IJPR.2020.147

Type of Article:  Original Research

Volume 8; Issue 5 (September 2020)

Page No.: 3555-3562

DOI: https://dx.doi.org/10.16965/ijpr.2020.147

CORRELATION BETWEEN SPASTICITY AND WEAKNESS OF THE LOWER LIMBS WITH FATIGUE IN PATIENTS WITH MULTIPLE SCLEROSIS

Taís Panizzi Dilda ¹, Alessandro Finkelsztejn ², Luciano Palmeiro Rodrigues *³.

¹ Specialization Course in Physiotherapy in Neurofunctional Physiotherapy at the Federal University of Rio Grande do Sul – UFRGS – Rua Felizardo, 750 – Bairro Jardim Botânico – Porto Alegre, Rio Grande do Sul – Brazil – CEP 90690-200

² Hospital de Clínicas de Porto Alegre. Rua Ramiro Barcelos, 2350 – Santa Cecília, Porto Alegre – RS, 90035-007

*³ Physiotherapy Course at the Federal University of Rio Grande do Sul UFRGS; PhD in Neuroscience – UFRGS. Rua Felizardo, 750 – Bairro Jardim Botânico – Porto Alegre, Rio Grande do Sul – Brazil – CEP 90690-200

Corresponding author: Luciano Palmeiro Rodrigues, Rua Felizardo, 750 – Bairro Jardim Botânico – Porto Alegre, Rio Grande do Sul – Brazil – CEP 90690-200 E-Mail: lucianopalmeiro@gmail.com

ABSTRACT

Background: Individuals affected by Multiple Sclerosis (MS) present weakness in the lower limbs (LL), abnormal muscle tone and fatigue.

Aims: To correlate the spasticity and weakness of lower limbs with fatigue in Multiple Sclerosis patients.

Methods: The study is the ex post fact type with a correlational design, performed with patients MS. A total of 45 individuals were evaluated. The Modified Fatigue Impact Scale in MS (MFIS) was used to asses fatigue; the Modified Ashworth Scale (MAS) for lower limb (LL) spasticity and the 5-repetition sit-to-stand (5STS) test to characterize the strength of LL.

Results: The mean of MFIS was 42.76 (±19.65) points, indicating the presence of fatigue among the patients and in the 5STS-test the average was 15.37 (±5.89) which chacacterized them with decreased muscle strength. Thirty-nine patients had some degree of spasticity in the lower limbs (86.66%). There was a positive correlation between fatigue and muscle strength of LL (r = 0.412 and p <0.05) and between fatigue and spasticity of adductors muscles (r =0.295) (p<0.049).

Conclusions: Muscle strength of lower limbs is related to fatigue in MS patients demonstrating that the higher the muscle strength, the lower the presence of this symptom in multiple sclerosis patients.

Key words: Multiple Sclerosis, Muscle Spasticity, Muscular Strength, Fatigue, Physiotherapy.

