Loneliness in Multiple Sclerosis: Possible Antecedents and Correlates.

PURPOSE: The prevalence and possible antecedents and correlates of loneliness in multiple sclerosis (MS) was examined. DESIGN: Cross-sectional, comparative study of MS (n = 63) and healthy adults (n = 21). METHODS: Data were collected using self-reports of loneliness and antecedents and correlates and analyzed using inferential statistics. FINDINGS: Those with MS had significantly higher loneliness scores than healthy adults (p < .05), and this was explained by employment status. Possible antecedents included marital status (p < .05), upper extremity function (r= -.28, p < .03), social disability frequency (r= -.49, p < .00), social disability limitations (r= -.38, p < .00), and personal disability limitations (r= -.29, p < .03). Social disability frequency (beta = -.41, p < .001) and marital status (beta = -.23, p < .046) accounted for 25% of the variance in loneliness scores. Possible correlates included depression (r= .49, p < .00), cognitive fatigue (r= .34, p < .01), psychosocial fatigue (r= .30, p < .02), and psychological quality of life (r= .44, p < .00). CONCLUSIONS: We provide evidence of loneliness in persons with MS, and this is associated with possible antecedents (e.g., marital status and disability limitations) and correlates (e.g., depression and fatigue). CLINICAL RELEVANCE: Loneliness should be recognized clinically as an important concomitant of MS.

Do depressive symptoms influence cognitive-motor coupling in multiple sclerosis?

OBJECTIVE: There is evidence that motor and cognitive impairments often co-occur in multiple sclerosis (MS). There is little research on influences of cognitive-motor coupling, particularly depressive symptoms. This study examined depressive symptoms as a moderator and/or confounder of cognitive-motor coupling in persons with MS. METHOD: The sample included 131 persons with MS who were allocated into elevated and nonelevated depressive symptom groups based on a cutoff score of 8 on the Hospital Anxiety Depression Scale. We assessed lower (i.e., 6-Minute Walk Test, Timed 25-Foot Walk Test) and upper (i.e., Nine-Hole Peg Test) body function as well as cognition (i.e., the Symbol Digit Modalities Test, CA Verbal Learning Test, and Brief Visuospatial Memory Test) in a research laboratory. Depressive symptomology was investigated as a moderator and/or confounder of cognitive-motor coupling using correlation and linear regression analyses. RESULTS: Upper and lower body function, but not cognition, differed significantly between depressive symptoms groups (p < .05). Scores on the motor and cognitive tests were uniformly correlated between depressive symptom groups. Depressive symptom category did not confound the coupling between motor and cognitive functions, and explained additional, but minimal, variation in the lower body motor function scores (p < .05). CONCLUSION: Strong coupling between motor function and cognitive processing speed in MS appeared to be consistent between depressive symptom groups. Elevated depressive symptoms might influence motor functioning more strongly than cognitive functioning in MS. (PsycINFO Database Record

Self-Regulatory Strategies as Correlates of Physical Activity Behavior in Persons With Multiple Sclerosis.

OBJECTIVE: To examine self-regulation strategies as correlates of physical activity in persons with multiple sclerosis (MS). DESIGN: Cross-sectional, or survey, study. SETTING: University-based research laboratory. PARTICIPANTS: Convenience sample of persons with MS (N=68). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Exercise Self-Efficacy Scale (EXSE), 12-item Physical Activity Self-Regulation Scale (PASR-12), and Godin Leisure-Time Exercise Questionnaire (GLTEQ). RESULTS: Correlation analyses indicated that GLTEQ scores were positively and significantly associated with overall self-regulation (r=.43), self-monitoring (r=.45), goal-setting (r=.27), reinforcement (r=.30), time management (r=.41), and relapse prevention (r=.53) PASR-12 scores. Regression analyses indicated that relapse prevention (B=5.01; SE B=1.74; ß=.51) and self-monitoring (B=3.65; SE B=1.71; ß=.33) were unique predictors of physical activity behavior, and relapse prevention demonstrated a significant association with physical activity behavior that was accounted for by EXSE. CONCLUSIONS: Our results indicate that self-regulatory strategies, particularly relapse prevention, may be important correlates of physical activity behavior that can inform the design of future behavioral interventions in MS.

