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Association between perceived fatigue and gait parameters measured by an instrumented treadmill in people with
Alon Kalron1,2
1Department of Physical Therapy, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. alkalron@gmail.com.
Background:
Multiple sclerosis (MS) is a multi-focal progressive disorder of the central nervous system often resulting in diverse clinical manifestations. Symptomatic fatigue is quite common in people with MS (PwMS), with prevalence as high as 85%. Nevertheless, it remains poorly understood and its association with walking capabilities unclear. Therefore, the objective of this investigation was to examine the relationship between symptomatic fatigue and spatio-temporal parameters of gait in PwMS based on an instrumented treadmill.
Methods:
One hundred and twenty-four relapsing-remitting patients diagnosed with MS, 84 women and 40 men aged 42.6 (S.D = 11.9), participated in this investigation. A convenience sample of 25 apparently healthy subjects, 15 women and 10 men aged 40.3 (S.D = 11.1), served as controls. Gait spatiotemporal parameters were obtained using the Zebris FDM-T Treadmill (Zebris1 Medical GmbH, Germany). The Modified Fatigue Impact Scale (MFIS), a self-reported questionnaire, was used to determine the level of symptomatic fatigue in the MS study group. PwMS were divided into two groups: fatigued and non-fatigued.
Results:
Forty-four PwMS were classified as suffering from fatigue (mean MFIS = 52.0, S.D = 13.7); 80 were classified as non-fatigued (mean MFIS = 14.5, S.D = 14.5). Individuals in the fatigued group walked slower than those in the non-fatigued group; 1.7 (S.D = 2.4) vs. 2.4 (S.D = 1.0); P < 0.001, respectively. Moreover, fatigued patients took smaller steps, had a shorter stride length, prolonged stance, double support phase and a shorter single support phase compared to the non-fatigued group. In the total group, fatigue was significantly correlated with 10 (out of 14) spatiotemporal parameters of gait, however, correlation scores <0.40 were considered as weak correlations. According to step one of the linear logistic regression analysis, the temporal gait component was found to explain 5.1% of the variance related to symptomatic fatigue, R2 = 0.051, χ2 (1) = 6.511, P = 0.011. Step two of the model added the gait spatial component, thus increasing the explaining variance to 9.3%; R2 = 0.093, χ2 (2) = 12.12, P = 0.002. The asymmetry gait parameter did not contribute to the equation.
Conclusions:
Perceived fatigue is related to walking speed in PwMS, nevertheless its contribution to level of fatigue is limited.
Insights
Symptomatic fatigue in people with multiple sclerosis (PwMS) is linked to slower walking speeds and altered gait parameters. While fatigue impacts gait, its overall contribution to the level of fatigue experienced by PwMS is limited.
Area of Science:
- Neurology
- Rehabilitation Medicine
- Biomedical Engineering
Background:
- Multiple sclerosis (MS) is a progressive central nervous system disorder with varied clinical presentations.
- Symptomatic fatigue affects up to 85% of people with MS (PwMS), yet its underlying mechanisms and impact on mobility remain unclear.
- Understanding the relationship between fatigue and gait is crucial for improving PwMS quality of life.
Purpose of the Study:
- To investigate the association between symptomatic fatigue and spatio-temporal gait parameters in PwMS.
- To quantify the relationship between fatigue levels and objective gait measurements using an instrumented treadmill.
Main Methods:
- 124 relapsing-remitting MS patients and 25 healthy controls underwent gait analysis on an instrumented treadmill.
- Gait spatio-temporal parameters were recorded.
- The Modified Fatigue Impact Scale (MFIS) assessed symptomatic fatigue in MS patients, who were then categorized as fatigued or non-fatigued.
Main Results:
- Fatigued PwMS exhibited significantly slower walking speeds (1.7 m/s) compared to non-fatigued PwMS (2.4 m/s).
- Fatigued individuals demonstrated shorter step length, prolonged stance and double support phases, and a shorter single support phase.
- Symptomatic fatigue correlated with 10 out of 14 spatio-temporal gait parameters, with temporal and spatial components explaining 9.3% of fatigue variance.
Conclusions:
- Perceived fatigue is demonstrably related to gait speed in people with MS.
- However, gait parameters explain only a limited portion of the variance in perceived fatigue levels among PwMS.
