Dyspnea, the silent threat in Parkinson's: a mixed methods study.

BACKGROUND: Dyspnea is considered a silent threat to people diagnosed with Parkinson's disease and may be a common concern in patients, however, little is known about how it affects quality of life. This study explored the experiences of independently mobile people who are affected by dyspnea in daily life. METHODOLOGY: This was a cross-sectional mixed methods study that included an online questionnaire and semi-structured interviews. The participants were included if they were diagnosed with Parkinson's disease; had a self-reported Hoehn and Yahr Score I, II or III; were mobilizing independently; and were Arabic speakers. Participants were excluded if they had any other musculoskeletal, cardiac, respiratory, or neurological diseases; or were previous or current smokers; or had been previously hospitalized due to respiratory complications. RESULTS: A total of 117 participants completed the Arabic version of the Dyspnea-12 Questionnaire. Dyspnea was reported in all participants and that it had an adverse effect on their quality of life, especially during activities of daily living. Additionally, participants reported a lack of knowledge about pulmonary rehabilitation and were unaware of the availability and potential benefits of participation in programs. CONCLUSION: Dyspnea was reported in people in the early stages (Hoehn and Yahr Stages I, II, and III) of Parkinson's disease, and may benefit from routine assessment of lung function, dyspnea management and participation in pulmonary rehabilitation.

Validity and Reliability of an Arabic Version of the Survey Instrument for Natural History, Aetiology and Prevalence of Patellofemoral Pain Studies: A Cross-Sectional Study.

BACKGROUND AND OBJECTIVES: Knee pain, specifically patellofemoral pain (PFP), may lead to limitations in physical activity and social participation. Identifying knee pain that is attributed to PFP is not an easy job for healthcare professionals. To overcome this issue, The Survey Instrument for Natural History, Aetiology and Prevalence of Patellofemoral Pain (SNAPPS), which is a self-reporting questionnaire instrument, was designed to identify PFP in many languages. However, the Arabic version of the SNAPPS is not validated yet. This study was performed to assess the validity and reliability of the Arabic version of the SNAPPS (A-SNAPPS). MATERIALS AND METHODS: A cross-sectional study was conducted to achieve the study goals. To assess reliability, 38 participants were asked to complete the A-SNAPPS two times on the same day with a 30 min break in between. Convergent validity of the A-SNAPPS was assessed by exploring the correlations of the SNAPPS total score with the visual analogue scale (VAS) scores, including VAS for usual pain, VAS for worst pain, and VAS for pain during activities such as jumping, running, ascending and descending stairs, and squatting. RESULTS: The validity test findings suggested that SNAPPS has a strong correlation with the VAS during ascending and descending stairs (r = 0.71) and moderate correlations during jumping (r = 0.54) and squatting (r = 0.57). The test-retest reliability ICC was 0.92, indicating a very strong test-retest reliability of the A-SNAPPS. CONCLUSIONS: The A-SNAPPS was cross-culturally adapted and validated, demonstrating very strong reliability.

The Effects of Digital Health Interventions for Pulmonary Rehabilitation in People with COPD: A Systematic Review of Randomized Controlled Trials.

Background and Objectives: Chronic Obstructive Pulmonary Disease (COPD) is the third most common cause of death globally. Pulmonary rehabilitation (PR) programmes are important to reduce COPD symptoms and improve the quality of life of people with COPD. Digital health interventions have recently been adopted in PR programmes, which allow people with COPD to participate in such programmes with low barriers. The aim of this study is to review and discuss the reported effects of digital health interventions on PR outcomes in people with COPD. Materials and Methods: To achieve the study goals, a systematic literature search was conducted using PubMed (MEDLINE), CINAHL, AMED, SPORTDiscus and the Physiotherapy Evidence Database. Randomised clinical trials (RCTs) were included if they met specified criteria. Two reviewers independently checked titles, abstracts, and performed full-text screening and data extraction. The quality assessment and risk of bias were performed in accordance with the PEDRO scale and Cochrane Risk of Bias tool 2, respectively. Results: Thirteen RCTs were included in this systematic review with 1525 participants with COPD. This systematic review showed the potential positive effect of digital health PR on the exercise capacity-measured by 6- and 12-min walking tests, pulmonary function, dyspnoea and health-related quality of life. There was no evidence for advantages of digital health PR in the improvement of anxiety, depression, and self-efficacy. Conclusions: Digital health PR is more effective than traditional PR in improving the pulmonary and physical outcomes for people with COPD, but there was no difference between the two PR programmes in improving the psychosocial outcomes. The certainty of the findings of this review is affected by the small number of included studies.

