Funding Acknowledgements Type of funding sources: None. Background Frailty is accompanied by, or ... more Funding Acknowledgements Type of funding sources: None. Background Frailty is accompanied by, or can be caused by, a combination of several physical, psychosocial and cognitive problems, and is highly prevalent in older patients with cardiovascular disease (CVD). However, different frailty assessment batteries (e.g. Fried and Vigorito) remain to be compared in terms of prognosis, as well as the subcomponents within those batteries. Purpose To examine which frailty measurements contribute to the prediction of frailty in CVD patients, and prognosis, and thus should be executed in clinical settings. Methods In 133 CVD patients (mean age 78.1 ± 6.7 years) the presence of frailty was examined by the Fried criteria and compared with the outcome from the multi-component frailty assessment tool of Vigorito including the Mini Nutritional Assessment (MNA), Katz-scale, 4.6 m gait speed, Timed Up and Go Test (TUG), handgrip strength, Mini Mental State Examination (MMSE), Geriatric Depression Sc...
Physical exercise is accepted as an effective treatment method to improve muscle strength, physic... more Physical exercise is accepted as an effective treatment method to improve muscle strength, physical fitness, and walking capacity. Evidence is robust for standardized endurance and resistance training programs in ambulatory persons with relapsing remitting multiple sclerosis (MS), with indications of beneficial effects in progressive type of MS. However, few studies have been performed in severely affected patients requiring at least unilateral support during walking. It is obviously more difficult to reach high-intensity training when motor dysfunction is pronounced and symptoms such as impaired balance and motor fatigability are present.1 The treatment potential and best modality in severely disabled patients are not yet established.
To conduct a placebo-controlled prospective study of the effectiveness of intrathecal bolus injec... more To conduct a placebo-controlled prospective study of the effectiveness of intrathecal bolus injections and continuous administration of baclofen on functional parameters in patients with severe spasticity of cerebral origin. To compare this functional evaluation with spasticity scores in different muscle groups. In 11 patients with spasticity of cerebral origin (mainly cerebral palsy), double-blind scoring of spasticity (Ashworth scale score and visual analog score), spasms, pain, and functional abilities was performed during tests with bolus injections including a placebo control. Eight patients were considered good responders and received a subcutaneous device for intrathecal drug delivery. Six of these patients were followed up for 2 years, during which they underwent the same scoring procedures as after their bolus injections. These patients were subjected to a blinded dose reduction test. There was a noticeable placebo effect on spasticity scores during tests with bolus injections. Eight patients demonstrated a significant beneficial effect of intrathecal bolus injections compared with this placebo effect. Functional improvements were noted in most patients. During continuous infusion, Ashworth scale scores were less favorable but still significantly lower than at baseline. Subjective evaluation (visual analog scores) remained positive, functional improvements were maintained, and patient comfort was invariably and significantly improved. Intrathecal administration of baclofen is a safe and effective treatment for spasticity of cerebral origin. Functional improvement was demonstrated. The presence of a placebo effect on the spasticity scores suggests the need for double-blind screening in each patient.
To investigate whether driving performance is impaired in persons with mild to moderate multiple ... more To investigate whether driving performance is impaired in persons with mild to moderate multiple sclerosis (MS). This study included 15 persons with MS (pwMS) and 17 healthy controls. The MS group exhibited mild to moderate impairments on the Expanded Disability Status Scale (median, Q1-Q3; 3.5, 2.5-4). The driving simulation required participants to drive in daily traffic while attending to a divided attention (DA) task. Computerized measures on the driving task included number of accidents, tickets, speed maintenance, standard deviation of lateral position, and time to collision. Response times and accuracy on the DA task were also computer generated. Additionally, pwMS completed a clinical evaluation encompassing motor, functional, visual, psychosocial and cognitive tests. No differences between healthy controls and pwMS were observed on all measures of the primary driving task. PwMS performed worse than healthy controls on DA response time (3.10 s, 2.87-3.68 versus 2.15 s, 2.04-2.43; p = 0.001) and accuracy (15 correct answers, 11-18 versus 24 correct answers, 22-25; p < 0.0001). Depression was significantly associated with time to collision (r = -0.77; p < 0.01). Subjects with mild to moderate MS are able to prioritize the driving task above the DA task. The relationship between depression and driving performance in MS merits further investigation.
