Effects of a multimodal intervention on gait and balance of subjects with progressive multiple sclerosis: a prospective longitudinal pilot study

Figures & data

Table 1 Detectable mean change in outcome measures for sample size of n=20 at 0.05 significance level with 0.80 power

Variable	CV (%) or SD of change	Detectable change
TUG	46%	30%
First 10 feet walk speed during TUG (cm/s)	15.2	11.6
TUG–short step length (cm)	8.2	6.3
TUG–long step length (cm)	9.2	7.1
1/TUG step duration (step/s)	0.25	0.19
T25FW speed (cm/s)	13.4	10.3

Abbreviations: CV, coefficient of variation; SD, standard deviation; TUG, timed up and go; T25FW, timed 25-foot walk.

Figure 1 Flowchart of the screening, enrollment, and follow-up of participants in the study.

Source: Copyright ©2014. Dove Medical Press. Reproduced from Bisht B, Darling WG, Shivapour ET, et al. Multimodal intervention improves fatigue and quality of life of subjects with progressive multiple sclerosis: a pilot study. Degenerat Neurol Neuromuscul Dis. 2015;2015(5):19–35.²⁰

Abbreviations: S, subject; NMES, neuromuscular electrical stimulation; MS, multiple sclerosis.

Figure 2 Time to complete timed up and go test at baseline, 3, 6, 9, and 12 months of the entire cohort (n=20), responders (n=10) and nonresponders (n=10).

Note: Values are mean ± standard error.

Figure 3 Walking speed during 25-foot walk test at baseline, 3, 6, 9, and 12 months of the entire cohort (n=20), responders (n=10) and nonresponders (n=10).

Note: Values are mean ± standard error.
Abbreviation: TUG, timed up and go.

Figure 4 Speed to walk toward 10 feet mark during timed up and go test at baseline, 3, 6, 9, and 12 months of the entire cohort (n=20), responders (n=10) and nonresponders (n=10).

Notes: Values are mean ± standard error. ^*p=0.041, significant difference from baseline for entire cohort.

Table 2 Mean change (95% CI) at 6, 9, and 12 months (all subjects)

Variable	6 months	9 months	12 months
TUG	−11% (−32%, 17%)	−8% (−34%, 28%)	−0.6% (−31%, 47%)
First 10 feet walk speed during TUG (cm/s)	7.9 (0.3, 15.2)	9.4 (−1.8, 21.0)	5.5 (−4.9, 15.5)
TUG–short step length (cm)	2.8 (−1.7, 7.4)	1.5 (−3.0, 6.1)	1.7 (−2.9, 6.2)
TUG–long step length (cm)	1.4 (−3.4, 6.2)	0.4 (−5.1, 5.9)	−0.8 (−5.5, 3.9)
1/TUG step duration (step/s)	0.07 (−0.07, 0.21)	0.01 (−0.12, 0.15)	0.02 (−0.12, 0.16)
T25FW speed (cm/s)	5.3 (−2.7, 13.2)	7.0 (−2.6, 16.5)	7.1 (−3.9, 18.1)

Abbreviations: CI, confidence interval; TUG, timed up and go; T25FW, timed 25-foot walk.

Figure 5 Berg Balance Scale scores of the entire cohort (n=20), and responders (n=10) and nonresponders (n=10) to TUG test at baseline (B), 3, 6, 9, and 12 months.

Notes: Upper and lower borders of the boxes represent 25th and 75th percentiles, respectively. The line within the boxes represents median and + sign represents mean. The whisker error bars show minimum and maximum values. ^**** represent lower quartile values overlapping with minimum values. Each black symbol represents individual subject’s score.
Abbreviation: TUG, timed up and go.

Table 3 Mean change (95% CI) at 6, 9, and 12 months for responder and nonresponder

