DALLAS—Scores on Guy’s Neurological Disability Scale (GNDS) correlate well with walking distance and presence of pain and spasticity among patients with multiple sclerosis (MS), according to a study presented at the 2014 Cooperative Meeting of CMSC and ACTRIMS. In addition, the Multidimensional Outcome Expectations for Exercise Scale (MOEES) questionnaire 3 subscales appear valid, and self-evaluative scale scores correlate with pain scores, as well as with a physical measure. Lead author Samuel M. Bierner, MD, and colleagues said that their early analysis revealed interesting relationships between patients’ perceived autonomy and daily pain scores. Dr. Bierner is affiliated with the Department of Physical Medicine and Rehabilitation at the University of Texas Southwestern Medical Center in Dallas.
Dr. Bierner and colleagues conducted a prospective cohort study designed to assess the relationship between attitudes toward exercise and autonomy and physical measures of upper and lower body strength and exercise performed. They reported the initial results of the cohort at the time of entry into the study.
Patients from an academic MS center completed two physical measures: grip strength dynamometry and the two-minute walk test (2MWT). They also completed the GNDS, the Impact on Participation and Autonomy Questionnaire (IPA), and the MOEES, previously validated in the ambulatory MS population. A medical history relevant to MS was elicited. In the second part of the study (not reported here), the subjects completed an exercise diary for two weeks.
The initial study of 46 subjects showed a mean GNDS score of 10.7 for males and 12.1 for females, and these scores were not statistically different. Bivariate correlation analyses showed a significant relationship between GNDS and 2MWT as well as GNDS and presence of pain or spasticity.
The IPA subscales—Autonomy Indoors scale, Family Role scale, and Autonomy Outdoors scale—showed significant correlations with average daily pain rating.
The MOEES scale data evaluated by principal components analysis showed excellent agreement with published three-subscale factor model. The Self-Evaluative subscale showed significant correlation with average daily pain rating.
Grip dynamometry results were 30.9 kg for the left hand and 32.1 kg for the right hand. Regression model showed that right-hand grip was predicted by MOEES Self-Evaluative subscale score, fatigue, and gender.
According to Dr. Bierner and colleagues, their initial study showed a relatively healthy sample, with GNDS disability scores lower than other published studies. Average grip strength was within normal limits for age and gender. The 2MWT was negatively correlated with GNDS total score and all IPA subscales. As expected, subjects who were able to walk greater distances had less perceived disability and greater autonomy and participation in their daily activities.
Subjects’ pain ratings correlated with multiple questionnaire scores, including the GNDS total score (reflecting perceived MS disability), the MOEES self-evaluative subscale, and all IPA subscales except work/education. Pain appears to affect one’s self evaluation, sense of disability, autonomy, and participation in daily activities.
According to the researchers, the three MOEES subscales (physical, social, and self-evaluative outcome expectations) appear valid. Principal component analysis of the MOEES responses from the 46 subjects revealed three factors that matched 13 of the 15 (86.7%) original questions used in the study validation. Question 9 (ie, “Exercise will aid in weight control”) and Question 13 (ie, “Exercise will increase my mental alertness”) were the two mismatches. The researchers noted that mean values from each subscale nearly matched those values published in the original MOEES validation paper.
—Glenn S. Williams