Confirmation of the accuracy of a short battery to predict fitness-to-drive of stroke survivors without severe deficits

Objective: The aim of this prospective study was to confirm the accuracy of a short assessment battery, used previously in a study to predict fitness-to-drive after stroke, in a new cohort of stroke survivors without severe deficits. Design: A prospective study. Subjects: A total of 43 (39 men and 4 women) consecutive survivors after stroke who were not severely impaired and who performed the pre-driving assessment, which included a standardized on-road test at the Belgian Road Safety Institute in Brussels, Belgium. On average, participants were 6 months post-stroke, independently ambulant with or without assistive devices, possessed valid drivers’ licenses and actively drove prior to stroke onset. Methods: Fitness-to-drive decisions based on performance in 15 tests of a full-scale assessment battery were predicted using only the scores from the 3 predictive tests previously identified. Results: When the discriminant equation from the previous study including performance in the 3 tests (figure of Rey, visual neglect (lateralized mean reaction time) and on-road test) was applied, 37 (86%) of the 43 participants were correctly predicted to pass or fail the pre-driving assessment. The sensitivity and specificity of the predictions were 77% and 92%, respectively. Conclusion: This study shows that the short assessment battery is a good predictor of fitness-to-drive in stroke survivors with moderate physical and cognitive impairments

Association between frailty and free-living walking performance in people with multiple sclerosis

OBJECTIVE: The purpose of this study was to examine the association between frailty and the quantity and quality of free-living walking and the mediating effect of frailty on the relationship between disability and walking performance in people with multiple sclerosis (MS). METHODS: Ninety-nine people with relapsing–remitting MS (mean age = 49.3 [SD = 9.8] y; 73.7% women; Expanded Disability Status Scale score range = 2.0–6.0) wore a triaxial accelerometer for 7 days. Recorded measures reflected the quantity (daily step counts, number of 30-second walking bouts, and signal vector magnitude) and quality (gait speed, step cadence, step and stride regularity, and sample entropy) of walking. For each walking quality measure, the typical (median), best (90th percentile), and worst (10th percentile) values were calculated. Frailty was evaluated through a 38-item frailty index. RESULTS: Participants were classified as not frail (n = 31), moderately frail (n = 34), and severely frail (n = 34) on the basis of established procedures. Patients who were moderately and severely frail exhibited poorer performance in all measures of walking quantity and quality, except for sample entropy, than individuals who were not frail. No differences in free-living walking performance were observed between the moderately and severely frail groups. Frailty did not mediate the relationship between disability (Expanded Disability Status Scale) and measures of walking quality. Conversely, frailty had a significant mediating effect on the relationship between disability and measures of walking quantity, such as daily step counts (indirect effect: b = −220.42, 95% CI = −452.03 to −19.65) and signal vector magnitude (indirect effect: b = −1.00, 95% CI = −1.86 to −0.30). CONCLUSIONS: Frailty is associated with poorer free-living walking performance in people with MS. The study findings suggest that frailty, rather than disability, may be primarily responsible for the lower amount of physical activity performed by people with MS in the real world. IMPACT: The observation that frailty and disability are differently related to measures of walking quality and quantity underscores the importance of a targeted approach to rehabilitation in people with MS

Frailty and falls in people living with multiple sclerosis

OBJECTIVE: To explore the association between frailty and history of falls in people living with multiple sclerosis (MS). DESIGN: Secondary analysis. SETTING: University research laboratories in the United States and Israel. PARTICIPANTS: 118 people with relapsing-remitting MS [age=48.9 years (SD=10.0); 74.6% female; expanded disability status scale (EDSS) range=1.0-6.0] were studied in this cross-sectional analysis. INTERVENTION: Not applicable. MAIN OUTCOMES: A frailty index was calculated from 40 health deficits by following standard validated procedures. The number of falls (12-month history) was recorded. RESULTS: Overall, 33.9%, 29.7%, and 36.4% of participants were classified as non-frail, moderately frail, and severely frail, respectively. The frailty index was significantly correlated (ρ=0.37, p<0.001) with higher scores on the EDSS. In univariable negative binomial regression analysis, the frailty index was associated with a higher number of falls (IRR=3.33, 95%CI[1.85-5.99], p<0.001). After adjustment for age, gender and EDSS, frailty remained strongly associated with history of falls (IRR=2.78, 95%CI[1.51-5.10], p=0.001). CONCLUSION: The current study identifies a significant relationship between frailty and history of falls in MS, independent of age, gender, and disease severity. These findings support the notion that frailty is a syndrome related to, but independent of, disability in MS