Abstract Purpose To assess the frequency and nature of sexual dysfunction in multiple sclerosis (MS) patients and to investigate the relationships of SD with clinical, demographic and psychosocial ...factors by comparing MS patients with and without SD. Methods Eighty-nine patients were included, 45 males and 44 females, aging an average of 37.4 ± 8.6 years (range:21–56). We applied Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19) and Arizona Sexual Experiences Scale (ASEX) to all patients. Disability was evaluated with the expanded disability status scale (EDSS). Results 60.7% (n = 54) of patients reported SD according to MSISQ scores. Women exhibited significantly higher MSISQ scores than men (42.6 ± 12.9 and 36.6 ± 13.3, respectively; P = 0.034). Women (7.9%) also reported to experience sexual arousal difficulties significantly more than men (1.1%) (P = 0.024) according to ASEX. The patients were classified into three MSISQ-19 subscales, Primary, Secondary and Tertiary SD. The most common reported dimension of SD was secondary (32.5%, n = 41). In this dimension of SD, patients mostly complained of pain-burning, memory-concentration problems and bowel symptoms. A significant relationship was found between Secondary SD and both EDSS score and disease duration (r = 0.34 p = 0.001 and r = 0.21 p = 0.042, respectively). Tertiary SD was also associated with EDSS score (r = 0.23 p = 0.03). Conclusion Sexual Dysfunction, a frequent problem for MS patients, is associated with gender. Women reported more SD than men. Secondary SD symptoms were the most common complaints for both men and women. Nonetheless women had more secondary SD symptoms than men. The emotional dimension of SD is related with disability.
Background
The risk of hepatitis B virus (HBV) reactivation remains unclear in people with multiple sclerosis (MS) receiving ocrelizumab. We aimed to assess HBV seroprevalence and reactivation risk ...in MS patients on ocrelizumab and to evaluate the effectiveness of antiviral prophylaxis against HBV reactivation.
Methods
In this single-center, cross-sectional study, 400 people with MS receiving ocrelizumab were screened for HBV at baseline and antiviral prophylaxis was implemented based on serological results. Patients were monitored for HBV reactivation, and outcomes were analyzed.
Results
Among 56 (14%) patients who had serology compatible with occult or resolved HBV infection, 49 (85.7%) received antiviral prophylaxis regularly and had no HBV reactivation during the follow-up. Reactivation of HBV occurred in 2 out of 7 (28.6%) patients who did not receive antiviral prophylaxis and in one patient who did not adhere to the prophylaxis regimen. All patients with reactivation had anti-HBs levels below 100 mIU/mL and the median titer was significantly lower than the patients with no HBV reactivation (
p
= 0.034).
Conclusion
This study highlights a 14% anti-HBc positivity, indicating a potential risk for HBV reactivation in people with MS receiving ocrelizumab. This suggests the importance of vigilant monitoring and the implementation of prophylactic measures. Our recommendation emphasizes antiviral prophylaxis, particularly for patients with low anti-HBs, and a pre-emptive strategy for others.
•Supervised Clinical Pilates training may be an alternative method in rehabilitation programs for pwMS.•Supervised Clinical Pilates training was superior and more effective than the home exercise ...program for improving walking endurance, balance, respiratory and cognitive function in pwMS.•Home exercise program can be used to improve mobility, core stability, and inspiratory muscle strength in pwMS who can not travel to treatment centers.
Multiple sclerosis (MS) is a chronic progressive and neurodegenerative disease. Exercise programs are needed to maintain and increase functional status in persons with MS (pwMS). Pilates exercises designed by a physiotherapist can enhance participation and functionality in pwMS.
The aim of this study was to investigate the effects of Clinical Pilates training on balance, walking, fall risk, respiratory, and cognitive functions in pwMS compared with an active comparator (home exercise training).
This study was a randomized controlled study.
This study was designed by researchers at Dokuz Eylül University, Izmir, Turkey.
Forty-two pwMS were included in this randomized controlled trial.
Walking, core stability, balance confidence, respiratory muscle strength, and cognitive functions were assessed before and after the program.
