BACKGROUND: Telerehabilitation is a practical option for individuals with multiple sclerosis (MS) to engage in sustained physical activity without -visiting a rehabilitation facility. The aim of this systematic review was to evaluate the feasibility, effectiveness, safety, and adherence of exercise-based telerehabilitation as compared with usual care for MS patients. METHODS: A comprehensive literature search adhering to PRISMA guidelines was conducted, focusing on studies published in English since 2000. The systematic review protocol was registered in PROSPERO. The selection process involved strict criteria, including studies focusing on people with MS, telerehabilitation centred on regular exercise, a control group receiving usual care, valid exercise testing, and adherence to randomized controlled trial principles. Methodological quality was assessed using the TESTEX tool, ensuring rigour in study design and reporting. RESULTS: Among the 281 records screened, 10 studies met the criteria. Telerehabilitation interventions varied in format and outcomes were assessed using diverse exercise tests and questionnaires. Despite variations, the studies collectively demonstrated promising feasibility and safety, with minimal withdrawals and minor adverse events. Effectiveness varied, with 5 out of 10 studies showing significant improvements in the intervention group. Adherence rates ranged from 38% to 100%. CONCLUSION: In most of the assessed aspects, telerehabilitation is comparable to regular centre-based rehabilitation.
- MeSH
- adherence pacienta MeSH
- cvičení * MeSH
- lidé MeSH
- roztroušená skleróza * rehabilitace MeSH
- telerehabilitace * MeSH
- terapie cvičením * metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- systematický přehled MeSH
BACKGROUND: In multiple sclerosis (MS), dysphagia is an important and common clinical symptom. Although often overlooked and underdiagnosed, it can have a significant impact on a patient's life, including social integration, and it can lead to malnutrition, aspiration pneumonia, and suffocation, i.e., life-threatening complications. Early detection of dysphagia is essential to prevent these risks. However, the optimal screening method and the inter-relationship between different methods used for dysphagia screening are not clear. The aim of this study was to compare the diagnostic performance of a simple question about swallowing problems, the DYsphagia in MUltiple Sclerosis (DYMUS) swallowing questionnaire, and the Timed Water Swallowing Test (TWST) to detect dysphagia in people with relapsing-remitting MS (RRMS). METHODS: Patients with MS were asked about subjective swallowing difficulties and, regardless of their response, completed the DYMUS questionnaire and underwent the TWST at their routine follow-up visit. Patients with at least one positive screening method were offered an objective assessment of swallowing function using the Fiberoptic Endoscopic Evaluation of Swallowing (FEES). The results were statistically analyzed and correlated with demographic and MS-related parameters. RESULTS: Of the 304 people with RRMS enrolled in the study, 46 (15.1 %) reported having subjective difficulty swallowing when asked a simple question. The DYMUS questionnaire was positive in 59 (19.4 %) of the 304 patients; 51 (16.8 %) had an abnormality on the TWST. A clear correlation (r = 0.351, p < 0.01) was found between the DYMUS and TWST results, but a significant proportion of patients (about half) had an abnormality on only one of these tests. The positivity of at least one of the screening methods used (DYMUS or TWST) had a better chance of identifying a patient with dysphagia than a simple question (p < 0.001). Of the patients with a positive result for difficulty swallowing, 37 underwent FEES, which confirmed dysphagia in 94.6% of this subgroup. Patients with higher Expanded Disability Status Scale (EDSS) scores, female gender, and older age were at higher risk of developing dysphagia. CONCLUSION: The DYMUS questionnaire and TWST had a confirmed potential to identify more patients with dysphagia than a simple question about swallowing problems. However, our study found only a partial overlap between DYMUS and TWST; a combination of these two methods was more sensitive in identifying patients with MS at risk of dysphagia. Furthermore, the screening showed excellent specificity: almost 95 % of the positively screened patients had dysphagia confirmed by objective methods. Age, female gender, and a higher EDSS score appear to be potential risk factors for dysphagia in patients with MS.
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
Background: Degenerative cervical spinal cord compression is becoming increasingly prevalent, yet the MRI criteria that define compression are vague, and vary between studies. This contribution addresses the detection of compression by means of the Spinal Cord Toolbox (SCT) and assesses the variability of the morphometric parameters extracted with it. Methods: Prospective cross-sectional study. Two types of MRI examination, 3 and 1.5 T, were performed on 66 healthy controls and 118 participants with cervical spinal cord compression. Morphometric parameters from 3T MRI obtained by Spinal Cord Toolbox (cross-sectional area, solidity, compressive ratio, torsion) were combined in multivariate logistic regression models with the outcome (binary dependent variable) being the presence of compression determined by two radiologists. Inter-trial (between 3 and 1.5 T) and inter-rater (three expert raters and SCT) variability of morphometric parameters were assessed in a subset of 35 controls and 30 participants with compression. Results: The logistic model combining compressive ratio, cross-sectional area, solidity, torsion and one binary indicator, whether or not the compression was set at level C6/7, demonstrated outstanding compression detection (area under curve =0.947). The single best cut-off for predicted probability calculated using a multiple regression equation was 0.451, with a sensitivity of 87.3% and a specificity of 90.2%. The inter-trial variability was better in Spinal Cord Toolbox (intraclass correlation coefficient was 0.858 for compressive ratio and 0.735 for cross-sectional area) compared to expert raters (mean coefficient for three expert raters was 0.722 for compressive ratio and 0.486 for cross-sectional area). The analysis of inter-rater variability demonstrated general agreement between SCT and three expert raters, as the correlations between SCT and raters were generally similar to those of the raters between one another. Conclusions: This study demonstrates successful semi-automated compression detection based on four parameters. The inter-trial variability of parameters established through two MRI examinations was conclusively better for Spinal Cord Toolbox compared with that of three experts' manual ratings.
