Regular exercise is important for patients with multiple sclerosis (MS) to maintain their functional ability and general health. The aim of this study was to determine whether a long-term exercise ...program has any effect on functional impairment or healthrelated quality of life (HRQOL) in subjects with mild to moderate MS. In a randomised controlled trial, subjects in the intervention group (n = 47) exercised according to a progressive exercise program, mainly consisting of resistance training, for six months. Subjects in the control group (n = 48) received no intervention. The subjects were assessed at baseline and at six months using the Multiple Sclerosis Functional Composite (MSFC), the Expanded Disability Status Scale (EDSS), the Functional Independence Measure (FIM), the MS Quality of Life-54 (MSQOL-54) questionnaire and the Centre for Epidemiologic Studies Depression Scale (CES-D). The drop-out rate was low (4%) with 91 subjects completing the study. At six months, the exercising subjects showed improvement on the MSFC (mean score change 0.114, 95% confidence interval CI 0.010 to 0.218), whereas the control subjects showed deterioration (mean score change -0.128, 95 % CI -0.232 to -0.025). The change between groups was statistically significant (interaction, p = 0.001). Consistent with the physical nature of the intervention, the change predominantly occurred in leg function/ambulation. The effect seen in the EDSS, FIM, MSQOL-54 or CES-D was nil. These findings indicate that MSFC is more sensitive than EDSS in the detection of improvement in functional impairment as a result of regular exercise. The unfavourable results from HRQOL do not rule out the possibility that other types of exercise programs may improve it in MS.
The relationship between fatigue impact and walking capacity and perceived ability in patients with multiple sclerosis (MS) is inconclusive in the existing literature. A better understanding might ...guide new treatment avenues for fatigue and/or walking capacity in patients with MS.
To investigate the relationship between the subjective impact of fatigue and objective walking capacity as well as subjective walking ability in MS patients.
A cross-sectional multicenter study design was applied. Ambulatory MS patients (n = 189, age: 47.6 ± 10.5 years; gender: 115/74 women/men; Expanded Disability Status Scale (EDSS): 4.1 ± 1.8 range: 0–6.5) were tested at 11 sites. Objective tests of walking capacity included short walking tests (Timed 25-Foot Walk (T25FW), 10-Metre Walk Test (10mWT) at usual and fastest speed and the timed up and go (TUG)), and long walking tests (2- and 6-Minute Walk Tests (MWT). Subjective walking ability was tested applying the Multiple Sclerosis Walking Scale-12 (MSWS-12). Fatigue impact was measured by the self-reported modified fatigue impact scale (MFIS) consisting of a total score (MFIStotal) and three subscales (MFISphysical, MFIScognitive and MFISpsychosocial). Uni- and multivariate regression analysis were performed to evaluate the relation between walking and fatigue impact.
MFIStotal was negatively related with long (6MWT, r = −0.14, p = 0.05) and short composite (TUG, r = −0.22, p = 0.003) walking measures. MFISphysical showed a significant albeit weak relationship to walking speed in all walking capacity tests (r = −0.22 to −0.33, p < .0001), which persisted in the multivariate linear regression analysis. Subjective walking ability (MSWS-12) was related to MFIStotal (r = 0.49, p < 0.0001), as well as to all other subscales of MFIS (r = 0.24–0.63, p < 0.001), showing stronger relationships than objective measures of walking.
The physical impact of fatigue is weakly related to objective walking capacity, while general, physical, cognitive and psychosocial fatigue impact are weakly to moderately related to subjective walking ability, when analysed in a large heterogeneous sample of MS patients.
•Despite being equally prevalent symptoms in MS the relation between gait impairments and fatigue is unclear.•General fatigue impact is not related to most walking outcomes in MS.•The physical impact of fatigue is weak to moderately related to both objective and subjective walking capacity in MS.
To improve walking and other aspects of physical function with a progressive 6-month exercise program in patients with multiple sclerosis (MS).
MS patients with mild to moderate disability (Expanded ...Disability Status Scale scores 1.0 to 5.5) were randomly assigned to an exercise or control group. The intervention consisted of strength and aerobic training initiated during 3-week inpatient rehabilitation and continued for 23 weeks at home. The groups were evaluated at baseline and at 6 months. The primary outcome was walking speed, measured by 7.62 m and 500 m walk tests. Secondary outcomes included lower extremity strength, upper extremity endurance and dexterity, peak oxygen uptake, and static balance. An intention-to-treat analysis was used.
Ninety-one (96%) of the 95 patients entering the study completed it. Change between groups was significant in the 7.62 m (p = 0.04) and 500 m walk tests (p = 0.01). In the 7.62 m walk test, 22% of the exercising patients showed clinically meaningful improvements. The exercise group also showed increased upper extremity endurance as compared to controls. No other noteworthy exercise-induced changes were observed. Exercise adherence varied considerably among the exercisers.