The objectives of this study were to assess the prevalence of temporomandibular disorders (TMDs) ... more The objectives of this study were to assess the prevalence of temporomandibular disorders (TMDs) in patients with relapsing-remitting multiple sclerosis (MS) and to investigate whether an association exists between the presence of TMD symptoms and the degree of MS-related disability. In all, 120 individuals were evaluated: 60 patients with a diagnosis of relapsing-remitting MS and 60 age- and sex-matched controls without neurological impairments. A questionnaire recommended by the European Academy of Craniomandibular Disorders for the assessment of TMD symptoms was administered. For those who answered affirmatively to at least one of the questions, the RDC/TMD Axis I instrument was used for a possible classification of TMD subtypes. The Expanded Disability Status Scale (EDSS) was the measure of the degree of MS-related disability. Fisher's exact test was used to analyze the data. ANOVA was used to detect significant differences between means and to assess whether the factors inf...
The Multiple Sclerosis Outcome Assessments Consortium (MSOAC) was formed by the National MS Socie... more The Multiple Sclerosis Outcome Assessments Consortium (MSOAC) was formed by the National MS Society to develop improved measures of multiple sclerosis (MS)-related disability. (1) To assess the current literature and available data on functional performance outcome measures (PerfOs) and (2) to determine suitability of using PerfOs to quantify MS disability in MS clinical trials. (1) Identify disability dimensions common in MS; (2) conduct a comprehensive literature review of measures for those dimensions; (3) develop an MS Clinical Data Interchange Standards Consortium (CDISC) data standard; (4) create a database of standardized, pooled clinical trial data; (5) analyze the pooled data to assess psychometric properties of candidate measures; and (6) work with regulatory agencies to use the measures as primary or secondary outcomes in MS clinical trials. Considerable data exist supporting measures of the functional domains ambulation, manual dexterity, vision, and cognition. A CDISC s...
European journal of physical and rehabilitation medicine, Jan 2, 2014
Patients with progressive multiple sclerosis (MS) have been attributed greater walking disability... more Patients with progressive multiple sclerosis (MS) have been attributed greater walking disability than relapsing--remitting MS (RRMS) patients but quantitative data on walking speed and ability are lacking. to investigate the impact of type of MS on severity of reduced walking ability and capacity taking into account age, sex, height and disease duration. cross--sectional observational multi--center study SETTING: European MS centers providing either in-- or out--patient services, or both. This study included 502 patients: 259, 162 and 81 patients showed RRMS, secondary and primary progressive MS respectively. Walking was evaluated by T25FW, six minute walk test and MS--Walking Scale--12. Patient characteristics were compared using a one--way ANOVA, and simple and multivariate regression analysis were applied with the walking measures. In adjusted (sex, age, weight, height and disease duration) analyses, walking impairments were more than 20% greater in progressive types of MS compa...
Funding Acknowledgements Type of funding sources: None. Background Frailty is accompanied by, or ... more Funding Acknowledgements Type of funding sources: None. Background Frailty is accompanied by, or can be caused by, a combination of several physical, psychosocial and cognitive problems, and is highly prevalent in older patients with cardiovascular disease (CVD). However, different frailty assessment batteries (e.g. Fried and Vigorito) remain to be compared in terms of prognosis, as well as the subcomponents within those batteries. Purpose To examine which frailty measurements contribute to the prediction of frailty in CVD patients, and prognosis, and thus should be executed in clinical settings. Methods In 133 CVD patients (mean age 78.1 ± 6.7 years) the presence of frailty was examined by the Fried criteria and compared with the outcome from the multi-component frailty assessment tool of Vigorito including the Mini Nutritional Assessment (MNA), Katz-scale, 4.6 m gait speed, Timed Up and Go Test (TUG), handgrip strength, Mini Mental State Examination (MMSE), Geriatric Depression Sc...
Physical exercise is accepted as an effective treatment method to improve muscle strength, physic... more Physical exercise is accepted as an effective treatment method to improve muscle strength, physical fitness, and walking capacity. Evidence is robust for standardized endurance and resistance training programs in ambulatory persons with relapsing remitting multiple sclerosis (MS), with indications of beneficial effects in progressive type of MS. However, few studies have been performed in severely affected patients requiring at least unilateral support during walking. It is obviously more difficult to reach high-intensity training when motor dysfunction is pronounced and symptoms such as impaired balance and motor fatigability are present.1 The treatment potential and best modality in severely disabled patients are not yet established.
To conduct a placebo-controlled prospective study of the effectiveness of intrathecal bolus injec... more To conduct a placebo-controlled prospective study of the effectiveness of intrathecal bolus injections and continuous administration of baclofen on functional parameters in patients with severe spasticity of cerebral origin. To compare this functional evaluation with spasticity scores in different muscle groups. In 11 patients with spasticity of cerebral origin (mainly cerebral palsy), double-blind scoring of spasticity (Ashworth scale score and visual analog score), spasms, pain, and functional abilities was performed during tests with bolus injections including a placebo control. Eight patients were considered good responders and received a subcutaneous device for intrathecal drug delivery. Six of these patients were followed up for 2 years, during which they underwent the same scoring procedures as after their bolus injections. These patients were subjected to a blinded dose reduction test. There was a noticeable placebo effect on spasticity scores during tests with bolus injections. Eight patients demonstrated a significant beneficial effect of intrathecal bolus injections compared with this placebo effect. Functional improvements were noted in most patients. During continuous infusion, Ashworth scale scores were less favorable but still significantly lower than at baseline. Subjective evaluation (visual analog scores) remained positive, functional improvements were maintained, and patient comfort was invariably and significantly improved. Intrathecal administration of baclofen is a safe and effective treatment for spasticity of cerebral origin. Functional improvement was demonstrated. The presence of a placebo effect on the spasticity scores suggests the need for double-blind screening in each patient.
