Neuro-orthopaedic check-up and walking in people with multiple sclerosis: toward a more specific assessment to improve rehabilitation results.

The rehabilitation process of people with multiple sclerosis (PwMS) is a challenge, and decision-making requires a thorough assessment to increase the chances of success in rehabilitation planning. The aim of this study was to investigate the importance of the neuroorthopaedic check-Up (NOChU) for gait prognosis. Participated in the study 105 PwMS with different levels of impairment. The NOChU includes measurements of passive range of motion (ROM), muscle strength, and spasticity. Additionally, was carried out the spatial-temporal analysis of the walking, Timed Up and Go test, and 6-min walk test. ROM remained relatively preserved to perform daily life activities except for ankle dorsiflexion. Muscle strength was also relatively preserved. Spasticity affected especially the ankle muscles, clearly the sural triceps. Among the NOChU measurements the catch seemed to have the most impact on walking on its different phases and on other activities. Accurate NOChU measurements play a crucial role in clinical settings, guiding informed decisions in rehabilitation planning. Future research endeavours could focus on exploring the correlations between NOChU deficiencies and the decline in walking capabilities among PwMS, with the goal of proposing personalized treatment strategies that address their specific requirements.

Evaluation of the optimal number of steps to obtain reliable running spatio-temporal parameters and their variability.

BACKGROUND: Spatio-temporal running parameters and their variability help to determine a runner's running style. However, determining whether a change is due to the measurement or to a specific condition such as an injury is a matter of debate, as no recommendation on the number of steps required to obtain reliable assessments exists. RESEARCH QUESTION: What is the optimal number of steps required to measure different spatio-temporal parameters and study their variability at different running speeds? METHODS: Twenty-five runners performed three experimental sessions of three bouts of treadmill running at 8, 10 and 12 km/h separated by 24 h. We measured cadence, stride, step, contact and flight time. We calculated the duty factor and the leg stiffness index (Kleg). Mean spatio-temporal parameters and linear (coefficient of variation, standard deviation) and non-linear (Higuchi fractal index, α1 coefficient of detrended fluctuation analysis) analyses were computed for different numbers of steps. Relative reliability was determined using the intraclass coefficient correlation. The minimal number of steps which present a good reliability level was considered as the optimal number of steps for measurement. Absolute reliability was assessed by calculating minimal detectable change. RESULTS: To assess the mean values of spatio-temporal running parameters, between 16 and 150 steps were required. We were unable to obtain an optimal number of steps for cadence, stride and step-time variabilities for all speeds. For the linear analyses, we deduced the optimal number of steps for Kleg and the contact time (around 350 steps). Non-linear analyses measurements required between 350 and 540 steps, depending on the parameter. SIGNIFICANCE: Researchers and clinicians should optimize experimental conditions (number of steps and running speed) depending on the parameter or the variability analysis targeted. Future studies must use absolute reliability metrics to report changes in response to a specific condition with no bias due to measurement error.

Effects of an Exercise Program and Cold-Water Immersion Recovery in Patients with Rheumatoid Arthritis (RA): Feasibility Study.

Rheumatoid Arthritis (RA) patients present is an increased cardiovascular risk (CVR) linked to systemic inflammatory manifestations. A physical activity program with known positive effects on CVR, followed by cryotherapy because of its analgesic and anti-inflammatory effects, may be interesting. However, there are no reports in the literature of such a program. This study aimed to determine the feasibility (acceptability, safety, and effectiveness) of an individualized Intermittent Exercise Program followed by cold-water immersion as a recovery for RA patients. The program was conducted three times per week by eighteen RA patients (one man) with means of age and BMI of 55 (11.9) years and 25.5 (4.7) kg·m-2. Outcomes were assessed before and after nine and seventeen sessions and included evaluation of acceptability by perceived exertion (Borg) and water temperature (VAS) measures at each session; safety by a number of painful and swollen joints (echography); physical function (health assessment questionnaire); general health status (Short Form-36) measures; and effectiveness by arterial stiffness (pulse wave velocity, or PWV) measures. The results showed good acceptability of the program; no patient dropped out of the protocol or even presented difficulties or perceived pain. The HR and PWV values decreased significantly (70.2 ± 8.4 to 66 ± 5.5; p < 0.05 and 8.9 ± 1.2 to 7.0 ± 0.8; p < 0.001) after nine exercise sessions. No aggravation of symptoms has been noted. This program is acceptable, safe, and effective; consider tailoring it for supervised home-based use.