Physical Function in Older Adults With Multiple Sclerosis: An Application of the Short Physical Performance Battery.

BACKGROUND AND PURPOSE: There is a growing prevalence of older persons living with multiple sclerosis (MS), and this cohort likely undergoes changes in physical function associated with MS and its progression as well as those associated with normal aging. This cross-sectional study examined physical function in a community-dwelling sample of older adults with MS compared with matched controls using the Short Physical Performance Battery (SPPB). METHODS: The sample (N = 40) included 20 older adults with MS and 20 older adults without MS who were matched on sex and age. All participants completed the SPPB. RESULTS: Statistically significant differences were observed between groups for the overall SPPB score (P = .013; d = 0.45) and the balance (P = .002; d = 0.46) and gait speed (P = .009; d = 0.30) component scores. The difference between groups in the lower extremity strength component approached significance (P = .056; d = 0.34). Of note, only 2 older adults without MS had SPPB scores below 10 (ie, 10%), whereas 8 older adults with MS had SPPB scores below 10 (ie, 40%); this represented a statistically significant difference in future risk for disability (P = .028). DISCUSSION/CONCLUSIONS: We provide preliminary evidence for reduced physical function based on the SPPB as a valid, objective measure of lower extremity functional performance among older adults with MS.

Investigating the needs and wants of healthcare providers for promoting exercise in persons with multiple sclerosis: a qualitative study.

PURPOSE: We undertook a qualitative study that explored the needs of healthcare providers for promoting exercise behaviour among persons with mild or moderate multiple sclerosis (MS). METHODS: We used interpretive description methodology, and conducted semi-structured interviews with Neurologists (n = 13), occupational therapists (n = 10), physical therapists (n = 11), and nurses (n = 10). The interviews were analysed using thematic analysis. RESULTS: We identified three themes with multiple subthemes regarding exercise promotion by healthcare providers. The first theme was "opportunities for exercise promotion" through the healthcare system, healthcare team, and clinical appointment. The second theme was "healthcare provider education" that included professional training, training among healthcare providers, and clear and defined exercise promotion protocols. The third theme was "patient tools/strategies" that should be delivered among persons with MS as part of the exercise prescription. CONCLUSIONS: Providers in MS healthcare consider the patient-provider interaction within the healthcare system, healthcare team, and clinical appointment as a novel opportunity for exercise promotion. Such an opportunity requires education of healthcare providers and provision of tools and strategies for exercise promotion among persons with MS. Implications for rehabilitation Healthcare providers are interested in and motivated for promoting exercise participation among persons with multiple sclerosis. Successful exercise promotion must consider opportunities at three different organisational levels, namely the healthcare system, the local healthcare team, and clinical appointment. Healthcare providers need further training for promoting exercise among persons with multiple sclerosis. The promotion of exercise among persons with multiple sclerosis will require resources and strategies that can be readily offered by providers.

Randomized controlled trial of an e-learning designed behavioral intervention for increasing physical activity behavior in multiple sclerosis.

BACKGROUND: Internet-delivered, behavioral interventions represent a cost-effective, broadly disseminable approach for teaching persons with multiple sclerosis (MS) the theory-based skills, techniques, and strategies for changing physical activity. OBJECTIVES: This pilot, randomized controlled trial examined the efficacy of a newly developed Internet website based on e-learning approaches that delivered a theory-based behavior intervention for increasing physical activity and improving symptoms, walking impairment, and neurological disability. METHODS: Participants with MS (N = 47) were randomly assigned into behavioral intervention (n = 23) or waitlist control (n = 24) conditions delivered over a six-month period. Outcomes were administered before and after the six-month period using blinded assessors, and data were analyzed using analysis of covariance in SPSS. RESULTS: There was a significant, positive intervention effect on self-reported physical activity (P = 0.05, [Formula: see text] = 0.10), and non-significant improvement in objectively measured physical activity (P = 0.24, [Formula: see text] = 0.04). There were significant, positive effects of the intervention on overall (P = 0.018, [Formula: see text] = 0.13) and physical impact of fatigue (P = 0.003, [Formula: see text] = 0.20), self-reported walking impairment (P = 0.047, [Formula: see text] = 0.10), and disability status (P = 0.033, [Formula: see text] = 0.11). There were non-significant improvements in fatigue severity (P = 0.10, [Formula: see text] = 0.06), depression (P = 0.10, [Formula: see text] = 0.07) and anxiety (P = 0.06, [Formula: see text] = 0.09) symptoms, and self-reported disability (P = 0.10, [Formula: see text] = 0.07). CONCLUSIONS: We provide evidence for the efficacy of an Internet-based behavioral intervention with content delivered through interactive video courses grounded in e-learning principles for increasing physical activity and possibly improving secondary outcomes of fatigue, depression, anxiety, and walking impairment/disability in persons with MS.

