The assessment of depression in people with multiple sclerosis : a systematic review of psychometric validation studies

Background: The prevalence of depression in people with multiple sclerosis (PwMS) is high; however, symptoms common to both conditions makes measurement difficult. There is no high quality overview of validation studies to guide the choice of depression inventory for this population. Methods: A systematic review of studies validating the use of generic depression inventories in people with MS was conducted using MEDLINE and PsycINFO. Studies validating the use of depression inventories in PwMS and published in English were included; validation studies of tests for cognitive function and general mental health were excluded. Eligible studies were then quality assessed using the COSMIN checklist and findings synthesised narratively by instrument and validity domain. Results: Twenty-one studies (N=5,991 PwMS) evaluating 12 instruments were included in the review. Risk of bias varied greatly between instrument and validity domain. Conclusions: The review of validation studies was constrained by poor quality reporting and outcome reporting bias. Well-conducted evaluations of some instruments are unavailable for some validity domains. This systematic review provides an evidence base for trade-offs in the selection of an instrument for assessing self-reported symptoms of depression in research or clinical practice involving people with MS. We make detailed and specific recommendations for where further research is needed. Registration: PROSPERO CRD42014010597 Keywords Depression; Multiple Sclerosis; Reproducibility of Results; Psychometrics; Chronic Diseas

Shortening self-report mental health symptom measures through optimal test assembly methods: Development and validation of the Patient Health Questionnaire-Depression-4

The objective of this study was to develop and validate a short form of the Patient Health Questionnaire‐9 (PHQ‐9), a self‐report questionnaire for assessing depressive symptomatology, using objective criteria.SafeWork Australia; Lady Davis Institute ofMedical Research of the Jewish General Hospital; Inova Diagnostics Inc; Canadian Arthritis Network; Euroimmun; Alberta Health Services, the University of Calgary Faculty of Medicine, and the Hotchkiss Brain Institute; United States Department of Health and Human Services, Health Resources and Services Administration; Health Research Council of New Zealand; National Center for Research Resources; Australian National Health and Medical Research Council fellowship; United Kingdom National Health Service Lothian Neuro-Oncology Endowment Fund; National Institute ofMental Health, Grant/Award Numbers: K02MH65919, P30 DK50456, R24 MH071604, R24MH56858, R24MH071604, R34MH072925, R34MH08467

MICROPROCESSOR CONTROL FEATURES

The very Underlying Principle of Control for the Otto Bock Myoelectric System is “Muscle contraction should lead to function.” If you think about picking up an object with your sound hand, you simply pick up the object. An amputee must concentrate on more activities than that of an individual with a sound hand. If an amputee wears a prosthesis they must first open their hand, then position their hand over the object, then close their hand around the object and finally determine how much grip force should be applied to the object. With all of those things to consider, the relationship between their input signal (EMG) and the output of the hand (motor speed or grip force) must remain constant to minimize the learning curve. If the relationship is variable, the patient must relearn how to control the hand depending on the variables and thus control can be very unpredictable. The analogy is getting into someone’s car that just had a brake job done. You are used to putting high pressure on the pedal in your car in order to slow the car down so when you touch the pedal in the other car, it brakes very abruptly. You need to relearn the relationship between pedal pressure and braking speed. This is something we need to avoid in myoelectric fittings. Therefore, the microprocessor control in the Otto Bock system contains features to minimize the effects of outside influences

The effectiveness of Robot-Assisted Gait Training versus conventional therapy on mobility in severely disabled progressIve MultiplE sclerosis patients (RAGTIME): Study protocol for a randomized controlled trial

Background: Gait and mobility impairments affect the quality of life (QoL) of patients with progressive multiple sclerosis (MS). Robot-assisted gait training (RAGT) is an effective rehabilitative treatment but evidence of its superiority compared to other options is lacking. Furthermore, the response to rehabilitation is multidimensional, person-specific and possibly involves functional reorganization processes. The aims of this study are: (1) to test the effectiveness on gait speed, mobility, balance, fatigue and QoL of RAGT compared to conventional therapy (CT) in progressive MS and (2) to explore changes of clinical and circulating biomarkers of neural plasticity. Methods: This will be a parallel-group, randomized controlled trial design with the assessor blinded to the group allocation of participants. Ninety-eight (49 per arm) progressive MS patients (EDSS scale 6-7) will be randomly assigned to receive twelve 2-h training sessions over a 4-week period (three sessions/week) of either: (1) RAGT intervention on a robotic-driven gait orthosis (Lokomat, Hocoma, Switzerland). The training parameters (torque of the knee and hip drives, treadmill speed, body weight support) are set during the first session and progressively adjusted during training progression or (2) individual conventional physiotherapy focusing on over-ground walking training performed with the habitual walking device. The same assessors will perform outcome measurements at four time points: baseline (before the first intervention session); intermediate (after six training sessions); end of treatment (after the completion of 12 sessions); and follow-up (after 3 months from the end of the training program). The primary outcome is gait speed, assessed by the Timed 25-Foot Walk Test. We will also assess walking endurance, balance, depression, fatigue and QoL as well as instrumental laboratory markers (muscle metabolism, cerebral venous hemodynamics, cortical activation) and circulating laboratory markers (rare circulating cell populations pro and anti-inflammatory cytokines/chemokines, growth factors, neurotrophic factors, coagulation factors, other plasma proteins suggested by transcriptomic analysis and metabolic parameters). Discussion: The RAGT training is expected to improve mobility compared to the active control intervention in progressive MS. Unique to this study is the analysis of various potential markers of plasticity in relation with clinical outcomes. Trial registration: ClinicalTrials.gov, identifier: NCT02421731. Registered on 19 January 2015 (retrospectively registered)