Locomotor Strategy to Perform 6-Minute Walk Test in People with Multiple Sclerosis: A Prospective Observational Study.

Two-thirds of people with Multiple Sclerosis (PwMS) have walking disabilities. Considering the literature, prolonged tests, such as the 6 min walk test, better reflect their everyday life walking capacities and endurance. However, in most studies, only the distance traveled during the 6MWT was measured. This study aims to analyze spatio-temporal (ST) walking patterns of PwMS and healthy people in the 6MWT. Participants performed a 6MWT with measures of five ST variables during three 1 min intervals (initial: 0'-1', middle: 2'30″-3'30″, end: 5'-6') of the 6MWT, using the GAITRite system. Forty-five PwMS and 24 healthy people were included. We observed in PwMS significant changes between initial and final intervals for all ST parameters, whereas healthy people had a rebound pattern but the changes between intervals were rather negligible. Moreover, ST variables' changes were superior to the standard measurement error only for PwMS between initial and final intervals for all ST parameters. This result suggests that the modification in PwMS' walking pattern is effectively due to their walking ability and not to a measurement, and suggests that PwMS could not manage their walking efficiently compared to healthy people, who could maintain their rhythm throughout the 6MWT. Further studies are needed to detect these patterns changes in the early evolution of the disease, identify clinical determinants involved in PwMS' walking pattern, and investigate whether interventions can positively impact this pattern.

Physical Activity during Weekdays and Weekends in Persons with Multiple Sclerosis.

The assessment of the functional performance status of persons with multiple sclerosis (PwMS) is a useful tool to optimize healthcare. This concept does not seem to be extensively explored in this population. This study aimed to determine the level of activity of PwMS during weekdays and weekends, and to establish associations between clinical parameters. Forty-one PwMS and 16 healthy persons participated in this study. Their physical activity in real-life conditions was assessed with an accelerometer. For the clinical evaluations, the quality of life, fatigue, gait, and balance were assessed. The level of activity between PwMS for weekdays, weekends, Saturdays, and Sundays was significantly reduced compared with the reference group (p = 0.001-0.00001, d = 0.95-1.76). PwMS had a constant level of activity throughout the week, whereas the reference group increased its level of activity on Saturdays (p = 0.04, d = 0.69). The level of activity was correlated in descending order with multiple sclerosis disability, body mass index, gait velocity, six-minute walk test, and timed up and go test. This study showed that PwMS had a stable level of activity throughout the week, contrary to healthy persons. It could be necessary to develop programs to facilitate physical activity and participation during the weekdays, but especially during weekends.

Ventilatory adaptation during eccentric cycling in patients with severe COPD: Potential implications for exercise training.

INTRODUCTION: Eccentric (ECC) cycling is viewed as an alternative to concentric (CON) cycling for exercise training in patients with severe COPD as it induces a much lower ventilatory demand for a given mechanical load than CON cycling. However, a more hyperpneic breathing pattern (i.e., higher fB and lower tidal volume (VT)) during ECC than during CON has been reported in healthy subjects. RESEARCH QUESTION: Do patients with severe COPD develop a more hyperpneic breathing pattern during ECC than during CON cycling, and is it associated with differences in dynamic hyperinflation, ventilatory efficiency and cardiometabolic adaptation? METHODS: Fourteen patients with severe COPD performed incremental CON and ECC cardiopulmonary exercise tests (CPET). Several physiological parameters including VT, fB, inspiratory capacity (IC) and oxygen consumption (V̇O2) were recorded at each workload increment during CPET. RESULTS: At the highest identical minute ventilation (V̇E) achieved during ECC and CON (28.6 ± 4.6 L.min-1), VT was lower (1010 ± 218 vs. 1100 ± 233 mL; p = 0.02), fB was higher (29.0 ± 5.1 vs. 27.0 ± 5.5 min-1; p = 0.03), IC(% baseline) was lower (84 ± 10 vs. 78 ± 9; p < 0.01) and markers of ventilatory efficiency were poorer during ECC than during CON. Similar results were found at the highest identical V̇O2 achieved during ECC and CON. CONCLUSION: The finding of a more hyperpneic ventilatory pattern during ECC cycling together with a lower IC and a poorer ventilatory efficiency suggests that ECC exercise training should be decided with caution in patients with severe COPD.