- Publikační typ
- časopisecké články MeSH
- MeSH
- demyelinizační autoimunitní nemoci CNS * diagnóza terapie MeSH
- demyelinizační nemoci * diagnóza terapie MeSH
- diagnostické zobrazování metody MeSH
- dospělí MeSH
- lidé MeSH
- mozek patologie MeSH
- neurozobrazování metody MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- práce podpořená grantem MeSH
OBJECTIVE: Long-term physiotherapy is of considerable benefit to patients with multiple sclerosis (MS) who have motor dysfunction or gait impairment. The aim of this study was to determine the effectiveness of a 12-week intensive circuit class therapy for patients with MS, with a wider focus on fatigue and gait ability. METHODS: A total of 46 patients with relapsing-remitting MS were divided randomly into 2 groups: 23 patients (mean Expanded Disability Status Scale (EDSS) 2.33 ± 0.74) participated in an intensive 12-week course of intensive circuit class therapy, and 23 patients (mean EDSS 2.04 ± 0.63) served as a control group. The EDSS, Timed Up and Go (TUG) test and Four-Stage Balance Test (FSBT) made up the physical testing part, supplemented by questionnaires such as the Modified Fatigue Impact Scale (MFIS), 12-Item Multiple Sclerosis Walking Scale (MSWS-12), Beck Depression Inventory (BDI) and 36-Item Short Form Survey (SF-36). RESULTS: Significant improvements were found among intensive circuit class therapy-exercising patients in FSBT (p < 0.05), TUG test (p < 0.01), MFIS (p < 0.01), BDI (p < 0.05), MSWS-12 (p < 0.05) and the 3 subscales of SF-36 after 12 weeks of intensive circuit class therapy, while there were no significant changes in the control group. CONCLUSION: Intensive circuit class therapy is an effective therapeutic approach for improving gait and balance problems in patients with MS. It has also proved to alleviate fatigue and symptoms of depression.
BACKGROUND: Central neuropathic extremity pain (CNEP) is the most frequent type of pain in multiple sclerosis (MS). The aim of the present study was to evaluate sensory and pain modulation profiles in MS patients with CNEP. METHODS: In a single-centre observational study, a group of 56 CNEP MS patients was compared with 63 pain-free MS patients and with a sex- and age-adjusted control group. Standardized quantitative sensory testing (QST) and dynamic QST (dQST) protocols comprising temporal summation and conditioned pain modulation tests were used to compare sensory profiles. RESULTS: Loss-type QST abnormalities in both thermal and mechanical QST modalities prevailed in both MS subgroups and correlated significantly with higher degree of disability expressed as Expanded Disability Status Scale (EDSS). Comparison of sensory phenotypes disclosed a higher frequency of the 'sensory loss' prototypic sensory phenotype in the CNEP subgroup (30%) compared with pain-free MS patients (6%; p = .003). CONCLUSION: The role of aging process and higher lesion load in the spinothalamocortical pathway might be possible explanation for pain development in this particular 'deafferentation' subtype of central neuropathic pain in MS. We were unable to support the role of central sensitization or endogenous facilitatory and inhibitory mechanisms in the development of CNEP in MS. SIGNIFICANCE: This article presents higher prevalence of the 'sensory loss' prototypic sensory phenotype in multiple sclerosis patients with central extremity neuropathic pain compared to pain-free patients. Higher degree of disability underlines the possible role of higher lesion load in the somatosensory pathways in this particular 'deafferentation' type of central neuropathic pain.