The relationship between sleep quality and gait in people with multiple sclerosis: A pilot study.

Background: Gait deficits are common among people with multiple sclerosis (PwMS). Therefore, investigating factors that may influence walking in PwMS is important. Previous studies in older adults and other neurological populations demonstrated the relationship between sleep quality and gait performance. Despite the fact that the prevalence of poor sleep quality is very high among PwMS, little is known about the effect of sleep quality on gait among PwMS. Objective: This study aimed to explore the relationship between sleep quality and gait performance in PwMS. Methods: Forty-one PwMS participated in the study between February 2019 and December 2019. Participants were asked to walk at a self-selected speed over 10 m with an inertial measurement unit (IMU) attached over the back. Walking speed, step length (left and right), and step time were calculated. Sleep was estimated objectively using a wrist-worn triaxle-accelerometer; the derived parameters were sleep efficiency (SE) and the number of awakening after sleep onset (NASO). Results: SE significantly correlated with step length (p=0.02). Furthermore, the NASO significantly correlated with gait speed (p=0.03), and step-time (p=0.02). These correlations remained significant even after adjusting for age and disease duration. Conclusion: We observed that when corrected for disease duration and age there were relationships between NASO and SE to gait parameters; these observations warrant further investigations.

The Impact of COVID-19 Confinement on Reading Behavior.

Background: The COVID-19 pandemic was detrimental to lifestyle and behavior. In this investigation, changes in reading habits during the pandemic were examined. Methods: The study is cross-sectional and survey-based. 1844 individuals completed an online survey about sociodemographic and reading habits during COVID-19. Multinomial logistic regression was used to examine the relationship between the study variables. Results: Most of the participants were active readers (71.5%-83.2%). Fewer (13.8-18.0%) reported a decrease in reading, while about half reported a no change, and 1/3rd reported an increase. Changes in reading habits were related to age, education, job type, and income. Conclusion: About half of the participants during the pandemic reported a change in reading habits. Interventions to further enhance reading among people during the pandemic might help ameliorate the negative impacts of the pandemic.

Translation, Cross-Cultural Adaptation and Psychometric Validation of the Arabic Version of the Cardiac Rehabilitation Barriers Scale (CRBS-A) with Strategies to Mitigate Barriers.

Cardiac rehabilitation (CR) utilization is low, particularly in Arabic-speaking countries. This study aimed to translate and psychometrically validate the CR Barriers Scale in Arabic (CRBS-A), as well as strategies to mitigate them. The CRBS was translated by two bilingual health professionals independently, followed by back-translation. Next, 19 healthcare providers, followed by 19 patients rated the face and content validity (CV) of the pre-final versions, providing input to improve cross-cultural applicability. Then, 207 patients from Saudi Arabia and Jordan completed the CRBS-A, and factor structure, internal consistency, construct, and criterion validity were assessed. Helpfulness of mitigation strategies was also assessed. For experts, item and scale CV indices were 0.8-1.0 and 0.9, respectively. For patients, item clarity and mitigation helpfulness scores were 4.5 ± 0.1 and 4.3 ± 0.1/5, respectively. Minor edits were made. For the test of structural validity, four factors were extracted: time conflicts/lack of perceived need and excuses; preference to self-manage; logistical problems; and health system issues and comorbidities. Total CRBS-A α was 0.90. Construct validity was supported by a trend for an association of total CRBS with financial insecurity regarding healthcare. Total CRBS-A scores were significantly lower in patients who were referred to CR (2.8 ± 0.6) vs. those who were not (3.6 ± 0.8), confirming criterion validity (p = 0.04). Mitigation strategies were considered very helpful (mean = 4.2 ± 0.8/5). The CRBS-A is reliable and valid. It can support identification of top barriers to CR participation at multiple levels, and then strategies for mitigating them can be implemented.