Walking speed improved in this randomized study. The results confirm that exercise is safe for multiple sclerosis patients and should be recommended for those with mild to moderate disability.
•Relations between DT walking performance and clinical characteristics were analysed.•Relations depend on type of motor and cognitive task used in the dual task.•Better mobility in MS is related to ...higher DT walking speed.•Faster information processing speed related to lower DTC.
Background: In persons with Multiple Sclerosis (pwMS) performing a simultaneous cognitive task while walking often results in slower gait. Clinical characteristics associated with reduced dual task (DT) performance are not yet entirely clear. This multi-centre study aimed to determine the relationship between clinical and demographical characteristics with dual task (DT) walking performance in pwMS during multiple DT conditions.
Methods: Nine DT conditions were analysed, consisting of combinations of three types of cognitive (‘digit span’, ‘subtraction’, ‘vigilance’) and three types of walking (‘walk’, ‘walk with cup’, ‘walk over obstacles’) conditions. Primary outcomes were DT gait speed (m/s) and motor DT cost of gait speed (DTCmotor, %). Secondary outcomes were clinical tests of physical and cognitive functioning and patient-reported and demographical outcomes. Firstly, univariate analyses and, subsequently, multivariate analyses with backward modelling, were conducted for each type of walking DT condition separately. Cognitive DT conditions were included in the models as main and as interaction effect with the secondary outcomes.
Results: Analysis were performed in 81 pwMS (EDSS 3.3 ± 1.0). In the final models of DTCmotor, the significant main effects were in ‘walk’ DT-conditions the Symbol Digit Modalities Test (SDMT), in ‘cup’ conditions the SDMT and Dynamic Gait Index and in ‘obstacles’ conditions age. For DT gait speed, main effects were found for the 2-Minute Walking Test (2MWT) and the Multiple Sclerosis Walking Scale for all walking conditions. Additionally, interactions between cognitive DT-conditions and SDMT, age and 2MWT were found.
Conclusion: Clinical characteristics related to DT walking performance differed according to cognitive-motor DT-condition used. Still, in general, pwMS with a better mobility demonstrated higher DT gait speed, while a faster information processing speed was related to a lower DTCmotor.
Background: Many persons with multiple sclerosis (PwMS) report increased fatigue in the afternoon and evening compared with the morning. It is commonly accepted that physical capacity also decreases ...as time of day progresses, potentially influencing the outcomes of testing.
Objective: The objective of this article was to determine whether self-reported fatigue level and walking capacity are influenced by time of day in PwMS.
Methods: A total of 102 PwMS from 8 centers in 5 countries, with a diverse level of ambulatory dysfunction (Expanded Disability Status Scale EDSS <6.5), participated. Patients performed walking capacity tests and reported fatigue level at three different time points (morning, noon, afternoon) during 1 day. Walking capacity was measured with the 6-Minute Walk Test (6MWT) and the 10-m walk test performed at usual and fastest speed. Self-reported fatigue was measured by the Rochester Fatigue Diary (RFD). Subgroups with mild (EDSS 1.5–4.0, n = 53) and moderate (EDSS 4.5–6.5, n = 49) ambulatory dysfunction were formed, as changes during the day were hypothesized to depend on disability status.
Results: Subgroups had different degree of ambulatory dysfunction (p < 0.001) but reported similar fatigue levels. Although RFD scores were affected by time of day with significant differences between morning and noon/afternoon (p < 0.0001), no changes in walking capacity were found in any subgroup. Additional analyses on subgroups distinguished by diurnal change in self-reported fatigue failed to reveal analogous changes in walking capacity.
Conclusions: Testing of walking capacity is unaffected by time of day, despite changes in subjective fatigue.
Summary Asthma is often difficult to control and it is likely that not all patients are optimally treated. This study aimed to explore asthma control in adults receiving fixed dose combination (FDC) ...therapy. Control of asthma was assessed using the mannitol challenge test as a monitoring tool to see if this would give additional information compared to the asthma control test (ACT). The study was an open-label, prospective study on 98 adults prescribed with FDC therapies for at least three months. 74 patients considered that their asthma was well controlled. However, 60 patients had a positive mannitol challenge test (PD15 < 635 mg), and when those with a positive response to the short-acting β2 -agonist (≥15%) after the mannitol challenge test were included, this increased to 64 patients (65%). Exploratory analysis determined that the spirometry parameters; FEV1 /FVC and FEV1 % of predicted, were statistically significant predictors of a positive mannitol challenge test. Co-morbid conditions such as concomitant upper airway involvement or eczema did not predict mannitol reactivity. Although most patients rated their asthma as well controlled, many provided a positive mannitol challenge test, suggesting the presence of underlying inflammation, despite treatment with fixed dose combination therapy.
