Mobility in Multiple Sclerosis Patients

Abstract

Multiple Sclerosis (MS) is a chronic autoimmune disease that is highly associated with gait limitations in people with MS (pwMS), and severely disabled patients are particularly affected. Currently, clinicians use objective and semi-objective rating scales to assess ambulation. These scales lack accuracy and sensitivity to real-world mobility changes and disease progression. As the disease progresses physical therapy interventions for mobility become more limited. This thesis aimed at providing new tools to improve walking assessment procedures, as well as providing physical therapy interventions for improving mobility in this population. This thesis comprises four studies: 1. A systematic review and meta-analysis examined the effects of physical therapy interventions on mobility in severe MS patients. Results indicated that robot assisted gait training (RAGT) improved walking endpoints except timed up and go (TUG). 2. We validated free-living walking measurements derived from a physical activity monitor (PAM) against standard mobility outcome assessments. In a cohort of 35 pwMS, the PAM was highly correlated with clinically validated measurements of mobility and endurance. This suggests that PAM could be a valuable clinical trial output. 3. An RCT examined remote ischemic preconditioning (RIPC) as an intervention to improve mobility in severe pwMS. RIPC for 6 weeks, (n=14) received intervention while(n=11) in sham group. Results showed that RIPC did not improve mobility nor PROMs in pwMS. 4. We studied the range of responses for the multiple sclerosis impact scale (MSIS) and multiple sclerosis walking scale (MSWS) in the general population without MS. Both PROMs scores of (n=198) were significantly affected by comorbidities, while the MSWS score was directly related to age. This thesis highlighted physical therapy interventions for severe MS patients, offering practical measures of real-world activity. Additionally, it explored factors affecting MSIS and MSWS scores in the general population. Future research and implications of these findings were discussed