Discriminative ability of the original and short form of the Activities-specific Balance Confidence scale and its individual items for falls in people with multiple sclerosis

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

Associations of Raynaud's Phenomenon in Juvenile Onset Systemic Lupus Erythematosus

INTRODUCTION: Raynaud's phenomenon (RP) is associated with mild disease in adults with systemic lupus erythematosus (SLE). Although RP is more frequently reported in juvenile onset SLE (jSLE) clinical associations were not studied. We aimed to investigate whether the presence of RP is associated with clinical and serological features at onset and outcomes in children with SLE. METHODS: Medical charts of children diagnosed with jSLE were reviewed. The presence of RP was evaluated by the presence of patients reporting symptoms, and patients were compared according to the presence of RP. RESULTS: Among the 52 included patients, 13 (25.0%) displayed RP. The clinical and laboratory features did not significantly differ according to the presence of RP. However, positive anti-dsDNA (76.9% vs. 35.8%, p = 0.02), anti-RNP (53.8% vs. 17.9%, p = 0.02), and anti-centromere (23.0% vs. 2.5% p = 0.04) antibodies were more frequently observed in patients with RP than in those without. RP was not found to be associated with initial disease severity, flare rate, remission, or damage accrual. DISCUSSION AND CONCLUSION: RP was associated with certain serological features. However, RP was not strongly associated with clinical features. Moreover, neither disease severity nor disease outcomes differed according to the presence of RP in children with SLE

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Discriminative ability of the original and short form of the Activities-specific Balance Confidence scale and its individual items for falls in people with multiple sclerosis.

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

Cross-cultural adaptation and psychometric properties of the Turkish version of the Manual Ability Measure-36 (MAM-36) in people with multiple sclerosis

ObjectiveThe 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.MethodsThe 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.ResultsMAM-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.ConclusionThe Turkish version of MAM-36 has been found as a valid and reliable method for measuring upper limb function in pwMS

Cognitive profile of persons with newly diagnosed multiple sclerosis

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Restless legs syndrome and related factors in people with multiple sclerosis in Turkey

Objective Restless legs syndrome is one of the most reported sleep disorders in multiple sclerosis (MS). The study aims to investigate the possible factors related to the occurrence and severity of restless legs syndrome in persons with MS (pwMS) comparing with healthy controls. Methods This is a case-control study that included 447 pwMS and 57 healthy controls. Demographic and clinical data such as gender, age, duration of education, body mass index, marital status, disease duration, and MS type were recorded. Neurological disability was assessed by the Expanded Disability Status Scale. The Restless Legs Syndrome Rating Scale was used to assess the severity of restless legs syndrome. Results The prevalence of restless legs syndrome in pwMS was 133 (29.8%) and 3 (4.9%) in healthy controls (p 0.05). Patients with restless legs syndrome have more advanced age, longer disease duration, and higher Expanded Disability Status Scale scores than patients without restless legs syndrome (p 0.05). Conclusions This study has shown that the presence of restless legs syndrome is high in persons with MS compared to healthy controls. Advanced age, disease duration, and higher disability level could be related to the increased rate of restless legs syndrome in persons with MS, especially those with high-frequency symptoms

Comparison of early treatment response of ocrelizumab in relapsing and progressive multiple sclerosis patients on the basis of cognitive functions

Introduction: Ocrelizumab has been shown to be an effective treatment of both relapsing multiple sclerosis (RMS) and progressive multiple sclerosis (PMS). Aims: To evaluate cognitive function changes with ocrelizumab as a part of treatment effectiveness. Methods: The data of 28 RMS and 100 PMS (primary or secondary MS) was investigated in this prospective study. Cognitive performance was assessed using Brief International Cognitive Assessment in Multiple Sclerosis (BICAMS- SDMT; Symbol Digit Modalities Test; CVLT-II; California Verbal Learning Test second edition; BVMT-R; Brief Visuospatial Memory Test Revised) compared to healthy controls. Each test was done twice; before ocrelizumab initation and at the sixth month. The data was analyzed with Mann-Whitney U test. Results:. CVLT-II scores were significantly increased in progressive form, at month 6 according to baseline assessment (p&lt;0,05) but no significant difference was observed in relapsing form. When two forms were compared to each other, the improvement in CVLT-II scores was significantly different in PMS over RMS. No significant differences were observed between the baseline and at month 6 in term of SDMT, BVMT-R scores in both forms(p&gt;0.05). Conclusions: Ocrelizumab may improve verbal skills in PMS in early phase of treatment. This finding is worth studying in detail and encourages further research to determine its causes. Our data also confirm that there is no early cognitive impairment in relapsing MS under ocrelizumab treatment.</p