The Role of Physiotherapists in Smoking Cessation Management: A Scoping Review.

Physiotherapy (PT) is a profession that includes education and close contact for long periods of time with patients for treatment sessions. Globally, smoking is prevalent and is expected to increase in the next decades; thus, smoking cessation (SC) is an important management strategy to mitigate further escalation. Little is known about PT practice in SC, and therefore, this study aimed to systematically review and discuss the published literature about the role of physiotherapists in smoking cessation management, opinions, and prevalence of SC counselling in physiotherapy practice; and to explore barriers towards smoking cessation counselling within physiotherapy practice. A systematic search was conducted through EBSCO, and articles were included if they assessed the role of PTs in SC management. The databases were searched for studies published between 1 January 1970 to 1 April 2022. Articles were excluded if they did not include PTs, if they did not include assessment of SC management/counselling, if they were not cross-sectional studies, if they were not written in the English language, or if they were conference abstracts. Seven studies were included in the review. The search identified no studies that have investigated the role of PTs in vaping cessation. It was found that PTs are not addressing SC counselling and management enough in their practice. In addition, the search revealed that lack of training, time, and knowledge are the most common barriers against including SC counselling in physiotherapy practice and rehabilitation programs. Exploring possibilities of including SC counselling according to the clinical guidelines is encouraged. Additionally, establishing solutions to overcome barriers against SC counselling as part of physiotherapy practice is essential.

Transcranial direct current stimulation for upper extremity spasticity rehabilitation in stroke survivors: A systematic review of randomized controlled trials.

OBJECTIVES: To examine the effects of transcranial direct current stimulation (tDCS) on upper extremity spasticity after stroke and to define the most effective tDCS parameters. LITERATURE SURVEY: Systematic review in the following databases: PubMed, SCOPUS, PEDro, CINAHL, MEDLINE, REHABDATA, AMED, and Web of Science databases. Studies up to June 2020 were included. METHODOLOGY: Studies were included if the sample was composed of individuals with stroke, the intervention followed a tDCS intervention (alone or combined with another intervention), and the study was a randomized controlled trial including at least one measurement assessing upper extremity spasticity. Two authors independently screened the included studies. Conflicting decisions between authors were resolved by discussion with the third author. The methodological quality was assessed using the Cochrane Collaboration's tool. The authors determined that the meta-analysis was not feasible due to the heterogeneity in the protocols among the included studies. SYNTHESIS: After the screening of 1204 records, a total of seven studies met the specified inclusion criteria and involved 320 participants (mean age = 60.3), 31.1% of whom were females. Patients with ischemic stroke comprised 77.2% of the total patients, and 42.2% were with right hemispheric stroke. Six studies exhibited "high" quality and one exhibited "moderate" quality. Five of the selected studies that combined the tDCS intervention and other traditional interventions showed a significant reduction in upper extremity spasticity after stroke following tDCS intervention. The other two studies that delivered tDCs alone did not show a significant difference. CONCLUSIONS: The evidence for the effect of tDCS on upper extremity spasticity after stroke was limited. The optimal tDCS treatment dosage remains unclear. Additional studies with large sample sizes and long-term follow-up are strongly warranted.

Exercise capacity in people with Parkinson's disease: which clinical characteristics are important?