Identifying preferred format and source of exercise information in persons with multiple sclerosis that can be delivered by health-care providers.

BACKGROUND: There is increasing recognition of the benefits of exercise in individuals with multiple sclerosis (MS), yet the MS population does not engage in sufficient amounts of exercise to accrue health benefits. There has been little qualitative inquiry to establish the preferred format and source for receiving exercise information from health-care providers among persons with MS. OBJECTIVE: We sought to identify the desired and preferred format and source of exercise information for persons with MS that can be delivered through health-care providers. SETTING AND PARTICIPANTS: Participants were adults with MS who had mild or moderate disability and participated in a range of exercise levels. All participants lived in the Midwest of the United States. METHODS: Fifty semi-structured interviews were conducted and analysed using thematic analysis. RESULTS: Two themes emerged, (i) approach for receiving exercise promotion and (ii) ideal person for promoting exercise. Persons with MS want to receive exercise information through in-person consultations with health-care providers, print media and electronic media. Persons with MS want to receive exercise promotion from health-care providers with expertise in MS (ie neurologists) and with expertise in exercise (eg physical therapists). CONCLUSIONS: These data support the importance of understanding how to provide exercise information to persons with MS and identifying that health-care providers including neurologists and physical therapists should be involved in exercise promotion.

Frontal brain activation changes due to dual-tasking under partial body weight support conditions in older adults with multiple sclerosis.

BACKGROUND: Gait impairments present while dual-tasking in older adults with multiple sclerosis (MS) have been associated with an increased risk of falls. Prior studies have examined prefrontal cortex (PFC) activity using functional near infrared spectroscopy (fNIRS) while dual-tasking in older adults with and without cognitive impairment. While the benefits of partial body weight support (PBWS) on gait have been clearly outlined in the literature, the potential use of PBWS to improve the ability to dual task in older adults with and without MS has not been examined. The aim of this study was to examine the effects of PBWS on the PFC activation while dual-tasking in older adults with and without MS. METHODS: Ten individuals with MS (mean 56.2 ± 5.1 yrs., 8 females) and 12 healthy older adults (HOA) (mean 63.1 ± 4.4 yrs., 9 females) participated in this study. PFC activation (i.e., oxygenated hemoglobin-HbO2) was measured using fNIRS. Assessments were done under two treadmill walking conditions: no body weight support (NBWS) and PBWS. Under each condition, participants were asked to walk at a comfortable speed (W) or walk and talk (WT). Linear mixed models were used to test for differences between cohorts, conditions, and tasks. RESULTS: HbO2 levels differed significantly between task (p < .001), cohort (p < .001), and BWS (p = .02). HbO2 levels increased under higher cognitive demands (i.e., W vs WT), in individuals with MS, and under different conditions (i.e., NBWS vs PBWS). Post-hoc analysis demonstrated a significant difference between cohorts during the WT and NBWS condition (p = .05). When examining the relative change in HbO2 levels during each task, a significant interaction between task, BWS, and cohort across time was observed (p < 0.01). While HOA increased PFC activation across time, MS exhibited a maintenance of PFC activation patterns during the WT under PBWS condition. CONCLUSIONS: This study establishes the potential impact of PBWS on PFC activation patterns under dual-tasking conditions and sheds light on the ability for PBWS to be used as a therapeutic tool in individuals with neurological conditions to decrease cognitive demands while dual-tasking and thus decrease the risk of falls.