To investigate whether driving performance is impaired in persons with mild to moderate multiple ... more To investigate whether driving performance is impaired in persons with mild to moderate multiple sclerosis (MS). This study included 15 persons with MS (pwMS) and 17 healthy controls. The MS group exhibited mild to moderate impairments on the Expanded Disability Status Scale (median, Q1-Q3; 3.5, 2.5-4). The driving simulation required participants to drive in daily traffic while attending to a divided attention (DA) task. Computerized measures on the driving task included number of accidents, tickets, speed maintenance, standard deviation of lateral position, and time to collision. Response times and accuracy on the DA task were also computer generated. Additionally, pwMS completed a clinical evaluation encompassing motor, functional, visual, psychosocial and cognitive tests. No differences between healthy controls and pwMS were observed on all measures of the primary driving task. PwMS performed worse than healthy controls on DA response time (3.10 s, 2.87-3.68 versus 2.15 s, 2.04-2.43; p = 0.001) and accuracy (15 correct answers, 11-18 versus 24 correct answers, 22-25; p < 0.0001). Depression was significantly associated with time to collision (r = -0.77; p < 0.01). Subjects with mild to moderate MS are able to prioritize the driving task above the DA task. The relationship between depression and driving performance in MS merits further investigation.
The objectives of this study were to assess the prevalence of temporomandibular disorders (TMDs) ... more The objectives of this study were to assess the prevalence of temporomandibular disorders (TMDs) in patients with relapsing-remitting multiple sclerosis (MS) and to investigate whether an association exists between the presence of TMD symptoms and the degree of MS-related disability. In all, 120 individuals were evaluated: 60 patients with a diagnosis of relapsing-remitting MS and 60 age- and sex-matched controls without neurological impairments. A questionnaire recommended by the European Academy of Craniomandibular Disorders for the assessment of TMD symptoms was administered. For those who answered affirmatively to at least one of the questions, the RDC/TMD Axis I instrument was used for a possible classification of TMD subtypes. The Expanded Disability Status Scale (EDSS) was the measure of the degree of MS-related disability. Fisher's exact test was used to analyze the data. ANOVA was used to detect significant differences between means and to assess whether the factors inf...
The Multiple Sclerosis Outcome Assessments Consortium (MSOAC) was formed by the National MS Socie... more The Multiple Sclerosis Outcome Assessments Consortium (MSOAC) was formed by the National MS Society to develop improved measures of multiple sclerosis (MS)-related disability. (1) To assess the current literature and available data on functional performance outcome measures (PerfOs) and (2) to determine suitability of using PerfOs to quantify MS disability in MS clinical trials. (1) Identify disability dimensions common in MS; (2) conduct a comprehensive literature review of measures for those dimensions; (3) develop an MS Clinical Data Interchange Standards Consortium (CDISC) data standard; (4) create a database of standardized, pooled clinical trial data; (5) analyze the pooled data to assess psychometric properties of candidate measures; and (6) work with regulatory agencies to use the measures as primary or secondary outcomes in MS clinical trials. Considerable data exist supporting measures of the functional domains ambulation, manual dexterity, vision, and cognition. A CDISC s...
European journal of physical and rehabilitation medicine, Jan 2, 2014
Patients with progressive multiple sclerosis (MS) have been attributed greater walking disability... more Patients with progressive multiple sclerosis (MS) have been attributed greater walking disability than relapsing--remitting MS (RRMS) patients but quantitative data on walking speed and ability are lacking. to investigate the impact of type of MS on severity of reduced walking ability and capacity taking into account age, sex, height and disease duration. cross--sectional observational multi--center study SETTING: European MS centers providing either in-- or out--patient services, or both. This study included 502 patients: 259, 162 and 81 patients showed RRMS, secondary and primary progressive MS respectively. Walking was evaluated by T25FW, six minute walk test and MS--Walking Scale--12. Patient characteristics were compared using a one--way ANOVA, and simple and multivariate regression analysis were applied with the walking measures. In adjusted (sex, age, weight, height and disease duration) analyses, walking impairments were more than 20% greater in progressive types of MS compa...
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