The participants were randomly divided into two groups. The Pilates exercises group (n = 21) received therapy weekly for 8 weeks along with a home exercise program. The home exercise group (n = 21) was given standardized exercises reflecting routine clinical practice. The program compliance was monitored by telephone calls once a week.
There were no significant differences in walking speed (p = 0.096), perceived walking ability (p = 0.165), and fear of falling (p = 0.385) between the Pilates and home exercise groups. Clinical Pilates training was superior to the home exercise program in walking endurance (p = 0.001), postural stability (p = 0.028), core stability (p = 0.016), respiratory (maximum inspiratory pressure: p = 0.037, maximum expiratory pressure: p = 0.008), and cognitive functions (p = 0.001–0.007). Clinical Pilates training may be preferred as an alternative method to improve balance, walking, respiratory, and cognitive functions in pwMS.
: Patient Determined Disease Steps (PDDS) scale is a patient-reported outcome measure to assess disability in persons with multiple sclerosis (pwMS). This scale can be used as an alternative to ...Expanded Disability Status Scale (EDSS) as it is a costly, more time-consuming, and clinician-based method. This study aimed to conduct Turkish translation and cross-cultural adaptation of PDDS and investigate its psychometric properties.
: Turkish translation and cross-cultural adaptation of PDDS was conducted. Its psychometric properties including validity (i.e. content, criterion, and construct) and test-retest reliability (relative and absolute) were investigated in 100 pwMS.
: PDDS had a significant strong correlation with EDSS (
= 0.61,
< .001). Regression model to predict EDSS scores from PDDS scores was significant (
< .001,
= 0.67). Both PDDS and EDSS were significantly correlated with age, disease duration, walking speed and endurance, perceived impact of MS on walking, functional mobility, working memory and information processing speed, visual memory, manual dexterity, and health-related quality of life (
< .05). No significant difference was observed in the correlation coefficients of PDDS and EDSS (
> .05). Relative test-retest reliability was found high ICC = 0.99 (95%CI = 0.99, 0.99). Absolute test-retest reliability was high as the Bland-Altman analyses showed no significant systematic bias between the repeated assessments. A narrow range of the limits of agreement indicated that PDDS had high stability and low variation between first and second assessments.
: Turkish version of PDDS presented high validity and test-retest reliability in pwMS.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Background
No study has investigated the impact of dual‐tasking difficulties as a risk factor for unemployment in people with multiple sclerosis (pwMS). The aim was to examine the influence of ...dual‐task performance on employment status and work difficulties and to identify the predictors of employment status in pwMS.
Methods
Eighty‐four pwMS, including 42 employed and 42 unemployed, participated in the study. Dual‐task difficulties were assessed using the Dual‐task Impact on Daily‐living Activities‐Questionnaire (DIDA‐Q), while dual‐task performance was evaluated through the 30‐second Walk Test and Nine‐Hole Peg Test, incorporating a cognitive task. Walking and cognitive function were also measured.
Results
Employed pwMS had better scores in walking, cognitive function, single and dual‐task performance than unemployed pwMS (p < .05). Lower scores in walking (odds ratio OR = 1.81, p < .001) and upper extremity‐related (OR = 1.44, p = .019) dual‐task performance and higher scores in the cognitive subscale of the DIDA‐Q questionnaire (OR = 1.20, p = .037) were significantly associated with higher odds of being unemployed. Among employed pwMS, DIDA‐Q subscales showed moderate‐to‐strong correlations with MSWSDQ‐23 scores. The other variables showed weak‐to‐moderate correlations with subscale and total scores of MSWSDQ‐23.
Conclusion
Cognitive function, as opposed to motor function, has been found to be a significant predictor of unemployment in pwMS.
Objective
The Manual Ability Measure-36 (MAM-36) has been used to assess subjective upper limb function in people with several neurological and non-neurological diseases. Besides, the MAM-36 is one ...of the most commonly used patient-reported outcome measures (PROMs) in people with multiple sclerosis (pwMS). The aim was to translate and conduct cross-cultural adaptation of the MAM-36 into Turkish and investigate its psychometric properties in pwMS.