Evaluation of Prolonged Walking in Persons with Multiple Sclerosis: Reliability of the Spatio-Temporal Walking Variables during the 6-Minute Walk Test.

BACKGROUND: Walking disorders represent the most disabling condition in persons with Multiple Sclerosis (PwMS). Several studies showed good reliability of the 6-min walk test (6MWT) (i.e., especially distance traveled), but little is known about the reliability of the Spatio-temporal (ST) variables in the 6MWT. OBJECTIVE: To evaluate the test-retest reliability of ST variables and perceived exertion during the 6MWT in PwMS and comparable healthy persons. METHODS: We explored three 1-min intervals (initial: 0'-1', middle: 2'30″-3'30″, end: 5'-6') of the 6MWT. Six ST variables and perceived exertion were measured (respectively, using the GAITRite system and the Borg Scale). These measurements were performed twice, 1 week apart. The test-retest effects were assessed using the intraclass correlation coefficient (ICC) or the weighted kappa. RESULTS: Forty-five PwMS and 24 healthy persons were included. The test-retest reliability of ST variables values was good-to-excellent for PwMS (ICC range: 0.858-0.919) and moderate-to-excellent for healthy persons (ICC range: 0.569-0.946). The test-retest reliability values of perceived exertion were fair for PwMS (weighted kappa range: 0.279-0.376) and substantial for healthy persons (weighted kappa range: 0.734-0.788). CONCLUSION: The measurement of ST variables during these 6MWT intervals is reliable and applicable in clinical practice and research to adapt rehabilitation care in PwMS.

What (more) can verbal fluency tell us about multiple sclerosis?

BACKGROUND: Clinical symptoms of multiple sclerosis (MS) are variable and may include cognitive impairment, which can be assessed with the verbal fluency test (VFT). This test is evaluated by counting words spoken during a 2-min period, which is not a functional approach. OBJECTIVE: The objectives of this observational study were to: (1) determine new parameters that reflect communication and cognitive functions in persons with multiple sclerosis (PwMS) considering the evaluation of real-time word production in the VFT; (2) compare the results with those of a control group; and (3) evaluate the impact of including errors. METHODS: A phonological fluency test ("letter P") and a semantic fluency test ("animals") were used. The real-time word production was recorded. The main variables studied were the total number of words, first word delay, moment of inflection of the curve corresponding to the change in the cognitive process, speed of word production before inflection, and maximum delay between 2 consecutive words. These variables were studied by taking into account or not errors. RESULTS: We included 68 PwMS and 33 healthy controls. VFT results were impaired in PwMS. The total number of words, first word delay, speed before inflection, and maximum delay were relevant to the study of phonologic fluency. For studying semantic fluency, the total number of words, first word delay, speed before inflection, and inflection time of the curve seemed relevant. Taking into account errors was significant only for total number of words. CONCLUSION: Taking into account errors in evaluating real-time word production in PwMS is of interest only for the total number of words performed but has no impact on the variables studied. These variables should be used to quantitatively evaluate verbal fluency with the objective of evaluating functionally relevant parameters (communication).

Walking Speed and Maximal Knee Flexion During Gait After Total Knee Arthroplasty: Minimal Clinically Important Improvement Is Not Determinable; Patient Acceptable Symptom State Is Potentially Useful.

