitations of all tests used to evaluate interventions. The aim of the present study was to clarify the reproducibility, smallest percentage difference needed to be able to detect a genuine change and correlation regarding the 10-m and 30-m timed walks (10TW 30TW) and the 'timed up and go' (TUG) test in people with moderate multiple sclerosis (MS).

METHOD: A repeated-measures design was used, with randomization into two groups and different time intervals used for testing. The 10TW and 30TW were performed three times and TUG twice at each testing. Self-selected speed was used for 10TW and forced speed (quickly but safely) for 30TW and TUG. Forty-three people were tested on three occasions within one week. Each person was tested at approximately the same time of the day and by the same physiotherapist on each occasion.

RESULTS: The reproducibility was very high. For a single testing occasion, the intraclass correlation was 0.97 for the 10TW and 0.98 for the 30TW and TUG. The smallest percentage difference needed to be able to detect a genuine change in the entire study group was approximately -23% or +31% for either the 1OTW or TUG. It was evident from the 30TW testing results that lower values applied to those with less (-14% to +17%) rather than more (-38% or +60%) disability. The correlation between all tests for the entire study group was 0.85 (0.76-0.91).

CONCLUSION: It is sufficient to use only one attempt and to choose only one of the tests when evaluating people with moderate MS. In the case of the 30TW greater attention must be paid to the degree of disability when determining the smallest percentage difference needed to establish a genuine change, than

Place, publisher, year, edition, pages
London: Whurr Publishers, 2007
Keyword
Adult, Cross-Over Studies, Female, Gait/physiology, Humans, Locomotion/physiology, Male, Middle Aged, Motor Activity/*physiology, Multiple Sclerosis/physiopathology/*rehabilitation, Musculoskeletal Equilibrium/physiology, Reproducibility of Results, Time Factors, Walking/*physiology
National Category
Physiotherapy
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-4699 (URN)10.1002/pri.358 (DOI)17536648 (PubMedID)
Available from: 2008-11-12 Created: 2008-11-12 Last updated: 2016-12-08Bibliographically approved
3. Self-perceived limitations of gait in persons with multiple sclerosis
Open this publication in new window or tab >>Self-perceived limitations of gait in persons with multiple sclerosis
2007 (English)In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 9, no 3, 136-143 p.Article in journal (Refereed) Published
Abstract [en]

This study aimed to describe the self-perceived walking limitations of those with multiple sclerosis (MS) using the Swedish translation of the 12-item MS Walking Scale [MSWS-12 (S)], and to investigate it for concurrent validity and internal consistency. Eighty-one persons, recruited from five centres in Sweden, were tested using the Four Square Step Test (FSST), the Timed Up and Go cognitive (TUGcog) and the Berg Balance Scale (BBS) in randomized order, besides filling in the MSWS-12 (S). Perceived limitations were reported in 89-96% of the sample, i.e. performance of activities related to standing or walking, decreased speed and distance, and qualitative aspects; and self-perception regarding the ability to run being most extremely affected. Correlations between the MSWS-12 (S) and the objective tests were low, as were correlations between items in the MSWS-12 (S) and the BBS or time taken to complete the TUGcog or the FSST. The internal consistency was acceptable for nine of the 12 items (0.7-0.84). The majority of the sample experienced limitations in several aspects of their walking ability. Concurrent validity was not established between the MSWS-12 (S) and the other tests. There may be a discrepancy in self- perception of disability and objective measures. The use of subjective, as well as objective measures is recommended.

Place, publisher, year, edition, pages
London: Taylor & Francis, 2007
Keyword
12-item MS Walking Scale, internal consistency, Swedish, balance, validity
National Category
Social Sciences Interdisciplinary Nursing
Research subject
vårdvetenskap
Identifiers
urn:nbn:se:oru:diva-3014 (URN)10.1080/14038190701256402 (DOI)
Available from: 2008-10-15 Created: 2008-10-15 Last updated: 2016-12-08Bibliographically approved
4. Predicting accidental falls in persons with Multiple Sclerosis: a longitudinal study
Open this publication in new window or tab >>Predicting accidental falls in persons with Multiple Sclerosis: a longitudinal study
(English)Manuscript (preprint) (Other academic)
National Category
Medical and Health Sciences
Research subject
Rehabilitation Medicine
Identifiers
urn:nbn:se:oru:diva-3015 (URN)
Available from: 2008-10-15 Created: 2008-10-15 Last updated: 2016-12-08Bibliographically approved
5. Factors perceived as being related to accidental falls by persons with multiple sclerosis
Open this publication in new window or tab >>Factors perceived as being related to accidental falls by persons with multiple sclerosis
2009 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 31, no 16, 1301-1310 p.Article in journal (Refereed) Published
Abstract [en]

Purpose. This study explores and describes factors that persons with multiple sclerosis (MS) perceive as being related to accidental falls. Method. A qualitative content analysis with primarily deductive approach was conducted using the International Classification of Functioning, Disability and Health. Twelve persons with MS, and identified as fallers, were interviewed. Results. Factors perceived to cause accidental falls that had not previously been targeted in MS populations in relation to falls were identified as divided attention, reduced muscular endurance, fatigue and heat sensitivity. Previously reported risk factors such as changed gait pattern, limited walking ability, impaired proprioception, vision and spasticity were supported. Activities involving walking, recreation and leisure, maintaining and changing body position, lifting or carrying, taking care of the home, washing the body, moving around, preparing meals and housekeeping were limited and considered to be risk activities. Supportive persons and assistive device reduced falls, and unsuitable physical environments and climate conditions induced falls. Several preventative strategies were described as partially compensating for the impairments, limitations and restrictions. Conclusions. Investigating accidental falls using the perspective of the patient gave important information about variables not earlier targeted in MS research.

Place, publisher, year, edition, pages
London: Taylor & Francis, 2009
Keyword
Multiple sclerosis, accidental falls, international classification of functioning, disability and health, balance, qualitative content analysis
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-3016 (URN)10.1080/09638280802532639 (DOI)000268663000001 ()19479575 (PubMedID)2-s2.0-70449729791 (Scopus ID)
Available from: 2008-10-15 Created: 2008-10-15 Last updated: 2017-03-24Bibliographically approved

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