BACKGROUND: People with Parkinson's (PwP) are suffering from reduced exercise capacity. However, little information is known about clinical correlates of exercise capacity in this population. OBJECTIVE: This study aimed to evaluate correlations between motor and non-motor symptoms with exercise capacity in PwP. METHODS: A total of 50 individuals with Parkinson's disease participated in the study. Exercise capacity was measured by 6 minutes' walk test (6MWT). Besides, the Movement Disorder Society-Unified Parkinson's Disease Rating Scale-Part III used to evaluate disease motor severity, Berg Balance Scale to assess balance, Montréal Cognitive Assessment to evaluate cognitive status, hospital anxiety and depression scale to assess depression and anxiety, Modified Fatigue Impact scale to evaluate fatigue, and the Pittsburgh Sleep Quality Index to evaluate sleep quality. RESULTS: The results showed that exercise capacity, when measured by the 6MWT, can be significantly predicted by balance, disease motor severity, anxiety, and age (R2 = 0.61 P < .0001). CONCLUSION: These results suggest that exercise capacity in PwP is multifactorial and can potentially be predicted by balance, motor severity, anxiety, and age.

The Effects of Virtual Reality Physiotherapy Interventions on Cardiopulmonary Function and Breathing Control in Cystic Fibrosis: A Systematic Review.

Motivation and adherence are the main factors that limit participation in physiotherapy exercise sessions and airway clearance in cystic fibrosis (CF) population. One of the newly developed techniques is to use virtual reality (VR) games to increase motivation and adherence during exercise sessions for this population. However, this area is still poorly investigated. This review aims to evaluate, summarize, and review published literature regarding the effects of VR exercise on cardiopulmonary function and the use of VR games as a tool for airway clearance technique in CF population. A systematic search was conducted using PEDro, MEDLINE, AMED, CINAHL Plus, and relevant associated keywords. Seventy-three citations were identified from the search, of which 10 were included in this review. Overall, the use of VR was found to have positive effects on cardiac function and improved adherence and motivation during the exercise sessions in people with CF. Incorporating VR into exercise and airway clearance interventions may be beneficial for people with CF. However, further studies with larger sample size and wider range of disease severity are required to be conducted in future.

Does Aerobic Exercise Facilitate Vaping and Smoking Cessation: A Systematic Review of Randomized Controlled Trials with Meta-Analysis.

Cigarette smokers try to quit using several strategies including electronic cigarette use (vaping). An alternative, easy and cheap method is exercise. However, little is known about the efficacy of aerobic exercise (AE) to augment smoking and vaping cessation. This study aimed to systematically review and discuss the reported effects of AE on long-term vaping and smoking cessation in randomized control trials (RCTs). RCTs were searched on different databases. The outcome measures included long-term vaping or smoking cessation and maximal or peak oxygen uptake (VO2max/peak) after vaping- or smoking cessation. Meta-analysis was conducted to examine the effects of AE on long-term vaping and smoking cessation, and the effects of AE on VO2max/peak. Cochrane Risk of Bias tool 2 was used to assess trials quality. Thirteen trials were included (5 high, 2 moderate and 6 low quality). Although two high quality trials revealed that 3 vigorous supervised AE sessions a week for 12 to 15 weeks increased the number of long-term successful quitters, the meta-analysis including the other trials showed that AE did not significantly increase success rate of long-term quitters. However, VO2max/peak was improved at the end of treatment. There were no trials on AE and vaping cessation. No evidence was found that AE promotes long-term smoking cessation. Nevertheless, AE improved VO2max and/or VO2peak in quitters.

Nursing Mothers' Experiences of Musculoskeletal Pain Attributed to Poor Posture During Breastfeeding: A Mixed Methods Study.