Preliminary Evidence For The Effects Of Aging And Multiple Sclerosis On Cognitive Performance: An Analysis Based On Effect Size Estimates.

Background/Study Context: Although cognitive impairment is common in persons with multiple sclerosis (MS), there are limited data on older adults with MS. The current pilot study involved a preliminary examination of cognitive impairments across a comprehensive neuropsychological assessment in older adults with MS compared with older adults without MS. METHODS: Twenty older adults with MS and 20 older adults without MS (≥60 years of age) underwent cognitive assessments, including the Trail Making Test (TMT) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). The primary analytical model involved independent-samples t tests on the TMT and RBANS scores. The analysis focused on ½ SD (i.e., Cohen's d of 0.5) for judging the differences as meaningful. RESULTS: Overall, the study hypotheses were supported such that older adults with MS demonstrated decreased cognitive performance that exceeded ½ SD compared with the older adults without MS. CONCLUSION: This preliminary study demonstrated moderate and meaningful differences in cognitive performance in older adults with MS compared with older adults without MS. This suggests a clear need for identifying strategies for alleviating cognitive impairment in older adults with MS.

Self-efficacy and Walking Performance in Persons With Multiple Sclerosis.

BACKGROUND AND PURPOSE: Impairment of walking function is a prevalent and burdensome feature of multiple sclerosis (MS), and represents a primary focus of rehabilitation research and clinical care. Research examining self-efficacy as a correlate of walking performance in MS is lacking; self-efficacy represents a theory-based, modifiable target of rehabilitation approaches for improving walking outcomes. This cross-sectional study examined the association between self-efficacy and walking performance in persons living with MS. METHODS: The sample included 69 persons with MS who completed the Multiple Sclerosis Self-Efficacy (MSSE) Scale and Exercise Self-Efficacy (EXSE) Scale and undertook the Timed 25-Foot Walk (T25FW) and the 6-Minute Walk (6MW) tests. The data were analyzed using the Pearson product moment correlation coefficients and linear regression. RESULTS: Correlation analysis indicated that function subscale scores on the MSSE correlated more strongly with T25FW (r = 0.55) than did the control subscale (r = 0.40) and EXSE (r = 0.38) scores, and both function (r = 0.67) and control (r = 0.53) subscale scores on the MSSE correlated more strongly with 6MW than did EXSE scores (r = 0.40). Linear regression analyses indicated that (1) function MSSE subscale, but not control subscale, explained significant variance in T25FW speed and 6MW distance and (2) function MSSE subscale, but not EXSE, explained significant variance in T25FW speed and 6MW distance. DISCUSSION AND CONCLUSIONS: We provide the first evidence of an association between self-efficacy, particularly for functioning with MS, and objective walking performance in MS. Future research to replicate and extend these results can inform rehabilitation efforts that target improvement of walking performance in persons with MS.Digital Abstract available for more insights from the authors (see Slides, Supplemental Digital Content 1, http://links.lww.com/JNPT/A171).

Reliability, precision, and clinically important change of the Nine-Hole Peg Test in individuals with multiple sclerosis.

This study evaluated the reliability, precision, and clinically important change of the Nine-Hole Peg Test (9-HPT) over a 1-week period. Sixty-nine patients with multiple sclerosis completed the 9-HPT on two occasions 1 week apart. Test-retest reliability was based on intraclass correlation coefficient, and precision was based on standard error of measurement and coefficient of variation. Clinically important change was based on the minimal detectable change. Intraclass correlation coefficients exceed 0.90 for all 9-HPT metrics. Standard error of measurements for dominant (DH) and nondominant (NDH) hand time were 1.58 and 2.69 s, and 0.03 peg/s for both DH and nondominant NDH speed, respectively. Coefficient of variations for DH and NDH time were 4.3 and 3.8%, and 4.5 and 4.6% for DH and NDH speed. Minimal detectable changes for DH and NDH time were 19.4 and 29.1%, and 18.6 and 20.5% for DH and NDH speed. These data provide evidence on reliability, precision, and clinically important change of the 9-HPT over a 1-week period in multiple sclerosis for clinicians and researchers.