BACKGROUND: Total knee arthroplasty (TKA) is the operation of choice in patients with end-stage knee osteoarthritis (OA). Up to 1 in 5 patients still encounter functional limitations after TKA, partly explaining patient dissatisfaction. Which gait ability to target after TKA remains unclear. To determine whether Minimal Clinical Important Improvement (MCII) or Patient Acceptable Symptom State (PASS) values could be derived from gait parameters recorded in patients with TKA. And, if so, to define those values. METHODS: In this ancillary study, we retrospectively analyzed gait parameters of patients scheduled for a unilateral TKA between 2011 and 2013. We investigated MCII and PASS values for walking speed and maximal knee flexion using anchor-based methods: 5 anchoring questions based on perceived body function and patients' satisfaction. RESULTS: Over the study period, 79 patients performed a clinical gait analysis the week before and 1 year after surgery, and were included in the present study. All clinical and gait parameters improved 1 year after TKA. Nevertheless, changes in gait outcomes were not associated with perceived body function or patients' satisfaction, precluding any MCII estimation in gait parameters. PASS values, however, could be determined as 1.2 m/s for walking speed and 50° for maximal knee flexion. CONCLUSION: In this study, we found that MCII and PASS values are not necessarily determinable for gait parameters after TKA in patients with end-stage OA. Using anchor questions based on perceived body function and patient's satisfaction, MCII could not be defined while PASS values were potentially useful. LEVEL OF EVIDENCE: Level III.

What Are the Minimal Detectable Changes in SDMT and Verbal Fluency Tests for Assessing Changes in Cognitive Performance in Persons with Multiple Sclerosis and Non-Multiple Sclerosis Controls?

INTRODUCTION: Cognitive impairment is frequent in persons with multiple sclerosis (PwMS) and can impact on activities of daily living. The capacity to differentiate real changes from background statistical noise induced by human, instrumentational, and environmental variations inherent to the evaluation would improve cognitive assessments. OBJECTIVE: To assess the short-term reproducibility of cognitive tests in non-multiple sclerosis (non-MS) persons and PwMS. METHODS: Sixty-two PwMS and 19 non-MS persons performed 2 measurements, 1 week apart, of the Symbol Digit Modalities Test (SDMT) and phonological and semantic verbal fluency. Test-retest reliability was evaluated by the intraclass correlation coefficients (ICC) and agreement by standard error of measurement (SEM) and minimum detectable change (MDC). RESULTS: The reliability of the cognitive variables studied had moderate to high ICC values (ICC > 0.8) in both populations. The threshold to consider a significant cognitive modification evaluated by SEM and MDC was lower in PwMS compared with non-MS persons. CONCLUSIONS: SDMT and verbal fluency have good short-term reproducibility in PwMS. Specific SEM and MDC cutoffs based on the same design of evaluation (especially retest timing) and to the targeted pathological population (MS vs. healthy) should systematically be used to consider cognitive modification as significant in research protocol as well as in clinical practice.

Nordic walking influence on biomechanical parameters: a systematic review.

INTRODUCTION: Nordic walking (NW) as a form of physical activity has been shown to have benefits in various domains, but little is known about the effect of NW on more specific biomechanical parameters. The purpose is to determine the impact of NW on the following parameters: walking speed/distance, muscle activation, spatiotemporal parameters, kinematics and ground reaction force. EVIDENCE ACQUISITION: A literature search was carried out in different databases from October 2008 to October 2018. This review was conducted and reported in accordance with the PRISMA statement. Finally, 42 studies with a median PEDro Score of 5.5/10 were included. EVIDENCE SYNTHESIS: The included studies reported increased walking distance (+14.8%, P<0.05), walking speed (+25.5%, P<0.05), and stride length (+10.4%, P<0.05), but decreased cadence (-6.2%, P<0.05). NW generally increased: muscle activation and strength for upper limbs; upper and lower limb range of motion, and ground reaction force. CONCLUSIONS: NW has beneficial effects on many biomechanical parameters. It appears to be an effective way of doing physical activity and could be used in physical rehabilitation or in daily life.

