Validity of maximal exercise testing in people with multiple sclerosis and low to moderate levels of disability.

BACKGROUND: Cardiopulmonary exercise testing can be considered the gold standard for assessing cardiorespiratory fitness. Little is known about the criteria for maximal exercise testing in people with multiple sclerosis (MS) and how these criteria behave across different levels of neurological disability. OBJECTIVE: The study objectives were to determine the criteria for maximal exercise testing across various levels of disability and to assess concomitant subgroup differences in measures related to the participant, disease, and function. DESIGN: This was a cross-sectional study. METHODS: Cardiopulmonary exercise testing was conducted with a sample of 56 participants with MS. Analysis of variance was used to assess the criteria in participants with MS and low, mild, and moderate levels of disability. RESULTS: Mean peak oxygen consumption (V̇o2peak) was 21.4 (SD=7.1) mL·kg(-1)·min(-1). An oxygen consumption (V̇o2) plateau was seen in 37.5% of participants. A respiratory exchange ratio of 1.10 or greater was achieved by 69.6% of the participants, a maximal heart rate within 90% of their age-predicted maximal heart rate was achieved by 48.2% of the participants, and 23.2% of the participants perceived their exertion to be 18 or greater on the Borg Scale of Perceived Exertion (scores of 6-20). The values for achieved heart rate and incidence of a V̇o2 plateau were significantly lower in participants with moderate levels of disability than in those with mild levels of disability. LIMITATIONS: The primary limitations of this study were its cross-sectional nature and relatively small sample of participants with moderate levels of disability. CONCLUSION: The findings suggest that the outcome of cardiopulmonary exercise testing in people with MS and low to mild levels of disability (Expanded Disability Status Scale scores of ≤4.0) is a valid measure of cardiorespiratory fitness, whereas the outcome in people with moderate levels of disability (Expanded Disability Status Scale scores of >4.0) is most likely symptom limited.

Perceived usability and use of custom-made footwear in diabetic patients at high risk for foot ulceration.

OBJECTIVE: To assess the perceived usability and use of custom- made footwear in diabetic patients who are at high-risk for foot ulceration, and to elucidate the determinants of usability and use. DESIGN: Survey. SUBJECTS: A total of 153 patients with diabetes, peripheral neuropathy, prior plantar foot ulceration and newly prescribed custom-made footwear, recruited from 10 Dutch multidisciplinary foot clinics. METHODS: The Questionnaire of Usability Evaluation was used to assess the patients' perception of weight, appearance, comfort, durability, donning/doffing, stability, benefit and overall appreciation of their prescription footwear (all expressed as visual analogue scores). Data on priorities for usability and footwear use (in h/day) were obtained from patient reports. Multivariate logistic regression analysis was used to assess determinants of usability and use. RESULTS: Median (interquartile range) score for overall appreciation was 8.3 (7.1-9.1). Scores ranged from 6.5 (4.5-8.6) for weight to 9.6 (6.3-9.9) for donning/doffing. Footwear comfort was listed most often (33.3%) as the highest priority. Footwear use was <60% of daytime (where daytime was defined as 16 h out of bed) in 58% of patients. The only significant determinant of footwear use was the perceived benefit of the footwear (p = 0.045). CONCLUSION: Perceived usability of footwear was mostly positive, although individual scores and priorities varied considerably. Footwear use was low to moderate and dependent only on the perceived benefit of the footwear. Therefore, practitioners should focus on enhancing the patient's ap-preciation of the therapeutic benefit of custom-made footwear.

A comparison of 3 generic health status questionnaires among stroke patients.

Several generic multidimensional health status questionnaires are available, but it is not clear whether or not these measures are interchangeable in terms of content. Consequently, we investigated the content validity of the Sickness Impact Profile 68 (SIP68), Medical Outcome Study Short Form 36 (SF-36), and the Darmouth COOP Functional Health Assessment Charts/World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (COOP/WONCA) charts. A total of 198 stroke patients referred to inpatient rehabilitation were interviewed 1 year poststroke. Subscales of the generic questionnaires were compared with one another and also with 3 domain-specific scales: the Barthel Index (BI) for physical functioning, the Center of Epidemiology Studies Depression (CES-D) scale for mental functioning, and the Frenchay Activities Index (FAI) for social functioning. Nonparametric Spearman correlations of at least 0.6 were accepted as evidence of content validity. Half of the physical subscales correlated with each other by at least 0.6. None of the 3 correlations in the mental domain and only 1 of 21 correlations in the social domain met the 0.6 threshold. Physical-oriented subscales correlated with BI almost as expected. In the mental domain, only the correlation of the CES-D with the SF-36 mental health scale was above 0.6, and in the social domain, only the correlation of the FAI with the SIP68 mobility range was above 0.6. The findings of this study suggest that generic health questionnaires are not mutually interchangeable. Physical and social health status of stroke patients is adequately covered by the SIP68. However, the SF-36 is more suitable for measuring the mental consequences of stroke.