Multiple sclerosis patients need and want information on exercise promotion from healthcare providers: a qualitative study.

BACKGROUND: There is growing recognition of the benefits and safety of exercise and its importance in the comprehensive care of persons with multiple sclerosis (MS), yet uptake is low. OBJECTIVE: We explored the needs and wants of patients with MS regarding exercise promotion through healthcare providers. SETTING AND PARTICIPANTS: Participants were adults with MS who had mild-or-moderate disability and a range of exercise levels. All participants lived in the Midwest of the United States. METHODS: Fifty semi-structured interviews were conducted and analysed using thematic analysis. Two themes emerged, namely interactions between patients and healthcare providers and needs and wants of patients. RESULTS: Analysis of participant accounts illustrate that current exercise promotion by healthcare providers does not meet patient needs and wants. The identified needs and wants of persons with MS involved (i) information and knowledge on the benefits of exercise and exercise prescription, (ii) materials to allow home and community exercise and (iii) tools for initiating and maintaining exercise behaviour. DISCUSSION AND CONCLUSION: Patients with MS frequently interact with healthcare providers and are generally unsatisfied with exercise promotion during interactions. Healthcare providers can address the low uptake of exercise among persons with MS by acting upon the identified unmet needs involving materials, knowledge and behaviour change strategies for exercise.

Co-occurring Risk Factors in Multiple Sclerosis.

OBJECTIVE: We examined individual and co-occurring risk factors as correlates of health outcomes in persons with multiple sclerosis (MS). METHODS: Sixty-nine participants with MS completed measures of nutrition, physical activity levels, comorbidity and neuroperformance. The data were analyzed using t-test analyses in SPSS Statistics 22.0. RESULTS: Total number of comorbidities (z = 2.36, p = .02), cardiovascular disease symptoms (z = 2.63, p = .01), Timed 25-Foot Walk (T25FW) speed (z = 2.53, p = .01), and 6 Minute Walk (6MW) distance (z = 2.61, p = .01) had significant differences in the cluster of co-occurring poor nutrition and insufficient levels of physical activity. There was a significant difference between those reporting two vs. one risk factor for number of comorbidities (z = 2.41, p = .02), cardiovascular disease symptoms (z = 2.40 p = .02), T25FW speed (z = 2.39, p = .02), and 6MW distance (z = 2.68, p = .01). CONCLUSIONS: These results suggest that: (1) the cluster of co-occurring poor diet and insufficient physical activity is associated with comorbidities and neuroperformance markers; and (2) that cluster is further synergistically associated with comorbidities and neuroperformance markers.

Individual and Co-occurring SNAP Risk Factors: Smoking, Nutrition, Alcohol Consumption, and Physical Activity in People with Multiple Sclerosis.

Background: Smoking, poor nutrition, excess alcohol consumption, and insufficient physical activity underlie most preventable causes of morbidity in the general population and may be associated with comorbidities and health outcomes in multiple sclerosis (MS). However, the frequency of co-occurrence of these risk factors in people with MS remains unclear. Methods: Sixty-nine individuals with MS completed self-report measures of smoking status, nutrition, alcohol use, physical activity levels, and sociodemographic and clinical characteristics. The data were analyzed using t tests and χ2 analyses. Results: Poor diet was the most common risk factor, with 85.5% of the sample not meeting dietary guidelines. Of participants with two risk factors, 90.3% were not meeting dietary and physical activity guidelines. Seventy-three percent of women were not meeting physical activity guidelines, compared with 38% of men (χ2 = 7.5, P < .01). There were also differential rates by sex of the most commonly co-occurring risk factors: 65% of women reported the co-occurrence of insufficient physical activity and poor diet, compared with 38% of men (χ2 = 4.2, P = .05). Conclusions: These results indicate that 85.5% of the sample was not meeting nutrition guidelines, 90.3% of participants with two risk factors reported the co-occurrence of poor diet and insufficient levels of physical activity, and physical activity levels and the total number of risk factors varied across sex.

