Research Report
Population: Adult
Evan T Cohen, PT, MA, PhD, NCS, Associate Professor, Rutgers, The State University of New Jersey cohenet@shrp.rutgers.edu
Donald Barone, DO, Associate Professor, Rowan University baroned1@rowan.edu
Christine Beswick, BA, CCRP, Director of Planning, Program Development and Special Projects, Rowan University beswicch@rowan.edu
Sara Soliman, DO, Attending Physician, Rowan University solimasn@rowan.edu
Keywords: Participation, Multiple Sclerosis, Walking, Psychosocial Impact
Purpose/Hypothesis: The purpose of this study was to compare measures of participation, psychosocial impact, and walking function in persons with multiple sclerosis (MS) using three different assistive devices (AD): a single-point cane (SPC), a narrow-based four-point cane (FPC) and a trekking pole (TP).
Subjects: 19 persons with MS (16 women and 3 men; ages 33-64, mean=52 years), and Extended Disability Severity Scale (EDSS) scores of 2.5-6.0 (median=4.0, IQR=1.75) completed the study.
Materials/Methods: This study used a randomized, crossover, repeated-measures design in which participants were randomly assigned the order in which they were given ADs. Each participant was provided with a properly sized AD and instructed in its use. They were then instructed to regularly utilize the AD until the next visit 1-2 weeks later. Participants completed the testing battery at each measurement visit. Participation was measured with the 12-item MS Walking Scale (MSWS-12), Activities-specific Balance Confidence Scale (ABC), 5-item Modified Fatigue Impact Scale (MFIS-5). Psychosocial impact was measured with the Psychosocial Impact of Assistive Devices Scale (PIADS) from which three subscales were derived: Competence (PIADS-C), Self-Esteem (PIADS-SE), and Adaptability (PIADS-A). Walking function was measured by distance during a 6-minute walking test (6MWT). The difference in a visual analog scale of fatigue (ΔVAS-F) given immediately before and after the 6MWT measured fatigue induced by the 6MWT.
Results: Participation: Use of the SPC (p=.02) and TP (p=.02) resulted in better walking participation compared to the FPC as measured with the MSWS-12. Use of the TP (p=.05) resulted in a lesser impact of fatigue on participation compared to the FPC. No differences were found between AD conditions in balance-related participation (ABC). Psychosocial Impact: PIADS-C was better with the SPC (p=.001) and TP (p=.017) compared to the FPC. PIADS-SE was better with the SPC (p=.006) and TP (p=.001) compared to the FPC. PIADS-A was better with the SPC (p=.008) and TP (p=.004) compared to the FPC. Walking Function: Participants walked greater 6WMT distances with the SPC (p=.000) and TP (p=.002) compared to the TP. No differences were found between AD conditions in ΔVAS-F.
Conclusions: Participants in this study reported higher levels of participation related to walking and fatigue, but not to balance, when using a SPC or TP compared to a FPC. Use of the SPC and TP also resulted in more positive psychosocial impact on competence, self-esteem and adaptability. Participants had better walking function with the SPC and TP compared with the FPC without inducing higher levels of fatigue.
Clinical Relevance: The SPC and TP are viable options to maximize participation and walking function in persons with MS-related walking disability. The SPC and TP were perceived by study participants as having a more positive psychosocial impact. This may the SPC or TP useful options for persons with MS who might benefit from the use of a walking AD but who are concerned about its negative psychosocial impact.
Citation:
Cohen, Evan T, PT, MA, PhD, NCS; Barone, Donald , DO; Beswick, Christine , BA, CCRP; Soliman, Sara , DO. The effect of different assistive devices on participation, psychosocial impact, and walking function in persons with multiple sclerosis.. Poster Presentation. IV STEP Conference, American Physical Therapy Association, Columbus, OH, July 17, 2016. Online. https://u.osu.edu/ivstep/poster/abstracts/003-cohen-et-al/