Responder	6 months	9 months	12 months
TUG (%)	−33 (−48, −13)	−39 (−55, −17)	−31 (−52, −2)
First 10 feet walk speed during TUG (cm/s)	14.9 (5.2, 24.7)	20.4 (5.8, 34.7)	11.6 (−3.0, 25.9)
TUG–short step length (cm)	6.8 (0.9, 12.8)	7.7 (1.8, 13.6)	6.9 (0.9, 12.8)
TUG–long step length (cm)	4.9 (−1.6, 11.3)	5.4 (−1.6, 12.5)	3.6 (−2.3, 9.6)
1/TUG step duration (step/s)	0.16 (0.08, 0.27)	0.20 (0.08, 0.31)	0.20 (0.08, 0.32)
T25FW speed (cm/s)	15.3 (2.6, 27.9)	16.6 (1.2, 32.0)	17.6 (0.01, 35.2)
Nonresponder
TUG (%)	17 (−25, 84)	39 (−19, 138)	47 (−20, 170)
First 10 feet walk speed during TUG (cm/s)	0.6 (−9.1, 10.4)	−1.5 (−15.8, 13.1)	−0.6 (−15.2, 13.7)
TUG–short step length (cm)	−1.2 (−7.1, 4.7)	−4.6 (−10.5, 1.3)	−3.5 (−9.4, 2.4)
TUG–long step length (cm)	−2.0 (−8.5, 4.4)	−4.6 (−11.6, 2.4)	−5.3 (−11.2, 0.7)
1/TUG step duration (step/s)	−0.02 (−0.25, 0.21)	−0.17 (−0.40, 0.06)	−0.16 (−0.39, 0.06)
T25FW speed (cm/s)	−4.7 (−12.8, 3.3)	−2.6 (−12.4, 7.2)	−3.4 (−14.6, 7.9)

Abbreviations: CI, confidence interval; TUG, timed up and go; T25FW, timed 25-foot walk.

Figure 6 Spatio temporal gait parameters during timed up and go test at baseline, 3, 6, 9, and 12 months of responders (n=10) and nonresponders (n=10).

Notes: (A) longer step length, (B) shorter step length, and (C) step duration. Values are mean ± standard error.

Table 4 Baseline variables – responder vs nonresponder

Variable	Responder (n=10)	Nonresponder (n=10)	p-value
Age (years), mean (SD)	52.0 (7.7)	51.5 (5.3)	0.878
Number of females (% of group)	7 (70%)	8 (80%)	1.0
MS duration (years)	12.1 (6.4)	17.2 (10.3)	0.200
EDSS (score), median (IQR)	6.25 (6.0–6.5)	6.50 (6.0–7.0)	0.236
DMD use (% of group)	4 (40%)	3 (30%)	1.0
FSS (score)	5.85 (5.17)	5.13 (4.10)	0.205
TUG time – total (s)	22.2 (14.9–26.7)	53.2 (26.1–81.8)	0.186
TUG time – stand (s)	2.5 (1.2–3.1)	3.2 (1.9-5.1)	0.449
TUG time – sit (s)	3.3 (3.2–4.5)	7.8 (5.4–15.7)	0.075*
TUG time – turn (s)	3.3 (2.8–4.3)	9.1 (5.3–15.0)	0.089*
TUG time – first 10 feet (s)	5.2 (4.3–8.9)	14.7 (6.6–23.8)	0.076*
TUG time – second 10 feet (s)	5.2 (3.2–6.9)	13.8 (8.1–23.1)	0.059*
TUG gait – long step (cm)	46.97 (11.13)	36.50 (11.01)	0.048**
TUG gait – short step (cm)	46.09 (34.13–50.01)	27.10 (22.40–38.26)	0.112
TUG gait – step duration (s)	0.84 (0.67–1.10)	1.40 (0.91–2.86)	0.069*
TUG gait – stride duration (s)	1.64 (1.34–1.84)	2.84 (2.17–5.76)	0.041**
TUG gait – double support duration (s)	0.23 (0.11–0.38)	0.77 (0.33–1.31)	0.121
T25FW speed (cm/s)	13.1 (9.7–25.8)	41.0 (16.5–98.5)	0.104
Berg balance test (score)	42.0 (35.0–46.0)	24.5 (4.0–41.0)	0.148

Notes:

* p<0.1;

** p<0.05. Data presented as mean (SD), n (%) or median (IQR).

Abbreviations: MS, multiple sclerosis; EDSS, expanded disability status scale; IQR, interquartile range; DMD, disease modifying drug; FSS, fatigue severity scale; SD, standard deviation; TUG, timed up and go; T25FW, timed 25-foot walk.

Figure 7 Correlation between changes in fatigue severity scale scores over 3 months and change in 25-foot walk speed over 12 months.

Notes: r, Pearson’s correlation coefficient; r(partial), Pearson’s partial correlation coefficient after removing the effect of baseline timed 25-foot walk speed.
Abbreviations: CI, confidence interval.

BishtBDarlingWGShivapourETMultimodal intervention improves fatigue and quality of life of subjects with progressive multiple sclerosis: a pilot studyDegenerative Neurological Neuromuscular Disease2015201551935

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