Background: Breastfeeding has various benefits for infants and mothers. However, if not performed in the correct posture, prolonged breastfeeding could cause musculoskeletal-related symptoms such as shoulder, neck, and upper back pain. In Jordan, nursing mothers do not have access to a breastfeeding midwifery team, a breastfeeding dietician, or a breastfeeding nurse for advice and education. The primary aim of this study was to explore nursing mothers' experiences of breastfeeding-related musculoskeletal pain; secondary aims were to explore nursing mothers' awareness of recommended breastfeeding postures and their experience of education and advice about breastfeeding postures. Methods: A cross-sectional mixed methods study was conducted with nursing mothers in Jordan who have breastfed their babies for 6 months or more following normal delivery, using an online survey questionnaire and semi-structured interviews. Participants were recruited through general practitioner clinics. Results: Four hundred ninety-three nursing mothers submitted the online questionnaire, and 12 interviews were completed. Nursing mothers reported experiencing nonspecific pain in lower back, neck, shoulder, and hand, attributed to breastfeeding. Pain in these joints affected mood, sleep, working ability, and quality of life by limiting activities of daily living. Findings showed that the majority of Jordanian nursing mothers did not receive education about safe or optimal breastfeeding positioning from health professionals. Conclusions: Nursing mothers in Jordan are not receiving appropriate education or advice about optimal postures for breastfeeding and have reported experiencing musculoskeletal pain, attributed to breastfeeding, that interferes with activities of daily living and affects quality of life. Postural education and advice should be provided to nursing mothers to prevent or avoid development of musculoskeletal pain.

Convergent and criterion-related validity of the short form of the International Physical Activity and the Incidental and Planned Physical Activity Questionnaires in people with multiple sclerosis.

BACKGROUND: Assessing physical activity (PA) in people with multiple sclerosis (PwMS) is essential to follow-up the recommended PA level. The International Physical Activity Questionnaire (IPAQ) and the Incidental and Planned Exercise Questionnaire (IPEQ) have been widely used, but their validity has not been investigated previously in PwMS. OBJECTIVE: This study aimed to assess the convergent and criterion validity of the IPAQ and the IPEQ in PwMS. METHODS: 50 PwMS were asked to wear an Actigraph for seven days and to fill the IPAQ and IPEQ. Sedentary, moderate (MPA), vigorous (VPA) and moderate to vigorous PA (MVPA) levels were recorded. RESULTS: Significant correlations were found between sitting time as reported by IPAQ and sedentary time as recorded by Actigraph (r = 0.41, p = 0.003), VPA by IPAQ and VPA as recorded by Actigraph (r = 0.46, p = 0.001), and MVPA by IPAQ and MVPA by Actigraph (r = 0.36, p = 0.011). IPEQ showed poor both criterion and convergent validity when compared to the Actigraph. Both IPAQ and IPEQ overestimate the intensities of PA for all the derived parameters. CONCLUSIONS: Findings of this study are important as they suggest that IPAQ in particular had convergent validity when compared to Actigraph data, but still had the problem of overestimating PA levels.

Age-related declines in muscle and respiratory function are proportionate to declines in performance in Master Track Cyclists.

PURPOSE: Respiratory and musculoskeletal function decline with age, irrespective of physical activity levels. Previous work has suggested that the age-related rate of decline in function of these two systems might be similar, but it is not known to what extent each system contributes to decreasing performance in ageing master cyclists. Therefore, the purposes of this study are (1) whether the age-related rate of decline in respiratory function, respiratory muscle strength, muscle architecture, muscle function, haemoglobin concentration, haematocrit and performance in master cyclists is uniform and (2) which parameters contribute most to the reduction in performance with age. METHODS: Master cyclists were recruited during the Track Cycling Masters World Championship 2019 in Manchester. Respiratory function and respiratory muscle strength were determined using spirometry and a mouth pressure device, respectively. Muscle architecture was determined using ultrasonography, and muscle function by countermovement jump. RESULTS: Forced expiratory volume in the first second, forced vital capacity, fascicle length, muscle thickness, take-off velocity, jump power, jump power per body mass, handgrip strength, haemoglobin concentration and performance correlated negatively with age (p ≤ 0.043). The age-related rate of decline did not differ significantly between parameters (p = 0.124), but it was slower for haemoglobin concentration (p = 0.041). Take-off velocity was the major determinant of performance in 200, 500 and 2000 m track cycling disciplines (R2adj = 0.675, 0.786 and 0.769, respectively; p < 0.001). CONCLUSION: Age-related decline in respiratory and muscle system is accompanied by a similar rate of decline in performance. The major contribution to the age-related decline of performance is reduced muscle function, specifically take-off velocity.