Gait quantification in multiple sclerosis: A single-centre experience of systematic evaluation.

Gait disorders can be disabling in persons with multiple sclerosis (PMS). Different gait parameters have been used to evaluate gait disorders according to the International classification of functioning. Some authors have reported a direct relation between evaluations over short distances and long-term outcomes. This relationship is of interest for the purposes of clinical research, as it enables short-distance evaluations to be used as a primary endpoint for trials. However, these endpoints are not always particularly relevant for PMS, and furthermore, all evaluations do not present the same metrological characteristics, especially with regards to reproducibility. However, it is essential to have good reproducibility in order to be able to test the effect of a therapeutic strategy on walking parameters in PMS. Using a range of walk tests (timed 25-foot walk in different conditions, namely comfortable walking, fast walking and dual-task walking; the Timed Up and Go test; the 6minute walk test) associated with neuromotor analysis of the lower limbs, we describe the advantages and limitations of gait evaluation in MS. Based on clinical experience accumulated over 4 years, we propose a minimum set of measurements to be used in clinical practice and also for research purposes.

Gait tests in multiple sclerosis: Reliability and cut-off values.

BACKGROUND: Gait limitation is one of the most common disabilities in people with multiple sclerosis (MS). Several studies have used gait parameters to determine the effects of different therapies. However, few studies have determined their reproducibility, also the therapeutic effects could be overestimated. RESEARCH QUESTION: To examine the reproducibility in gait measurements during short and long distances. METHODS: In this cross-sectional study we recruited a group of MS patients and compare it to a control group. The participants performed the following tests in a fixed order: a 25-foot walk at a comfortable speed, at a fast speed and during a dual task, a timed up-and-go test (TUG) and a six- minute walk test (6MWT). Two measurements were conducted a week apart. Systematic error was evaluated by the Student t-test, reliability by the intra-class correlation coefficients (ICC) and agreement by the minimum detectable change (MDC95). RESULTS: A total of 58 people with MS and 19 healthy people were included. The absence of systematic error was only found for the fast speed condition. The reliability of the gait parameters had moderate to high ICC values (ICC > 0.7) except for the dual task cost (DTC) which was 0.45. The MDC95 was higher in people with MS compared to healthy people, and it was higher in people with MS for gait speeds in all conditions (> 34%). For the TUG and 6MWT, the MDC95 were 51.5% and 31.7% respectively. For people with MS the smallest MDC95 was found for the stance time for all conditions (6.8%), whereas the highest was found for the dual task cost (158.7%). SIGNIFICANCE: The MDC95 values were higher than the cut-off point based on the minimally important clinical difference (MICD) proposed in previous studies. Thus, the MDC95 should be used as a cut-off rather than MICD values.

Multiple Sclerosis and Clinical Gait Analysis before and after Fampridine: A Systematic Review.

BACKGROUND: Gait impairment is one of the most disabling symptoms in people with multiple sclerosis (PwMS). Fampridine, has demonstrated a positive effect on gait speed in PwMS after 14 days of treatment but the long-term effects have not yet been demonstrated. This study reviews the long-term effects of fampridine on gait in PwMS. SUMMARY: This systematic review was conducted according to the PRISMA statement. Studies were considered long term if treatment exceeded 28 days. From the 498 studies identified, 18 (2,200 patients) fulfilled all eligibility criteria. Only 3 studies followed-up patients for >1 year and one of these showed a non-significant improvement in the gait speed. Key Messages: Fampridine seems to be beneficial at improving gait speed in PwMS in the long term. Further long-term studies are needed on related gait and functional parameters.

Variable compensation during the sit-to-stand task among individuals with severe knee osteoarthritis.