Background: Heat sensitivity and cognitive deficits are typical manifestations of multiple sclerosis (MS). Although cognitive deficits are quite well characterized, practically no data exist on the ...effects of heat on cognitive performances in MS.
Objective: To assess the effects of short-term heat stress on cognitive functioning in subjects with MS.
Methods: A total of 23 heat-sensitive MS and 19 healthy control (HC) subjects participated. Moderate heat exposure took place in a Finnish sauna. Cognitive functioning was measured with tests of sustained attention and processing speed, the Paced Auditory Serial Addition Test (PASAT 3” and 2”) and the computerized visual vigilance test, before, during and after heat exposure.
Results: During the heat exposure, the core body temperature of the MS group rose significantly more (p = 0.002) than that of the HC group. The heat stress worsened the performance of the MS group in the PASAT 3” (p = 0.025) but not in the other cognitive measures. The performance in the PASAT 3” was reversed almost to the baseline level only 1- h after the heat exposure.
Conclusions: A significant increase in core body temperature during heat stress is associated with a mild and reversible worsening of the PASAT 3” performance, while visual vigilance performance seems to remain almost unaffected.
Purpose. This study was designed to evaluate symptomatic fatigue in patients with mild to moderate multiple sclerosis (MS) during inpatient rehabilitation. We examined fatigue at the beginning and at ...the end of a 3-week rehabilitation period as well as its daily variation.
Method. Ninety-one patients participated. Fatigue severity was measured using the Fatigue Severity Scale (FSS). On the basis of the FSS scores, patients were divided into a fatigue (n = 66) and non-fatigue (n = 25) group. General fatigue was self-evaluated using a Visual Analogue Scale (FVAS). Depression was measured using The Centre for Epidemiologic Studies Depression scale (CES-D).
Results. In the fatigue group the mean FSS score decreased by 0.34 points, whereas in the non-fatigue group it increased by 0.23 points. The difference for change between groups was significant (p = 0.003), but a covariate analysis showed that this was strongly affected by a decrease in depression. Fatigue varied greatly from day-to-day. The lowest FVAS coefficient of variation per patient was 9% and the highest 131%.
Conclusion. Inpatient rehabilitation decreases MS patients' fatigue. This effect seems to be modified by an improvement in mood.
This books contains papers written on issues related to externally mandated mathematics tests and their influence on school mathematics. Chapter 1 presents an overview of the book, including brief ...abstracts of each chapter. Chapter 2 presents a summary of the overall problems associated with the need for valid information. Remaining chapters include: (3) Implications of the National Council of Teachers of Mathematics (NCTM) Standards for Mathematics Assessment (Norman Webb & Thomas A. Romberg); (4) Curriculum and Test Alignment (Thomas A. Romberg, and others); (5) State Assessment Test Development Procedures (James Braswell); (6) Test Development Profile of a State-Mandated Large-Scale Assessment Instrument in Mathematics (Tej Pandey); (7) Assessing Students' Learning in Courses Using Graphics Tools: A Preliminary Research Agenda (Sharon L. Senk); (8) Mathematics Testing with Calculators; Ransoming the Hostages (John G. Harvey); (9) Gender Differences in Test Taking: A Review (Margaret R. Meyer); (10) Communication and the Learning of Mathematics (David Clarke, and others); (11) Measuring Levels of Mathematical Understanding (Mark Wilson); (12) A Framework for the California Assessment Program to Report Students' Achievement in Mathematics (E. Anne Zarinnia & Thomas A. Romberg); (13) Evaluation--Some Other Perspectives (Phillip C. Clarkson). A reference list organized by chapter contains 300 citations. Appendices include the NCTM Evaluation Standards, a classification matrix, illustrative questions, history and rationale for student mathematics journals, SMP Project student log sample pages, and the report of Vermont's Mathematics Portfolio Assessment Program. (MKR)
This volume is concerned with the alignment between the way the mathematical performance of students is assessed and the reform agenda in school mathematics. The chapters in this book have been ...prepared to raise a set of issues that scholars are addressing during this period of transition from traditional schooling practices toward the reform vision of school mathematics. Chapters are: (1) "Issues Related to the Development of an Authentic Assessment System for School Mathematics" (T. A. Romberg and L. D. Wilson), (2) "A Framework for Authentic Assessment in Mathematics" (S. P. Lajoie), (3) "Sources of Assessment Information for Instructional Guidance in Mathematics" (E. A. Silver and P. A. Kenney), (4) "Assessment: No Change without Problems" (J. De Lange), (5) "The Invalidity of Standardized Testing for Measuring Mathematics Achievement" (R. E. Stake), (6) "Assessment Nets: An Alternative Approach to Assessment in Mathematics Achievement" (M. Wilson), and (7) "Connecting Visions of Authentic Assessment to the Realities of Educational Practice (M. E. Graue). Subject and author indexes are provided, and references are listed with each chapter. (MKR)
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