Abstracts: 23rd Annual RIMS Conference 2018

2018 Multiple Sclerosis  
Approximately 90% of people with Multiple Sclerosis (pwMS) own a mobile phone to communicate, retrieve health-related information and interact with MS health care services. The use of a smartphone involves a cognitive load on the working memory and requires physical resources to manipulate the device. This represents a source of distraction and hazard when pwMS are simultaneously engaged in other tasks like walking. Aims: To assess the effect of texting on a smartphone on spatialtemporal
more » ... ers of gait objectively assessed by means of inertial sensors. Methods: Forty-five pwMS (low disability EDSS 1-2.5, n=23, moderate disability EDSS 3-6, n=22) and 17 healthy controls were tested under two conditions: 1) walking along a 20m straight path 2) same as 1) while texting on a smartphone with a dedicated application previously employed in similar studies. Stride length, gait speed, cadence, stance, swing and double support phase were calculated. A two-way RM-ANOVA was performed to investigate differences associated with the presence of the disease and the performed task. Results: Significant effects of task and group were found for speed, stride length and cadence (p<0.001) while significant task x group interactions were detected only for speed and stride length. Healthy individuals and low-disability pwMS seems to give higher priority to texting, while individuals with moderate disability privilege walking. This results in larger speed and stride length reduction in controls and pwMS with low disability in "texting+walking" condition (-30% speed, -15% stride length) with respect to pwMS with moderate disability (-20% speed, -5% stride length). Conclusions: The smaller changes in speed and stride length found in pwMS with higher disability during the dual-task, seem to indicate that MS might induce a prioritization towards the motor task, probably due to a protective mechanisms which take into account the motor and sensory impairments associated with the disease. Background: it is known that Multiple Sclerosis (MS) affects men and women differently in terms of prevalence, cognitive impairments, disability accumulation, and overall risk of a poorer prognosis. However sex-related issues still remain partly unexplored. For instance, although walking impairments represent a common feature in MS and thus have been extensively investigated, it is unknown whether men and women with MS exhibit different gait patterns. Aims: to assess the existence of possible sex-related differences in terms of spatio-temporal and kinematic parameters of gait in people with with MS (pwMS) using computerized three-dimensional gait analysis Methods: Sixty pwMS (32F, 28M) stratified in two groups (low disability, EDSS 1-3, n = 28, mild-moderate disability EDSS 3.5-5.5, n = 32) underwent a computerized 3D gait analysis performed using a motion-capture system composed of 8 infrared cameras. Trend of flexion-extension and dorsi-plantar-flexion at hip, knee and ankle joints were calculated together with main spatial-temporal parameters. One-way ANOVA was performed to investigate differences associated with sex on all variables of interest. Results: When normalized considering individuals' anthropometry, no significant differences were found between men and women with MS in speed, stride length, cadence and stance/swing phase's duration. In contrast, men exhibited significantly reduced ankle plantar-flexion at the terminal stance/initial swing, increased knee flexion at initial contact and increased hip flexion at initialmid stance and terminal swing with respect to women. However, when analyzed according to their disability level, some changes become either more evident (hip joint) or tend to disappear (ankle joint) as the disease progresses. Conclusions: The obtained results suggest that it is crucial to investigate gait dysfunctions in pwMS without neglecting their sex. Such an approach may be useful not only in better understanding the pathophysiology of gait disturbances originated by MS, but also in supporting a better orientation of rehabilitative treatments. Abstracts: 23rd Annual RIMS Conference 2018 Abstracts Multiple Sclerosis Journal 2018; 838-881 RIMS Abstracts 839 Multiple Sclerosis Journal 2018; 838-881 journals.sagepub.com/home/msj Background: To develop and implement effective fall prevention interventions for people with multiple sclerosis (PwMS) who are full-time wheelchair users, a deeper understanding of the circumstances surrounding falls among these individuals is needed. This study explored circumstances of falls among full-time wheelchair users with MS. Methods: A mixed method approach was used to explore circumstances of falls of 18 full-time wheelchair users with MS. In addition to collecting participants' demographic information (age, gender, type of wheelchair used, duration of wheelchair use, and duration of disability), self-reported fall frequency in the past 6 months, fear of falling and activity restriction due to fear of falling was collected. Qualitative data in the form of participants' responses to an open-ended question yielding information regarding the circumstances of the