Predictors of community-based ambulatory activity: prospective six-month study of multiple sclerosis patients.
|Title||Predictors of community-based ambulatory activity: prospective six-month study of multiple sclerosis patients.|
|Publication Type||Journal Article|
|Authors||Wundes A, McAleenan J, Severson BJ, Bamer AM, Brown T|
Background: Multiple Sclerosis (MS) may cause gait impairment, reduced ambulatory activity and risk of falls. Ankle-worn accelerometers can record detailed ambulatory activity even in patients with abnormal gait patterns. We conducted a prospective 6-month study to evaluate the correlation of ambulatory activity, clinical tests, self-reported walking activity/fatigue and falls in MS patients. Methods: Participants wore StepWatch accelerometer for one week in months 1 and 6; parameters of ambulatory activity levels, endurance and burst activity were assessed. We calculated metabolic equivalents of activity. Further, EDSS (expanded disability status scale), Timed 25 Foot Walk (T25W), Hauser Ambulation Index (HA), Berg Balance Test (BBT), Lower Extremity Motor Coordination test, the MS-Walking Scale (MSWS) and Modified Fatigue Impact Scale (MFIS) were completed at baseline and at end of study. Participants were monitored by monthly phone calls towards falls. Results: 40 patients enrolled (mean age 55 years, mean baseline EDSS 5.2; range 2.5-6.5). Patients took an average of 6151 (SD:2729) steps/ day. Mean sustained activity over a 30-minute time frame was 16 steps/min (SD:8); mean peak activity 44 steps/min (SD:9). Most ambulation occurred during low to medium activity levels. The two accelerometer measurements did not differ significantly. Baseline EDSS, T25W, HA, BBT and MSWS predicted total step counts and peak activity (p0.006); highest correlation was found for HA and MSWS. No correlation between fatigue (MFIS) and any parameters of ambulatory activity was observed. On average participants had 4.7 falls/6 months; 26% had no falls, 11% had one fall and 63% had 2 falls during the study. There was no significant correlation between ambulatory activity, any of clinical tests or questionnaires and falls. Conclusions: Our study describes ambulatory activity of MS patients with moderate disability and found no change over a 6 month period. Several clinical tests commonly used in MS research and care predicted overall and peak ambulatory activity; highest correlation was noted with simple measurements such as HA and MSWS. No correlation between fatigue and physical activity was observed, which may suggest a poor relation between perceived fatigue and actual physical activity. Finally, neither accelerometer measures nor clinical tests/questionnaires were associated with falls indicating that alternative predictors of falls need to be developed.