BACKGROUND: Individuals with knee osteoarthritis (OA) show variability during the sit-to-stand (STS) task, so they may not perform the STS in the same way. This study aimed to determine whether individuals with knee OA have different strategies in performing the STS. METHODS: Participants with knee OA and able-bodied individuals underwent STS evaluation at a self-selected pace with use of a motion measurement system consisting of 12 cameras and 2 force plates. RESULTS: In total, 101 participants (57 women) with knee OA showed 3 main STS strategies. As compared with the 27 controls (14 women), 24 OA participants, compensated STS, showed greater trunk flexion (47.1° vs. 38.3°; P<0.01) and trunk obliquity (4.6° vs. -0.8°; P<0.001) when completing the STS task in the same amount of time as controls (2.4 vs. 2.7s; P=0.999). The second group (n=59), inadequately compensated STS, also compensated with trunk flexion (47.7° vs. 38.3°; P<0.01) and trunk obliquity (1.6° vs. -0.8°; P<0.001) but took longer than controls (3.4 vs. 2.7s; P=0.001). The third group (n=18), severe impaired STS, took an extended amount of time to execute the STS (6s), with marked trunk flexion (59.2°) and obliquity (4.1°), so participants in this group were perhaps severely impaired in completing the STS. CONCLUSION: This study identified 3 groups STS trunk strategies among participants with STS. Moreover, the data reveal a concise representation of the relations among strategy variables. The findings could be used to simplify the characterization of the STS among patients with knee OA and aid with follow-up.

Influence of Body Mass Index on Sagittal Knee Range of Motion and Gait Speed Recovery 1-Year After Total Knee Arthroplasty.

BACKGROUND: The purpose of this prospective study was to investigate the influence of body mass index (BMI) on gait parameters preoperatively and 1 year after total knee arthroplasty (TKA). METHODS: Seventy-nine patients were evaluated before and 1 year after TKA using clinical gait analysis. The gait velocity, the knee range of motion (ROM) during gait, their gains (difference between baseline and 1 year after TKA), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), quality of life, and patient satisfaction were assessed. Nonobese (BMI <30 kg/m2) and obese patients (BMI ≥30 kg/m2) were compared. Healthy controls were also assessed. Univariate and multivariate linear regression analyses were used to assess the association between gait speed and ROM gains. Adjustment was performed for gender, age, and WOMAC pain improvement. RESULTS: At baseline, gait velocity and knee ROM were significantly lower in obese compared with those in the nonobese patients (0.99 ± 0.27 m/s vs 1.11 ± 0.18 m/s; effect size, 0.53; P = .021; and ROM, 41.33° ± 9.6° vs 46.05° ± 8.39°; effect size, 0.52; P = .022). Univariate and multivariate linear regressions did not show any significant relation between gait speed gain or knee ROM gain and BMI. At baseline, obese patients were more symptomatic than nonobese (WOMAC pain: 36.1 ± 14.0 vs 50.4 ± 16.9; effect size, 0.9; P < .001), and their improvement was significantly higher (WOMAC pain gain, 44.5 vs 32.3; effect size, 0.59; P = .011). CONCLUSION: These findings show that all patients improved biomechanically and clinically, regardless of their BMI.

Similar Running Economy With Different Running Patterns Along the Aerial-Terrestrial Continuum.

PURPOSE: No unique or ideal running pattern is the most economical for all runners. Classifying the global running patterns of individuals into 2 categories (aerial and terrestrial) using the Volodalen method could permit a better understanding of the relationship between running economy (RE) and biomechanics. The main purpose was to compare the RE of aerial and terrestrial runners. METHODS: Two coaches classified 58 runners into aerial (n = 29) or terrestrial (n = 29) running patterns on the basis of visual observations. RE, muscle activity, kinematics, and spatiotemporal parameters of both groups were measured during a 5-min run at 12 km/h on a treadmill. Maximal oxygen uptake (V̇O2max) and peak treadmill speed (PTS) were assessed during an incremental running test. RESULTS: No differences were observed between aerial and terrestrial patterns for RE, V̇O2max, and PTS. However, at 12 km/h, aerial runners exhibited earlier gastrocnemius lateralis activation in preparation for contact, less dorsiflexion at ground contact, higher coactivation indexes, and greater leg stiffness during stance phase than terrestrial runners. Terrestrial runners had more pronounced semitendinosus activation at the start and end of the running cycle, shorter flight time, greater leg compression, and a more rear-foot strike. CONCLUSIONS: Different running patterns were associated with similar RE. Aerial runners appear to rely more on elastic energy utilization with a rapid eccentric-concentric coupling time, whereas terrestrial runners appear to propel the body more forward rather than upward to limit work against gravity. Excluding runners with a mixed running pattern from analyses did not affect study interpretation.