Methods
The MAM-36 was translated and culturally adapted into Turkish. Two hundred pwMS were recruited for the psychometric study. Hand skills, handgrip strength, upper limb spasticity, disability level, and quality of life were evaluated by the validated performance-based tests and questionnaires including the Arm Function in Multiple Sclerosis Questionnaire (AMSQ) which is a validated MS-specific PROM to assess upper limb function.
Results
MAM-36 was significantly correlated with the performance-based tests and questionnaires, EDSS, age, and disease duration (
p
< 0.05). MAM-36 and AMSQ were strongly correlated (
r
s
= − 0.90,
p
< 0.01). PwMS with spasticity had significantly lower MAM-36 scores compared to those without spasticity (
p
< 0.01). Internal consistency (Cronbach’s alpha = 0.97) and test-retest reliability (ICC = 0.97) was high.
Conclusion
The Turkish version of MAM-36 has been found as a valid and reliable method for measuring upper limb function in pwMS.
Background
Balance confidence is an essential component of fall risk assessment in persons with multiple sclerosis (pwMS).
Aims
The aims of this cross-sectional study were to 1) investigate the ...ability of the 16-item Activities-specific Balance Confidence scale (ABC-16), 6-item Activities-specific Balance Confidence scale (ABC-6), and each item of the ABC-16 for distinguishing fallers and 2) determine cutoff scores for these scales to discriminate fallers and non-fallers in pwMS.
Methods
One hundred and fifty-six participants fallers/non-fallers: 60 (38.5%)/96 (61.5%), median EDSS: 1.5 were enrolled. Balance confidence was assessed using the ABC-16 and ABC-6. The self-reported number of falls in the past three months was recorded. Descriptive assessments, including walking, balance, and cognition were performed. Logistic regression and receiver operating characteristic analyses were conducted to estimate the sensitivities and specificities of the ABC-16 and ABC-6.
Results
Both the ABC-16 (AUC: 0.85) and ABC-6 (AUC: 0.84) had the discriminative ability for falls. Each item of the ABC-16 scale was a significantly related to falls odds ratio (OR) range: 1.38 to 1.89. Items 8 and 10 had the highest odds ratio (OR: 1.85; 95%CI: 1.47–2.33, OR: 1.89; 95%CI: 1.49–2.40; respectively). We found cutoff scores of ≤ 70 of 100 (sensitivity: 71.67, specificity: 86.46) and ≤ 65/100 (sensitivity: 76.67, specificity: 79.17) in discrimination between fallers and non-fallers for the ABC-16 and ABC-6, respectively.
Conclusion
Both original and short forms of the ABC scale are an efficient tool for discriminating fallers and non-fallers in pwMS. Although all items are related to falls, outdoor walking activities have the strongest associations with falls than other items.
To compare the effectiveness and treatment persistence of ocrelizumab, cladribine and natalizumab in patients with relapsing-remitting multiple sclerosis switching from fingolimod.
Using data from ...MSBase registry, this multicentre cohort study included subjects who had used fingolimod for ≥6 months and then switched to ocrelizumab, cladribine or natalizumab within 3 months after fingolimod discontinuation. We analysed relapse and disability outcomes after balancing covariates using an inverse-probability-treatment-weighting method. Propensity scores for the three treatments were obtained using multinomial-logistic regression. Due to the smaller number of cladribine users, comparisons of disability outcomes were limited to natalizumab and ocrelizumab.
Overall, 1045 patients switched to ocrelizumab (n=445), cladribine (n=76) or natalizumab (n=524) after fingolimod. The annualised relapse rate (ARR) for ocrelizumab was 0.07, natalizumab 0.11 and cladribine 0.25. Compared with natalizumab, the ARR ratio (95% confidence interval CI) was 0.67 (0.47 to 0.96) for ocrelizumab and 2.31 (1.30 to 4.10) for cladribine; the hazard ratio (95% CI) for time to first relapse was 0.57 (0.40 to 0.83) for ocrelizumab and 1.18 (0.47 to 2.93) for cladribine. Ocrelizumab users had an 89% lower discontinuation rate (95% CI, 0.07 to 0.20) than natalizumab, but also a 51% lower probability of confirmed disability improvement (95% CI, 0.32 to 0.73). There was no difference in disability accumulation.