Brain activation changes during locomotion in middle-aged to older adults with multiple sclerosis.

Mobility and cognitive impairments are common in persons with multiple sclerosis (MS), and are expected to worsen with increasing age. However, no studies, to date, in part due to limitations of conventional neuroimaging methods, have examined changes in brain activation patterns during active locomotion in older patients with MS. This study used functional Near Infrared Spectroscopy (fNIRS) to evaluate real-time neural activation differences in the pre-frontal cortex (PFC) between middle-aged to older adults with MS and healthy controls during single (Normal Walk; NW) and dual-task (Walking While Talking; WWT) locomotion tasks. Eight middle-aged to older adults with MS and eight healthy controls underwent fNIRS recording while performing the NW and WWT tasks with an fNIRS cap consisting of 16 optodes positioned over the forehead. The MS group had greater elevations in PFC oxygenation levels during WWT compared to NW than healthy controls. There was no walking performance difference between groups during locomotion. These findings suggest that middle-aged to older individuals with MS might be able to achieve similar levels of performance through the use of increased brain activation. This study is the first to investigate brain activation changes during the performance of simple and divided-attention locomotion tasks in MS using fNIRS.

Systematically developed pilot randomized controlled trial of exercise and cognition in persons with multiple sclerosis.

Cognitive impairment is common and debilitating among persons with multiple sclerosis (MS) and might be managed with exercise training. The present pilot study adopted a single-blind randomized controlled trial (RCT) design and is the first to examine the effect of a systematically developed, progressive treadmill walking exercise training intervention on cognition among fully ambulatory persons with MS. Ten fully ambulatory females with MS were randomly assigned into exercise training intervention or waitlist control conditions. The intervention condition involved 12 weeks of supervised, progressive chronic treadmill walking exercise training. Participants underwent measures of cognition (i.e., cognitive processing speed (CPS), executive function), walking performance, and cardiorespiratory fitness before and after the 12-week period; baseline and follow-up assessments were performed by blinded assessors. Overall, there were large intervention effects on CPS (d = 0.95), walking performance (d = 0.76), and cardiorespiratory fitness (d > 1.08). The change in cardiorespiratory fitness was significantly associated with change in CPS (r = .60), but not walking performance. This small pilot RCT provides preliminary proof-of-concept data supporting progressive treadmill walking exercise training for potentially improving CPS, walking performance, and cardiorespiratory fitness in fully ambulatory persons with MS, and that improved fitness might be a possible mechanism for improved CPS.

Accuracy and precision of smartphone applications and commercially available motion sensors in multiple sclerosis.

BACKGROUND: There is increased interest in the application of smartphone applications and wearable motion sensors among multiple sclerosis (MS) patients. OBJECTIVE: This study examined the accuracy and precision of common smartphone applications and motion sensors for measuring steps taken by MS patients while walking on a treadmill. METHODS: Forty-five MS patients (Expanded Disability Status Scale (EDSS) = 1.0-5.0) underwent two 500-step walking trials at comfortable walking speed on a treadmill. Participants wore five motion sensors: the Digi-Walker SW-200 pedometer (Yamax), the UP2 and UP Move (Jawbone), and the Flex and One (Fitbit). The smartphone applications were Health (Apple), Health Mate (Withings), and Moves (ProtoGeo Oy). RESULTS: The Fitbit One had the best absolute (mean = 490.6 steps, 95% confidence interval (CI) = 485.6-495.5 steps) and relative accuracy (1.9% error), and absolute (SD = 16.4) and relative precision (coefficient of variation (CV) = 0.0), for the first 500-step walking trial; this was repeated with the second trial. Relative accuracy was correlated with slower walking speed for the first (rs = -.53) and second (rs = -.53) trials. CONCLUSION: The results suggest that the waist-worn Fitbit One is the most precise and accurate sensor for measuring steps when walking on a treadmill, but future research is needed (testing the device across a broader range of disability, at different speeds, and in real-life walking conditions) before inclusion in clinical research and practice with MS patients.