most recent fall were also collected. Qualitative data were analyzed via thematic analysis. Results: Among study participants 72% were female. Participants' mean age was 56 years; their mean length of MS duration and duration of wheelchair use was 20 years and 6 years, respectively. The median number of falls in the past six months was 3, and 83% reported fear of falling. Among the participants reporting fear of falling, 78% reported restriction in activity. Analysis of the participants' descriptions of the circumstances of their most recent falls resulted in three main categories: action-related fall contributors (e.g., transfer, wheelchair propulsion, reaching), (2) location of falls (e.g., bathroom, bedroom, living room, garage, garden), and (3) fall attributions, which were further categorized as intrinsic (e.g., distraction, muscle weakness, losing balance) and extrinsic (e.g. surface condition, equipment failure). Conclusion: Results reveal the diverse nature of fall circumstances among PwMS who are full-time wheelchair users. Findings will inform the development of an intervention to support full-time wheelchair users with MS in their fall prevention efforts. Background: Scientific evidence suggests that regular physical activity in people with multiple sclerosis (PwMS) has beneficial effects. The objective of this prospective randomized clinical trial was to investigate the effects of outdoor physical activity program supplemented with a health education on walking endurance, health-related quality of life, sleep quality, impact of fatigue and adherence to treatment in Spanish PwMS. Patients and Methods: Twenty-three PwMS were selected and randomly assigned to the Treatment (TG) or Control (CG) group. The TG completed a treatment program supervised by a physiotherapist and a nurse both specialized in PwMS of 24 sessions of physical activity based on walking (twice a week, outdoors) and 4 group sessions of health education (empowerment and healthy lifestyle). The CG did not change his physical activity habits or receive any additional information. All participants were evaluated on an initial and final examination 12 weeks apart. The variables studied were walking endurance: Six Minutes Walking Test (6MWT), health-related quality of life (HRQL): Short-Form 36 scale (SF-36), sleep quality: Pittsburgh Sleep Quality Index (PSQI), fatigue impact: Fatigue Severity Scale (FSS) and attendance. In the case of the TG, a satisfaction questionnaire was administered. Results: The TG showed statistically significant results in walking endurance (6MWT: p = 0.000), HRQL (SF-36 vitality subscale: p = 0.011) and fatigue impact (FSS: p = 0.023). There were no significant changes in sleep quality (PSQI: p = 1,000). Adherence to the treatment was 14% higher than others offered by the Center and the satisfaction of the program was 9 points out of 10. Conclusions: The results suggest that a program of regular physical activity based on walking outdoors supplemented with professional advice to empower PwMS, increases walking endurance and vitality, contributes to the management of fatigue, increases adherence to treatment and it is perceived as very satisfactory. Introduction: External accreditation in smaller hospitals bears a higher relative cost. Contributing factors are the fixed cost for the survey process and a higher administrative burden. The achievability and desirability of external accreditation for smaller hospitals is open for discussion. Objectives: To achieve JCI accreditation as a rehabilitation hospital. Method: The National MS Center Melsbroek began its accreditation trajectory at the end of 2013. The administrative burden was decreased by involving people who are actually doing clinical work and by working bottom up. The NMSC used its position within its network to gain access to knowledge and cooperation with specialized personnel concerning JCI accreditation and quality improvement. This helped to formulate a clear path to 'constant survey readiness'. Results: In October 2017 the NMSC attained, as the first rehabilitation hospital within the BeNeLux, the JCI accreditation for hospitals. Discussion: We showed that it was possible for a smaller hospital to gain external accreditation, but the challenges of a higher relative cost and a higher administrative burden should be acknowledged. Strategies to handle these challenges should be explored before starting an accreditation trajectory. Preferably using the advantages of a small hospital as a key strategy. Quality projects and other engagement were formulated mostly bottom up due to the small scale of the hospital. This facilitates the implementation of quality of care standards for clinical practice. The multidisciplinary, patient-centered approach also reflected well. The surveying team stated to have seen an organization working together around a patient as one. The external accreditation was a learning moment for the organization. It considerably increased involvement of stakeholders and positive imaging of the center. Analyzing the impact of the accreditation on rehabilitation outcome will be an objective for the future.
doi:10.1177/1352458518771862 pmid:29790435 fatcat:kzlnivlhgrdfporx7bflirtclu