Cíl: Potíže s chůzí jsou častým a závažným symptomem RS. Validovaný dotazník pro zhodnocení poruch chůze u pacientů s RS v českém jazykovém prostředí chybí. Cílem studie proto bylo vytvořit a validovat českou verzi dotazníku 12-Item Multiple Sclerosis Walking Scale (MSWS-12). Jedná se o jednoduchý anamnestický nástroj sestávající z 12 otázek. Materiál a metodika: Česká verze dotazníku MSWS-12 byla vytvořena metodou zpětného překladu a validována na souboru 50 pacientů s RS a 25 zdravých dobrovolníků. Dotazník byl administrován opakovaně s odstupem jednoho týdne za účelem hodnocení opakovatelnosti a reprodukovatelnosti. Chůze byla objektivně hodnocena pomocí testů Timed Up and Go (TUG) a Timed 25-Foot Walk (T25FW). Výsledky byly korelovány také s Expanded Disability Status Scale (EDSS) a Four-Stage Balance Test (FSBT). Výsledky: Skóre MSWS-12 dosáhlo u zdravých kontrol hodnot 12,4 ± 0,7 bodů. U pacientů s RS byly hodnoty významně vyšší (p < 0,001) a dosahovaly v průměru 24,0 ± 11,8 bodů. Hodnoty skóre MSWS-12 úzce korelovaly s objektivními testy chůze i disabilitou, tj. s TUG testem (r = 0,788; p < 0,001), T25FW testem (r = 0,878; p < 0,001), EDSS (r = 0,878; p < 0,001) i FSBT (r = 0,831; p < 0,001). Opakovatelnost MSWS-12 hodnocená pomocí Pearsonovy korelace byla vynikající (r = 0,96; p < 0,001). Hodnota Cronbachova alfa odrážející reprodukovatelnost dosáhla 0,983, což prokazuje vysokou vnitřní konzistenci dotazníku. Závěr: Česká verze dotazníku MSWS-12 prokázala velmi dobrou validitu v hodnocení poruch chůze u pacientů s RS a vynikající reprodukovatelnost a vnitřní konzistenci.
Aim: Walking difficulties are a common and serious symptom of MS. A validated questionnaire for the evaluation of gait disorders in patients with MS in the Czech language is missing. The aim of this study was to create and validate the Czech version of the 12-Item Multiple Sclerosis Walking Scale (MSWS-12) questionnaire, a simple anamnestic tool consisting of 12 questions. Materials and methods: The Czech version of the MSWS-12 questionnaire was created by the forward-backward translation method and validated in 50 MS patients and 25 healthy volunteers. The questionnaire was administered repeatedly one week apart to assess repeatability and reproducibility. Walking was objectively assessed using the Timed Up and Go (TUG) test and the 25 Foot Walk (T25FW) test. The results were correlated also with the Expanded Disability Status Scale (EDSS) and the Four-Stage Balance Test (FSBT). Results: Healthy controls scored 12.4 ± 0.7 points in the MSWS-12. In patients with MS, the values were significantly higher (P < 0.001) and reached 24.0 ± 11.8 points in average. The MSWS-12 score values closely correlated with walking tests and level of disability. i.e., the TUG test (r = 0.788; P < 0.001), T25FW test (r = 0.878; P < 0.001), EDSS (r = 0.878; P < 0.001), and FSBT (r = 0.831; P < 0.001). The repeatability assessed by Pearson´s correlation was 0.96 (P < 0.001). The reproducibility value of Cronbach’s alpha reached 0.983, which demonstrates the high internal consistency of the questionnaire. Conclusion: The Czech version of the MSWS-12 questionnaire showed very good validity in the evaluation of gait disorders in MS patients, and excellent reproducibility and internal consistency.
- MeSH
- lidé MeSH
- neurologické poruchy chůze * MeSH
- průzkumy a dotazníky MeSH
- reprodukovatelnost výsledků MeSH
- roztroušená skleróza * komplikace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
BACKGROUND AND PURPOSE: Non-myelopathic degenerative cervical spinal cord compression (NMDC) frequently occurs throughout aging and may progress to potentially irreversible degenerative cervical myelopathy (DCM). Whereas standard clinical magnetic resonance imaging (MRI) and electrophysiological measures assess compression severity and neurological dysfunction, respectively, underlying microstructural deficits still have to be established in NMDC and DCM patients. The study aims to establish tract-specific diffusion MRI markers of electrophysiological deficits to predict the progression of asymptomatic NMDC to symptomatic DCM. METHODS: High-resolution 3 T diffusion MRI was acquired for 103 NMDC and 21 DCM patients compared to 60 healthy controls to reveal diffusion alterations and relationships between tract-specific diffusion metrics and corresponding electrophysiological measures and compression severity. Relationship between the degree of DCM disability, assessed by the modified Japanese Orthopaedic Association scale, and tract-specific microstructural changes in DCM patients was also explored. RESULTS: The study identified diffusion-derived abnormalities in the gray matter, dorsal and lateral tracts congruent with trans-synaptic degeneration and demyelination in chronic degenerative spinal cord compression with more profound alterations in DCM than NMDC. Diffusion metrics were affected in the C3-6 area as well as above the compression level at C3 with more profound rostral deficits in DCM than NMDC. Alterations in lateral motor and dorsal sensory tracts correlated with motor and sensory evoked potentials, respectively, whereas electromyography outcomes corresponded with gray matter microstructure. DCM disability corresponded with microstructure alteration in lateral columns. CONCLUSIONS: Outcomes imply the necessity of high-resolution tract-specific diffusion MRI for monitoring degenerative spinal pathology in longitudinal studies.
- MeSH
- difuzní magnetická rezonance MeSH
- komprese míchy * diagnostické zobrazování MeSH
- krční obratle diagnostické zobrazování MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- mícha diagnostické zobrazování MeSH
- nemoci míchy * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Research Support, N.I.H., Extramural MeSH