REFERENCES

[1]. Mohamed K, Koriem M. Multiple sclerosis: New insights and trends. Asian Pac J Trop Biomed. 2016; 6: 429-440.
https://doi.org/10.1016/j.apjtb.2016.03.009
[2]. Halabchi F, Alizadeh Z, Sahraian MA, Abolhasani M. Exercise prescription for patients with multiple sclerosis; potential benefits and practical recommendations. BMC Neurology. 2017; 17: 1-11.
https://doi.org/10.1186/s12883-017-0960-9
PMid:28915856 PMCid:PMC5602953
[3]. Kamm CP, Uitdehaag BM, Polman CH. Multiple sclerosis: current knowledge and future outlook. Eur Neurol. 2014; 72: 132-41.
https://doi.org/10.1159/000360528
PMid:25095894
[4]. Ng AV, Miller RG, Gelinas D, Kent-Braun JA. Functional relationships of central and peripheral muscle alterations in multiple sclerosis. Muscle Nerve. 2004; 29: 843-852.
https://doi.org/10.1002/mus.20038
PMid:15170617
[5]. Kjolhede T, Vissing K, Dalgas U. Multiple sclerosis and progressive resistance training: a systematic review. Mult Scler J. 2012; 18: 1215-2.
https://doi.org/10.1177/1352458512437418
PMid:22760230
[6]. Bethoux F, Marrie RA. A cross‐sectional study of the impact of spasticity on daily activities in multiple sclerosis. Patient. 2016; 9: 537-546.
https://doi.org/10.1007/s40271-016-0173-0
PMid:27154536
[7]. Vermersch P. Mobility ImproVEment with spasticity in multiple sclerosis in Europe: The MOVE 1 EU study. Neurodegenerative Disease Management. 2014; 4: 407-415.
https://doi.org/10.2217/nmt.14.44
PMid:25531685
[8]. Kister I, Bacon TE, Chamot E, Salter AR, Cutter GR, Kalina JT, Herbert J. Natural history of multiple sclerosis symptoms. International Journal of MS Care. 2013; 15: 146-158.
https://doi.org/10.7224/1537-2073.2012-053
PMid:24453777 PMCid:PMC3883021
[9]. Flachenecker P, Henze T, Zettl UK. Spasticity in patients with multiple sclerosis-Clinical characteristics, treatment and quality of life. Acta Neurologica Scandinavica. 2014; 129: 154-162.
https://doi.org/10.1111/ane.12202
PMid:24256407
[10]. Norbye AD, Midgard R, Thrane G. Spasticity, gait, and balance in patients with multiple sclerosis: A cross‐sectional study. Physiother Res Int. 2019; e1799.
https://doi.org/10.1002/pri.1799
PMid:31287210
[11]. Bethoux F. Gait disorders in multiple sclerosis. Continuum. 2013; 19: 1007-1022.
https://doi.org/10.1212/01.CON.0000433286.92596.d5
PMid:23917098
[12]. Rooney S, Wood L, Moffat F, Paul L. Prevalence of fatigue and its association with clinical features in progressive and non-progressive forms of Multiple Sclerosis. Mul Scler Relat Disord. 2019; 28: 276-282.
https://doi.org/10.1016/j.msard.2019.01.011
PMid:30639830
[13]. Sangelaji B, Kordi M, Banihashemi F, Nabavi SM, Khodadadeh S, Dastoorpoor M. A combined exercise model for improving muscle strength, balance, walking distance, and motor agility in multiple sclerosis patients: A randomized clinical trial. Iran J Neurol. 2016; 15: 111-20.
[14]. Williams AE, Vietri JT, Isherwood G, Flor A. Symptoms and association with health outcomes in relapsing-remitting multiple sclerosis: results of a US patient survey. Mult Scler Int. 2014; 2014: 203183.
https://doi.org/10.1155/2014/203183
PMid:25328704 PMCid:PMC4189937
[15]. Van Asch P. Impact of Mobility Impairment in Multiple Sclerosis 2 – Patients Perspectives European Neurological Review. 2011; 6: 115-20.
https://doi.org/10.17925/ENR.2011.06.02.115
[16]. Kurtzke JF. Rating neurologic impairment in multiple sclerosis: An expanded disability status scale (EDSS). Neurology. 1983; 33: 1444-5.
https://doi.org/10.1212/WNL.33.11.1444
PMid:6685237
[17]. Bohannon RW, Smith MB. Interrater Reliability of a Modified Ashworth Scale of Muscle Spasticity. Physical Therapy. 1987; 67: 206-207.
https://doi.org/10.1093/ptj/67.2.206
PMid:3809245
[18]. Moller AB, Bibby BM, Skjerbaek AG, Jensen E, Sorensen H, Stenager E, Dalgas U. Validity and variability of the 5-repetition sit-to-stand test in patients with multiple sclerosis. Disabil Rehabil. 2012; 34: 2251-8.
https://doi.org/10.3109/09638288.2012.683479
PMid:22612360
[19]. Bohannon RW, Shove ME, Barreca SR, Masters LM, Sigouin CS. Five-repetition sit-to-stand test performance by community-dwelling adults: A preliminary investigation of times, determinants, and relationship with self-reported physical performance. Isokinetics and Exercise Science. 2007; 15: 77-81.
