Predicting falls among patients with multiple sclerosis:Comparison of patient-reported outcomes and performance-based measures of lower extremity functions

Background Accurate fall screening tools are needed to identify those multiple sclerosis (MS) patients at high risk of falling. The present study aimed at determining the validity of a series of performance-based measures (PBMs) of lower extremity functions and patient-reported outcomes (PROs) in predicting falls in a sample of MS patients (n = 84), who were ambulatory independent. Methods Patients were assessed using the following PBMs: timed up and go (TUG), timed 25-foot walk (T25FW), cognitive T25FW, 2-min walk (2MW), and cognitive 2MW. Moreover, a series of valid and reliable PROs were filled in by participants including the activities-specific balance confidence (ABC), 12-item multiple sclerosis walking scale (MSWS-12), fall efficacy scale international (FES-I), and modified fatigue impact scale (MFIS). The dual task cost (DTC) of 2MW and T25FW tests were calculated as a percentage of change in parameters from single to dual task conditions. Participants were classified as none-fallers and fallers (⩾1) based on their prospective fall occurrence. Results In the present study, 41(49%) participants recorded ≥ 1 fall and were classified as fallers. The results of logistic regression analysis revealed that each individual test, except DTC of 2MW and T25FW, significantly predicted future falls. However, considering the area under the curves (AUCs), PROs were more accurate compared to PBMs. In addition, the results of multiple logistic regression with the first two factors extracted from principal component analysis revealed that both factor 1 (PROs) and factor 2 (PBMs) significantly predicted falls with a greater odds ratio (OR) for factor 1 (factor 1: P = <0.0001, OR = 63.41 (6.72–597.90)) than factor 2 (P <0.05, OR = 5.03 (1.33–18.99)). Conclusions The results of this study can be used by clinicians to identify and monitor potential fallers in MS patients

Correlation between Acoustic Parameters and Disease Severity and Duration in Patients with Multiple Sclerosis

Background: Since in multiple sclerosis (MS), changes in speech and voice quality often precede other signs and symptoms; early diagnosis of these changes is necessary. In this study, an acoustic examination of phonation subsystem was performed. Due to the progressive nature of multiple sclerosis, the aim of this study was to examine the correlation between acoustic parameters of voice quality and disease severity and duration. Methods: This descriptive-analytic study was performed on 43 patients with multiple sclerosis. The disease severity was detected by a neurologist based on the Expanded Disability Status Scale (EDSS) for each patient. Acoustic analysis was performed during the production of sustained vowel /a/ and accordingly, the maximum phonation time (MPT), perturbation of the frequency (jitter), perturbation of amplitude (shimmer), the maximum and minimum frequency, and the highest and lowest intensity were evaluated. All the acoustic analyses were performed using PRAAT software. Data were statistically analyzed using Spearman's correlation coefficient by SPSS version 21. Results: The lowest intensity showed a significant correlation with disease severity (P=0.00). Also, the highest and lowest intensity showed a significant correlation with disease duration (P=0.022 and P=0.002). Conclusion: One of the earlier symptoms of central nervous system impairment resulting from multiple sclerosis is changes in phonation subsystem and voice quality. These changes may appear at any clinical stages; however, the symptoms might get worse over time, with the progression of the disease. Therefore, immediate acoustic assessments and interventions can prevent more degradation of voice quality

Acute Responses of Cytokines and Adipokines to Aerobic Exercise in Relapsing vs. Remitting Women with Multiple Sclerosis

Objective: To examine the acute effect of exercise on cytokines and adipokines during relapse and the remitting phase of multiple sclerosis (MS). Methods: Thirty women with MS in the relapsing or remitting phase were matched with fifteen healthy controls. Participants performed a single-bout of aerobic exercise at 60-70% maximal heart rate. Furthermore, five women in the relapsing phase were enrolled (control relapse) and did not receive any intervention. Blood samples were taken before, immediately after, 1-hour and 6-hours after the exercise. Results: Levels of IL-10 and TNF-α in response to exercise were similar in healthy and MS remitting subjects. Compared to baseline, TNF-α levels in relapsing subjects were significantly decreased immediately after exercise. Immediately following exercise, leptin levels significantly decreased in relapsing subjects. Adiponectin and IL-6 showed no significant difference between groups. Conclusion: After relapse, exercise does not induce inflammatory cytokine response and temporarily improves both cytokine and adipokine balance

The Effectiveness of Mindfulness-based Stress Reduction on Sleep Quality in Patients With Multiple Sclerosis

Background: Poor sleep quality (SQ) is a common problem in patients with multiple sclerosis (MS), which may reduce the quality of life and mood state and cause neuropsychological issues.  Objectives: This study aimed to investigate the effectiveness of mindfulness-based stress reduction (MBSR) on the SQ in women who suffer from MS.  Materials & Methods: From the patients with MS diagnosed by neurologists, 48 were selected by convenient sampling and randomly assigned to MBSR and control groups. The participants of two groups filled out the Pittsburgh sleep quality questionnaire as a pre-test, 8 weeks later as a post-test, and 1 month later as a follow-up. The MBSR group received 8 sessions of group therapy, while the control group did not receive any psychotherapy. The data were analyzed using variance analysis.   Results: The results showed that the SQ of the MBSR group improved in all aspects significantly (P<0.01).  Conclusion: Mindfulness-based stress reduction is helpful for improving the SQ in patients with MS