Cardiopulmonary Function and Aerobic Exercise in Parkinson's: A Systematic Review of the Literature.

BACKGROUND: Cardiorespiratory impairments are considered the main cause of mortality in the late stages of Parkinson's. Aerobic exercise has been shown to improve pulmonary function in asthmatic patients and in healthy people. However, effects of aerobic exercise on cardiopulmonary function in people with Parkinson's have not been investigated. Therefore, this study aimed to review the effects of aerobic exercise on cardiopulmonary function in people with Parkinson's. METHODS: A systematic search was conducted using MEDLINE, AMED, CINHAL Plus, and relevant associated keywords, from January 1970 to January 2020. Inclusion criteria for the studies were: aerobic exercise as part of the intervention, pulmonary function test, and/or cardiopulmonary exercise test as outcome measures. RESULTS: In total, 329 citations were identified from the search, of which nine were included in this review. In general, aerobic exercise was found to have positive effects on cardiac function for people with Parkinson's, but there is a lack of studies on the effects of aerobic exercise on pulmonary function. CONCLUSION: People with early stages of Parkinson's may experience positive effects of aerobic exercise on cardiac fitness. Further research is needed in this area, particularly into the effects of aerobic exercise on pulmonary function in early stages of the disease.

Cross cultural adaptation and psychometric evaluation of an Arabic version of the modified fatigue impact scale in people with multiple sclerosis.

BACKGROUND: Fatigue is a common symptom in multiple sclerosis and has significant impacts on participation and quality of life. Thus, fatigue assessment in this population is always a necessity. OBJECTIVES: to examine the underlying structure, validity and test-retest reliability of an Arabic translated and culturally adapted version of the Modified Fatigue Impact scale (A-MFIS). METHODS: The study was carried out into two phases: firstly, the English version of the MFIS was translated into Arabic and secondly, a detailed analysis of the psychometric properties and the structure of the translated version was conducted using Principle Component Analysis (PCA). Convergent validity was assessed by comparison with measures of disease severity, quality of life and with another measure of fatigue. Test retest reliability was assessed with intra-class correlations. RESULTS: 145 subjects participated in the study. The PCA revealed that the instrument has two main factors "cognitive" and "physical", rather than the original three factors scale. Significant correlations were found between the A-MFIS and measures of disease severity and quality of life (P<0.05). Furthermore, the A-MFIS subscale and total scores have good to high test-retest reliability. CONCLUSION: The A-MFIS has high reliability and concurrent validity with other measures of disease severity and quality of life.

The effects of aerobic exercise on sleep quality measures and sleep-related biomarkers in individuals with Multiple Sclerosis: A pilot randomised controlled trial.

