Author Of 2 Presentations
P1045 - Predicting fall risk in persons with Multiple Sclerosis utilizing the 12-Item Multiple Sclerosis Walking Scale (ID 262)
Abstract
Background
Evidence suggests that 50-80% of persons with Multiple Sclerosis (PwMS) have difficulty walking and impaired balance, with half of them falling at least once a year. Falls can lead to increased risk of injury and fear of falling, which may further impair a person’s function. Studies have previously shown that patient-reported outcomes (PRO’s) predict PwMS’ risk of falling but small sample sizes and variable cut-off scores have limited generalization of the findings.
Objectives
To determine the predictive value of a cut-off score for the 12-Item Multiple Sclerosis Walking Scale (MSWS-12) to identify PwMS with greater fall risk.
Methods
A total of 135 PwMS were included as part of a preliminary analysis of an ongoing, larger cross-sectional study in which the MSWS-12 and frequency of falls (self-reported over past 6 months) were collected. PwMS were designed as “faller” if they had >1 fall in the past 6 months. Descriptive statistics were used to describe the clinical characteristics of the fallers (n=82) and non-fallers (n=53) (age, gender, disease duration, use of assistance, and Patient Determined Disease Steps; PDDS). Clinical characteristics and MSWS-12 scores of the faller and non-faller groups were compared. A Receiver Operating Characteristic (ROC) curve was used to estimate the classification accuracy of the MSWS-12. Optimal cut-off scores were calculated using the Youden index and sensitivity and specificity were calculated.
Results
There were no differences in age, gender, or disease duration between fallers and non-fallers. Fallers had higher median PDDS scores (3; 0-6 versus 1, 0-6; (p< 0.01)) and higher median MSWS-12 scores (67.5 versus 38.3; p<0.001) than non-fallers. Fallers were more dependent on assistive devices compared to non-fallers (p<0.01). The MSWS-12 cutoff score for fallers was ≥45.83 (Youden index: 0.46), with a sensitivity of 78.1%, specificity of 67.9% and a classification accuracy of 76.7% to detect fallers.
Conclusions
MSWS-12 was found to be predictive of fall risk in PwMS with a cut-off score much lower than previously reported. These findings indicate a lower threshold of the MSWS-12 score may help clinicians identify PwMS at greatest fall risk so that appropriate fall risk prevention interventions may be implemented.
P1110 - The impact of lower limb strength on walking in persons with Multiple Sclerosis: a preliminary analysis (ID 263)
Abstract
Background
Persons with MS (PwMS) report weakness and walking difficulty as some of their most disabling symptoms. Lower limb (LL) weakness is prevalent in PwMS and is associated with more significant disability, impaired balance, and increased difficulty walking. However, limited research exists describing the relationship between strength of specific LL muscle groups and walking in the same cohort.
Objectives
To determine the impact of dominant (D) and non-dominant (ND) LL strength on Patient Reported Outcomes (PROs) and objective walking outcome measures in PwMS.
Methods
A cross-sectional sample of PwMS (n = 137) derived from a larger, ongoing study was used. The following walking measures were collected at a single visit: 12-item MS Walking Scale (MSWS-12), Timed 25 foot walk (T25FW), and D and ND Stride Length (StrL), Step Length (SL), and Double Support Time (DStime). Isometric peak torque of Hip extension and flexion (HExt; Flex) Knee extension and flexion (KExt; Flex), Ankle plantar and dorsiflexion (APF; DF), and Hip abduction (HAbd) were also collected. Descriptive statistics were performed (age, gender, disease duration and disability level: Patient Determined Disease Steps; PDDS) and a correlational analysis was used to determine the strength of the association of walking to strength in muscle groups.
Results
The MS cohort had a mean age of 51.4 yrs (range: 21-75), disease duration of 14.5 yrs (range: 0.3-40.0), and median PDDS of 2.5 (range: 0-7), with 74.1% being female. All muscle groups were correlated with SL and StrL, and inversely correlated with T25FW, MSWS-12, and DStime. Strong associations were observed between D HFlex and StrL (D: r=.621,p <0.001; and ND: r=.636,p <0.001), D HFlex and ND SL (r=.608,p <0.001), ND KFlex and StrL (D: r=.610,p <0.001; and ND: r=.622,p <0.001), ND HAbd and ND SL (r=.640,p <0.001) and ND HAbd and StrL (r=.605,p <0.001). Weak to moderate correlations (r = ± .190 to .599, p<0.05) were found for all remaining strength and walking measures assessed.
Conclusions
All LL muscle groups (HExt, HFlex, KExt, KFlex, APF, ADF, and HAbd) were associated with the PRO (MSWS-12) and objective walking variables (T25FW, gait parameters: StrL, SL, and DStime) collected. These findings suggest that strength training interventions of these muscles may improve walking in PwMS. Importantly, this study improves understanding of the relationship between different major LL muscle groups with both walking performance and perceived difficulty walking in PwMS.