After fingolimod cessation, ocrelizumab and natalizumab were more effective in reducing relapses than cladribine. Due to the low ARRs in all three treatment groups, additional observation time is required to determine if statistical difference in ARRs results in long-term disability differences.
•Sedentary behaviour is a major problem in persons with multiple sclerosis (pwMS).•Total sitting time was associated with gender, employment status, and fatigue independent of physical activity level ...and fear of falling.•Being male increased the risk of sitting 3.08 times, being employed increased the risk of sitting 4.65 times, and having each unit higher score on the fatigue scale increased the risk of sitting 1.03 times.•There was no difference between weekday and weekend sitting times.
Sedentary behaviour is a major problem in persons with multiple sclerosis (pwMS). However, little is known about the related factors of sedentary behaviour in MS. Our study aimed to examine the association between sedentary behaviour and physical activity level, fear of falling, and fatigue.
Demographic and clinical data have been recorded. Sedentary behaviour was assessed with the Marshall Sitting Questionnaire, physical activity level was evaluated with the Godin Leisure Time Exercise Questionnaire, fear of falling was evaluated with the Fall Efficacy Scale International, and fatigue was evaluated with the modified fatigue impact scale (MFIS). The Timed 25-Foot Walk, 6-Minute Walk Test, Timed Up and Go Test, and 12-Item Multiple Sclerosis Walking Scale were also used to assess walking and perceived walking disability.
We recruited 71 pwMS 49 were female (69 %), mean age:38.08 years, median EDSS:1.5. The mean daily sitting time was 593.54 min (∼10 h). No significant correlation was found between sitting times and demographics, leisure time physical activity, fear of falling, walking, perceived walking disability, and neurological disability level (p > 0.05). Logistic regression analysis indicated that being male increased the risk of sedentary behaviour by 3.08 times, being employed increased the risk of sitting by 4.65 times, and each point increase in MFIS scores resulted in a 1.03-fold elevation in the odds of prolonged sitting.
The fact that pwMS, even with a mild disability spend almost 10 h sitting highlights the significance of sedentary behaviour in this population. Developing strategies to address modifiable factors, such as fatigue, may be effective in reducing sedentary behaviour.
Purpose: To linguistically and culturally adapt the Multiple Sclerosis Work Difficulties Questionnaire-23 (MSWDQ-23) for use in Turkey, and to examine its reliability and validity.
Methods: Following ...standard forward-back translation of the MSWDQ-23, it was administered to 124 people with multiple sclerosis (MS). Validity was evaluated using related outcome measures including those related to employment status and expectations, disability level, fatigue, walking, and quality of life. Randomly selected participants were asked to complete the MSWDQ-23 again to assess test-retest reliability.
Results: Confirmatory factor analysis on the MSWDQ-23 demonstrated a good fit for the data, and the internal consistency of each subscale was excellent. The test-retest reliability for the total score, psychological/cognitive barriers, physical barriers, and external barriers subscales were high. The MSWDQ-23 and its subscales were positively correlated with the employment, disability level, walking, and fatigue outcome measures.
Conclusions: This study suggests that the Turkish version of MSWDQ-23 has high reliability and adequate validity, and it can be used to determine the difficulties faced by people with multiple sclerosis in workplace. Moreover, the study provides evidence about the test-retest reliability of the questionnaire.
Implications for rehabilitation
Multiple sclerosis affects young people of working age.
Understanding work-related problems is crucial to enhance people with multiple sclerosis likelihood of maintaining their job.
The Multiple Sclerosis Work Difficulties Questionnaire-23 (MSWDQ-23) is a valid and reliable measure of perceived workplace difficulties in people with multiple sclerosis: we presented its validation to Turkish.
Professionals working in the field of vocational rehabilitation may benefit from using the MSWDQ-23 to predict the current work outcomes and future employment expectations.
