Physical activity in mild multiple sclerosis: contribution of perceived fatigue, energy cost, and speed of walking.

Purpose: To clarify the relationship between leisure-time physical activity, perceived fatigue, and energy expenditure while walking in people with multiple sclerosis.Methods: Sixty-six people afflicted with multiple sclerosis (MS) (32 women) with a mild neurological disability, participated in this study. Energy expenditure was separately measured at rest, during comfortable walking and during fast walking via a portable metabolic device using breath-by-breath technology (COSMED K5, COSMED Srl, Rome, Italy). The Godin leisure-time exercise questionnaire assessed leisure-time physical activity. The Modified Fatigue Impact Scale determined the level of perceived fatigue.Results: Seventeen people with MS were classified as physically active; 49 were insufficiently active. Scores recorded on the Godin Leisure-Time Exercise Questionnaire were 47.8 (SD = 18.4), 7.0 (SD = 8.2), respectively. Insufficiently physically active people with MS walked slower at both normal and fast walking conditions. However, no differences between groups were observed in energy expenditure measures in both walking speeds. O2 cost was 0.20 (SD = 0.13) and 0.21 (SD = 0.06) in the active and insufficiently active group, respectively. The insufficiently active group reported more perceived fatigue compared with the active patients; 33.3 (SD = 18.6) vs. 15.0 (SD = 19.0), p value = 0.002. Perceived fatigue was a significant variable maintaining a 10.4% variance related to leisure-time physical activity.Conclusions: Leisure-time physical activity was inversely associated with perceived fatigue and walking speed in persons with mild MS. Rehabilitation professionals should be aware of these relationships when planning rehabilitation strategies.Implication for rehabilitationThis study found that perceived fatigue is a barrier to physical activity participation even in people with mild multiple sclerosis and minimal disability.Insufficiently active people with multiple sclerosis expend the same amount of energy while walking as active multiple sclerosis individuals, though walking slower.The relationship between perceived fatigue and physical activity participation requires further exploration in the multiple sclerosis population.

Perspectives in multiple sclerosis health care: special focus on the costs of multiple sclerosis.

Brain disorders are amongst the leading causes of disease and disability worldwide, accounting for 35% of the burden of all diseases in Europe. Despite their enormous personal and national impact the knowledge of the financial and economic impression of brain disorders has been relatively little researched. Recently it has been estimated that there are nearly 400,000 multiple sclerosis (MS) patients in Europe, which is 0.003% of all brain disease patients in the continent. In MS economic consequences are predominantly the early loss of work capacity and the impact of physical and psychological disabilities in a population of young adults, hospitalization during severe disease exacerbations and the need for assistance in activities of daily living. In the last decade the introduction of new immunomodulatory treatments led to an increase in direct costs due to the cost of these drugs, but also led to a more intensive management of patients. However, most studies of MS costs were carried out prior to the widespread use of newer treatments. In the present study we estimated the economic impact of MS in Israel and compared the traditional-vertical management model with the integrated-multidisciplinary model of health service delivery following the introduction of immunomodulatory treatments. Mean direct health cost was 8,554 euros and 5,599 euros in the traditional and integrative models, respectively (p<0.01). After 1-year follow-up, full-time employment decreased by 10% in the traditional model and increased by 17% in the integrated model (p<0.05). Analysis of variance demonstrated that the model of service delivery explained most of the difference in cost between the two models. Compared to mean annual costs in Europe that are estimated at 23,695 euros per case the cost of health services in Israel by MS patients is significantly lower. MS represents a high economic burden to society. In line with the findings from 15 studies published in Europe, we can conclude that studies agree with the following findings: a) costs outside the healthcare system, non-medical costs and informal care dominate the costs of MS, b) costs increase with increasing severity of the disease and c) an integrated service delivery model that is satisfying to patients on the one hand and cost effective on the other is to be recommended.

Assessment of multiple sclerosis lesions with spherical harmonics: comparison of MR imaging and pathologic findings.

Spherical harmonics (SH) were used to approximate the volume and three-dimensional geometry of multiple sclerosis (MS) lesions in deceased patients. The institutional ethical committee does not require its approval for studies involving pathologic specimens. Pathologic findings were used as the reference standard. In addition, lesion volume was measured with cylindrical approximation (CA). Volumetric comparisons of biases were based on summary statistics, Spearman correlation, Wilcoxon test, and two-way analysis of variance. Shape comparison metrics included mean distance and Dice similarity coefficient (DSC). Eight of 11 lesions had smaller biases with SH method (P < .001). Median biases with SH and CA did not differ significantly, as compared with pathologic findings (r = 1.00 vs 0.99, respectively). Variances of the biases were significantly smaller for SH (P = .04). Ranges of normalized distance and DSC were 0.1%-2.5% and 75%-96%, respectively. Mean DSC was significantly higher than 70% (P < .001). SH method provided unbiased lesion volume and added geometric information that may enable a better understanding of the pathogenesis and lesion evolution over time.

Bone strength in multiple sclerosis: cortical midtibial speed-of-sound assessment.

It has been previously suggested that multiple sclerosis (MS) patients are at increased risk for osteoporosis due to reduced mobility, decreased exposure to sunlight and recurrent steroid treatment. In order to systematically evaluate bone strength we assessed 256 MS patients (171 females, 75 males) through quantitative ultrasound measurement of cortical bone. Tibial speed of sound (SOS, m/sec) was measured at midpoint of the tibial shaft using a Soundscan 2000 (Myriad Ultrasound Systems, Rehovot, Israel) and results were compared to age- and gender-matched population norms. T-score distribution in male MS patients was similar to normal population. In contrast, for female MS patients T-score distribution was significantly different from population norms, reflected by increased SOS in 30.4% (T-score intervals 1-2 and >2 above normal values; P=0.001), compared with 7.4% in controls. These findings held true for both female patients younger and older than 45 years of age. Increased neurological disability and specifically motor involvement were more frequent in female patients with increased SOS (P<0.05). Bone strength was preserved in MS patients. In a subgroup of female patients increased SOS was conceivably related to spasticity.