The practice of physical activity and cryotherapy in rheumatoid arthritis: systematic review.

INTRODUCTION: Rheumatoid arthritis (RA) is an autoimmune, chronic and inflammatory disease, which the affected patients present a higher cardiovascular mortality rate. Physical activities have been identified as the most important strategy to prevent cardiovascular diseases. However, the articular damage and the chronic pain caused by RA challenges its regular practice. Moreover, persons with RA tend to avoid PA due to the fear of exacerbating the inflammatory potential and pain. One alternative to avoid the collateral effects of the PA could be the cryotherapy. Therefore, this study aimed to review studies focused on the use of both PA and cryotherapy in RA patients and to identify evidences that both therapies could be combined in order to optimize the symptomatic treatment. EVIDENCE ACQUISITION: Four databases (MEDLINE, CINAHL, Elsevier and PEDro) were searched to identify publications regarding RA patients, PA and cryotherapy intervention by the terms and operators (rheumatoid arthritis AND exercise OR physical activity OR activity OR training OR reconditioning OR cryotherapy OR cold OR immersion). The selected studies should at least present one measure of the aerobic capacity, disease activity or pain relief. Among 19 studies with RA patients identified, only 4 studies used PA combined with cryotherapy. The other 13 studies used physical activities and 2 studies used cryotherapy intervention. EVIDENCE SYNTHESIS: The results of the physical activities combined with cryotherapy studies showed an improvement in the disease activity and pain relief, however without details of the physical activities intervention and an aerobic capacity. Among the physical activities studies, evidence was found suggesting that aerobic exercises and multiactivity exercises with high intensity are the more effective for improve the aerobic capacity. CONCLUSIONS: Even if few studies on cryotherapy were found, there are enough evidences in the literature that demonstrate the benefits of this intervention on pain relief and disease activity. In summary, neither study found associated physical activities to improve aerobic capacity with cryotherapy to improve disease activity and pain relief. This may be an innovative therapeutic strategy to improve the aerobic capacity in arthritis patients and consequently reduce their cardiovascular risk while minimizing pain and disease activity.

Fampridine and quality of life in individuals with multiple sclerosis.

BACKGROUND: Fampridine improves walking in patients with multiple sclerosis (pwMS). However, little is known about its impact on the quality of life (QoL) of pwMS. OBJECTIVES: This study aimed to evaluate the contribution of fampridine on the QoL of pwMS and to determine if improvements in QoL are best associated with walk respondents. METHODS: Fifty pwMS were included in this study. The PERSEPP scale and the GaitRite system were used to evaluate QoL and gait respectively. QoL was evaluated 7 days before fampridine (Pre1), on the day the fampridine treatment was initiated (Pre2), and 14 and 21 days after fampridine (Post1 and Post2 respectively). Gait was assessed at Pre-1, Pre-2 and Post-1. RESULTS: For all patients, fampridine had significant effects (p = 0.05-10(-4), d = 0.25-0.45) on the Overall, Relationship difficulties, Fatigue, Time perspective and Symptoms QoL indices and for gait parameters (p = 0.05-10(-4), d = 0.17-0.38). Non-respondents scored significant effects (p < 0.05-0.01, d = 0.32-0.41) for Overall, Time perspective and Symptoms QoL indices, whereas respondents scored significant effects (p < 0.05-0.01, d = 0.51-0.8) for Overall, Relationship difficulties, Fatigue and Symptoms. CONCLUSION: The QoL of pwMS improved after fampridine, suggesting a real benefit in their lives. However, the contributions to the overall QoL index seem different between groups.