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
Functional Electrical Stimulation Cycling May Be Beneficial in Moderate to Severe MS
Functional electrical stimulation (FES) cycling may be an effective exercise option in people who have moderate to severe multiple sclerosis (MS), reported Deborah Backus, PhD, and colleagues.
The study included 16 people with MS who had an Expanded Disability Status Scale score of greater than 6.5. Subjects trained two to three times per week for about one month (ie, in a total of 12 sessions) on the RT-300 FES cycle, and the intensity of FES was adjusted for each participant’s comfort level. “The goal was to cycle at 40 to 50 rpm for 30 minutes, either actively or with electrical stimulation for assistance,” noted Dr. Backus, who is the Director of MS Research at the Eula C. and Andrew C. Carlos MS Rehabilitation and Wellness Program at the Shepherd Center in Atlanta.
The investigators analyzed data collected immediately before and after the four-week training period using the MS Quality of Life Inventory (MSQLI) subscales, Modified Ashworth Scale (MAS, spasticity), and manual muscle test (MMT, strength). The study authors also collected data from each training session to monitor subjects’ progress on the cycle and any status changes.
Fourteen participants (six females) completed the training. The researchers found that all persons maintained or increased the amount of time that they could cycle, and seven increased the resistance against which they cycled.
“The most important finding is that there were no adverse events and no increase in any MS-related symptoms,” said Dr. Backus. “Participants demonstrated a significant increase in one measure of cognitive processing speed and a significant decrease in fatigue. There was no significant change in the other subscales of the MSQLI. There was neither a significant increase nor a decrease in MAS and MMT scores.”
The investigators also found that the type of MS and use of antispasticity medications, disease-modifying therapies, or dalfampridine or 4-aminopyridine “did not appear to influence the response to training.
“Further study is required to examine the parameters of FES cycling that are most effective for people with different constellations of MS symptoms and to fully explore the potential benefits for optimizing function and improving health in people with moderate to severe MS,” Dr. Backus concluded.
—Colby Stong
Clinical Characteristics Predictive of High Costs Among Patients With MS
Baseline use of corticosteroids and documentation of other brain MRI results may be significantly associated with higher costs for patients with multiple sclerosis (MS), according to data presented.
“This study provides insight into factors associated with high-cost MS patients and may help to prospectively identify potential high-cost MS patients who may benefit from cost-effective proactive clinical management,” the researchers said. “Additionally, while most patients have documentation of brain MRI in their medical records, many of the additional clinical characteristics needed to assess disease severity are not documented in the medical record.”
Debra F. Eisenberg, MS, PhD, and colleagues sought to assess patient demographics, clinical characteristics, medication use, and resource use among patients with MS stratified as low, medium, and high cost through administrative claims review and patient medical record review. For their observational, retrospective cohort study, the researchers used data drawn from the HealthCore Integrated Research Database (HIRD), which includes medical and pharmacy claims data.
Patients age 18 or older newly diagnosed with MS during the period from January 1, 2007, to April 30, 2011, were identified in the database. Annualized MS-related cost was computed, and patients were classified into high-, medium-, and low-cost strata. A total of 400 patients with a confirmed diagnosis of MS and documentation of brain MRI were selected for medical record review. Bivariate analyses and multivariate logistic regression models were used to identify factors associated with high-cost patients.