BACKGROUND: Sleep disturbances are highly prevalent in people with multiple sclerosis(MS), and are associated with pain, fatigue, depression, and reduced quality of life (QoL). Importantly, sleep has been considered a critical brain state for motor learning and memory consolidation. Therefore, interventions that target sleep managementin people with MS are needed. OBJECTIVES: To explore the effects of a six weeks moderate-intensity aerobic exercise intervention on sleep characteristics and sleep-related biomarkers specifically serotonin, melatoninand cortisol in people with MS using a pilot randomized controlled trial. METHODS: Participants were randomly allocated to either a moderate-intensity aerobic exercise program (MAE, n = 20) or a home exercise program (HEP, n = 20). Participants were assessed at baseline and follow-up. Subjective and objective measures were used to assess sleep quality. The Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) were used to subjectively assess sleep. While Actigraphy was used to objectivelyassess sleep. Blood samples were collected for measurement of cortisol, melatonin and serotonin from MS participants in both groups at 8:00 am±1 hour. RESULTS: Seventeen participants in the MAE and 13 in the HEP group completed the study. Compared to the HEP group, people with MS who participated in a moderate-intensity aerobic exercise experienced significant improvements (P < 0.05) on the PSQI, ISI, and several objective sleep parameters measured using actigraphy. Only the serotonin levels increased significantly over the six-week period in the MAE group compared to the HEP group. The change score in serotonin (from baseline to follow up assessment) was significantly correlatedwith the change score in PSQI (r = -0.97, p < 001) and the change score in ISI (r = -0. 56, p = 0.015) only in the MAE group but not the HEP group. CONCLUSIONS: Exercise may be a non-pharmacological, inexpensive, safe method to improve sleep quality in people with MS. The improvement in the serotonin level due to aerobic exercisemight explain one of the physiologic mechanisms driving these improvements.

Fear of Falling in People With Multiple Sclerosis: Which Clinical Characteristics Are Important?

BACKGROUND: Fear of falling (FOF) is an important risk indicator for health-related outcomes and quality of life in patients with multiple sclerosis (MS). However, factors associated with FOF in MS are not well investigated. OBJECTIVES: This study was done to explore predictors of FOF in this population. METHODS: Seventy relapsing remitting patients with MS were evaluated. Fear of falling was assessed using the Fall Efficacy Scale-International (FES-I). Motor outcomes included: 30-second chair stand test (30s-CST), Berg Balance Scale (BBS), 10-Meter Walk Test (10MWT), and 6-Minute Walk Test (6MWT). Cognitive status was determined using the Montréal Cognitive Assessment (MOCA) and Symbol Digit Modalities Test (SDMT). Affective factors including depression, fatigue, and sleep were also assessed using the Beck Depression Inventory (BDI), Modified Fatigue Impact Scale (MFIS), and Pittsburgh Sleep Quality Index (PSQI), respectively. RESULTS: Fear of falling was significantly correlated with all motor and affective measures used. However, a stepwise regression found that only BBS from motor measures, MOCA from cognitive measures, and sleep disorders from affective factors were significantly predictive of the FOF. CONCLUSIONS: Fear of falling in patients with MS is multifactorial and includes motor and nonmotor factors. Thus, therapies that aim to reduce risk of falling in this population should address motor functions, cognitive abilities, and sleep quality.

The association between physical activity and sleep characteristics in people with multiple sclerosis.

STUDY OBJECTIVES: The majority of individuals with multiple sclerosis (MS) suffer from sleep disorders. In this study, we investigated the relationship between physical activity and sleep characteristics in MS patients. METHODS: Sixty MS patients were recruited in the study. Sleep characteristics were assessed using the Actisleep device while physical activity levels were assessed using mobility accelerometer. RESULTS: The results showed that means (±SD) of sleep latency (SL) and sleep efficiency (ES) for MS patients were 23.89±13.23min and 87.52±76.89% respectively. The participants' total time in sleep (TST) and wake after sleep onset (WASO) were 353.25±63.98min and 83.84±42.23min respectively. With respect to physical activity levels, means (±SD) of light (LA), moderate (MA), vigorous (VA) activities and moderate to vigorous physical activity (MVPA) were 11,660.15±18,145, 212.04±148.67, 9.70±9.26 and 222.88±154.60 counts per minute, respectively. Pearson's correlation analysis showed that WASO correlated significantly with LA, MA and MVPA (P<0.05). These correlations remained significant even after accounting for age, body weight and disease severity (P<0.05). CONCLUSION: The results show a positive relationship of physical activity with sleep parameters in individuals with MS.