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.
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.
Specific rehabilitation of patients with amputated lower limbs is first of all rehabilitation to walk with a prosthesis (artificial limb). After 20 years of practice of prosthetic early fitting for ...lower limbs amputees using practice prosthesis, the authors suggest that this technique is still up-to-date. The taking charge of amputated patients by a specialised team is an important element if one wants to achieve a good functional result. A rehabilitation milieu, where the new amputee is with a large number of patients with the same pathology, also constitutes a framework that is reassuring as well as stimulating and allows the patient to imagine the situation in which he/she can find himself/herself a few weeks later.
Listeriosis is a rare disease caused by the bacterium Listeria monocytogenes and mainly affects at risk people. Listeriosis can lead to sepsis, central nervous system (CNS) infections and death. The ...objectives of this study were to describe and quantify comorbidities and neurological sequelae underlying non-perinatal listeriosis cases and to describe the factors associated with death and CNS infections in non-perinatal listeriosis.
We retrospectively collected clinical data through computerized, paper or microfilmed medical records in two Belgian university hospitals. Logistic regression models and likelihood ratio tests allowed identifying factors associated with death and CNS infections.
Sixty-four cases of non-perinatal listeriosis were included in the clinical case series and 84 % were affected by at least one comorbid condition. The main comorbidities were cancer, renal and severe cardio-vascular diseases. Twenty-nine patients (45 %) suffered from a CNS infection and 14 patients (22 %) died during hospitalization, among whom six (43 %) had a CNS involvement. Among surviving patients, eleven suffered from neurological sequelae (22 %) at hospital discharge; all had CNS infection. Five of these patients (45 %) still suffered of their neurological sequelae after a median follow-up of one year (range: 0.08-19). The factor associated with death during the hospitalization was the presence of a severe cardiovascular disease (OR = 4.72, p = 0.015). Two factors inversely related with CNS infections were antibiotic monotherapy (OR = 0.28, p = 0.04) and the presence of renal disease (OR = 0.18, p = 0.02).
In a public health context these results could be a starting point for future burden of listeriosis studies taking into account comorbidity.
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