Mobility With MS

Fatigue impairs mobility in multiple sclerosis while pain and depression do not, study says

(RxWiki News) Are you having problems getting around due to your multiple sclerosis (MS)? Many people living with MS report mobility as a common problem. Increasing mobility in people living with MS first requires pinpointing the reasons behind it.

A recent study examined how instances of fatigue, pain and depression affect the outcome of the six minute walk (6MW) test in people with MS.

The study found that 6MW performance was associated with fatigue but not symptoms of depression or pain.

"Discuss any mobility problems with your doctor."

Lead author, R. W. Motl, PhD, of the Department of Kinesiology and Community Health at the University of Illinois and team observed 33 MS patients and 33 healthy controls matched on age, sex, height and weight in a research laboratory setting.

The participants completed several questionnaires including the Fatigue Severity Scale (FSS), Short-Form of the McGill Pain Questionnaire (SF-MPQ), Patient Determined Disease Steps (PDDS) and Hospital Anxiety and Depression Scale (HADS-D) prior to completing a 6MW test.

The FSS is a nine item questionnaire used to measure fatigue severity on a seven point scale over the previous four weeks.

The SF-MPQ is a 15 item checklist that measures types of pain on a four point scale over the previous four weeks.

The HADS-D is a 14 item scale that measures anxiety and depression on a four point scale over the previous four weeks. The anxiety portion of the scale was not included in this study.

The PDDS contains a single item self-reporting scale ranging from zero to eight that measures neurological impairment.

The 6MW test requires participants to walk as fast and far as possible for six minutes down a hard, flat surface while a researcher measures the distance traveled. Participants in this study were allowed to use a cane or other assisting device if necessary.

The 6MW test is a good tool for assessing MS because symptoms such as fatigue, pain and depression can affect the mechanics of movement. The test is long enough for a patient to reach aerobic metabolism and the distance covered is appropriate for assessing mobility difficulties.

The study found that pain and depression did not significantly affect the 6MW score but that fatigue did in both the control and MS groups with the MS group having low ankle power generation, or propulsion off the ground when they stepped, and slow speeds.

This is particularly significant as a recent large-scale survey shows that 73 percent of MS patients report fatigue as a symptom that affects their mobility.

These finding show the importance of managing fatigue in patients with MS. While pharmaceutical approaches to managing fatigue exist, non-pharmaceutical approaches such as energy conservation, recharge efforts, enhancing resistance to fatigue and temperature control can be implemented into the patient’s routine.

Possible limitations to the study include a relatively small sample size and a relatively narrow participant group consisting of mostly Caucasians, women and mild cases of MS.

This study conflicts with previous studies that show pain and depression does cause elicit slow speeds in walking tests. This could be because the setup and participants in previous studies varied from this study.

The study was published in the July edition of the European Journal of Physical and Rehabilitation Medicine.

The research was supported by the University of Illinois at Urbana-Champaign Research Board.

The authors report no conflicts of interest.

Review Date: 
August 2, 2012