https://doi.org/10.3233/IES-2007-0253
[20]. Pavan K, Schmidt K; Marangoni B; Mendes MF; Tilbery CP; Lianza S. Esclerose múltipla: adaptação transcultural e validação da escala modificada de impacto de fadiga. Arq Neuro-Psiquiatr. 2007; 65: 669-673.
https://doi.org/10.1590/S0004-282X2007000400024
PMid:17876412
[21]. Filho HA, Carvalho SRS, Dias RM, Alvarenga RMP. Principais testes utilizados na avaliação de fadiga na esclerose múltipla. Revisão Sistemática. Rev Bras Neurol. 2010; 46: 37-43.
[22]. Henze T, Mackensen SV, Lehrieder G, Zetti UK, Pfiffner C, Flachenecker P. Linguistic and psychometric validation of the MSSS-88 questionnaire for patients with multiple sclerosis and spasticity in Germany. Health and Quality of Life Outcomes. 2014; 12: 327-345.
https://doi.org/10.1186/s12955-014-0119-y
PMid:25080934 PMCid:PMC4148533
[23]. Arroyo R, Massana M, Vila C. Correlation between spasticity and quality of life in patients with multiple sclerosis: the CANDLE study. Int J Neurosci. 2013; 123: 850-858.
https://doi.org/10.3109/00207454.2013.812084
PMid:23819835
[24]. Oreja-Guevara C, Gonzalez-Segura D, Vila C. Spasticity in multiple sclerosis: results of a patient survey. Int J Neurosci. 2013; 123: 400-408.
https://doi.org/10.3109/00207454.2012.762364
PMid:23297730
[25]. Bowser B, O’Rourke S, Brown CN, White L, Simpson KJ. Sit-to-stand biomechanics of individuals with multiple sclerosis. Clin Biomech. 2015; 30: 788-794.
https://doi.org/10.1016/j.clinbiomech.2015.06.012
PMid:26144661
[26]. Hoang PD, Gandevia SC, Herbert RD. Prevalence of joint contractures and muscle weakness in people with multiple sclerosis. Disabil Rehabil. 2014; 36: 1588-93.
https://doi.org/10.3109/09638288.2013.854841
PMid:24236496
[27]. Téllez N, Río J, Tintoré M, Nos C, Galán I, Montalban X. Does the Modified Fatigue Impact Scale offer a more comprehensive assessment of fatigue in MS? Mult Scler. 2005; 11: 198-202.
https://doi.org/10.1191/1352458505ms1148oa
PMid:15794395
[28]. Amtmann D, Bamer AM, Noonan V, Lang N, Kim J, Cook KF. Comparison of the psychometric properties of two fatigue scales in multiple sclerosis. Rehabil Psychol. 2012; 52: 159-166.
https://doi.org/10.1037/a0027890
PMid:22686554 PMCid:PMC3422656
[29]. Fiest KM, Fisk JD, Patten SB, Tremlett H, Wolfson C, Warren S, McKay KA, Berrigan LI, Ann Marrie R. Fatigue and Comorbidities in Multiple Sclerosis. Int J MS Care. 2016; 18: 96-104.
https://doi.org/10.7224/1537-2073.2015-070
PMid:27134583 PMCid:PMC4849402
[30]. Chalah MA, Kauv P, Créange A, Hodel J, Lefaucheur JP, Ayache SS. Neurophysiological, radiological and neuropsychological evaluation of fatigue in multiple sclerosis. Multiple Sclerosis and Related Disorders. 2019; 28: 145-152.
https://doi.org/10.1016/j.msard.2018.12.029
PMid:30594815
[31]. Sosnoff J, Gappmaier E, Frame A, Motl RW. Influence of Spasticity on Mobility and Balance in Persons with Multiple Sclerosis. JNPT. 2011; 35: 129-132.
https://doi.org/10.1097/NPT.0b013e31822a8c40
PMid:21934374
[32]. Wagner JM, Kremer TR, Van Dillen LR, Naismith RT. Plantarflexor weakness negatively impacts walking in persons with multiple sclerosis more than plantarflexor spasticity. Arch Phys Med Rehabil. 2014; 95: 1358-65.
https://doi.org/10.1016/j.apmr.2014.01.030
PMid:24582617 PMCid:PMC4152915
[33]. Karpatkin H, Babyar S, DiCarrado S, McDarby M, Narovlianski M, Perez B, Rimawi I. Increases in fatigue do not change spasticity scores in persons with multiple sclerosis. Neurodegener Dis Manag. 2018; 8: 143-150.
https://doi.org/10.2217/nmt-2017-0049
PMid:29943692
[34]. Valet M, Lejeune T, Yumiko G. et al. Fatigue and physical fitness of mildly disabled persons with multiple sclerosis: a cross-sectional study. Int J Rehabil Res. 2017; 00: 1-7.
https://doi.org/10.1097/MRR.0000000000000238
PMid:28658030
[35]. Patejdl R, Zettl UK. Spasticity in multiple sclerosis: Contribution of inflammation, autoimmune mediated neuronal damage and therapeutic interventions. Autoimmun Rev. 2017; 16: 925-936.
https://doi.org/10.1016/j.autrev.2017.07.004
PMid:28698092

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