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The Role of Cognitive Impairment on Physical Therapy Attendance and Outcomes in Multiple Sclerosis
Kayla E Gomes1, Jennifer A Ruiz, Sarah A Raskin
1Outpatient Rehabilitation, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, Connecticut (K.E.G.); Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, Connecticut (J.A.R., H.M.D., L.O.N., E.S.G.); Departments of Rehabilitative Medicine (J.A.R., H.M.D., L.O.N., E.S.G.) and Medical Sciences (J.A.R., E.S.G.), Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut; Neuroscience Program, Trinity College, and Department of Psychology, Trinity College, Hartford, Connecticut (S.A.R.); Multiple Sclerosis Center of Excellence West, Veterans Affairs, and Rehabilitation Care Service, VA Puget Sound Health Care System, and Department of Rehabilitation Medicine, University of Washington, Seattle, Washington (A.P.T.); and Department of Neurology, University of Connecticut School of Medicine, Farmington (E.S.G.).
Background And Purpose:
Many persons with multiple sclerosis (PwMS) experience cognitive impairments, which may affect their ability to engage in physical therapy. There is limited information on how cognitive impairments are associated with PwMS' ability to participate and improve their functional outcomes. This study aimed to assess the relationship between cognitive functioning and PwMS' attendance, total goal attainment, and functional improvement following physical therapy intervention.
Methods:
Participants (n = 45) were PwMS who participated in a larger self-management study and enrolled in physical therapy within the past 2 years. Objective cognitive functioning was examined using tests of prospective memory, retrospective memory, working memory, and processing speed, along with a self-report measure. Bivariate analyses were conducted to examine the relationship between cognitive functioning and each physical therapy outcome (session attendance, attaining goals, and changes in functional outcome measures), followed by logistic regressions with age, education, gender, and disability level as covariates.
Results:
Difficulty learning new verbal information was associated with a greater likelihood of "no showing" one or more of their physical therapy sessions. Reductions in working memory and processing speed were associated with PwMS not meeting all their rehabilitation goals. Despite deficits in new learning, memory, and processing speed, 85.2% of those with pre-/postscores showed improvements in at least one functional outcome measure following physical therapy intervention.
Discussion And Conclusions:
These findings demonstrate the ability for PwMS to make functional motor gains despite the presence of cognitive impairments and highlight the potential contributions of cognitive functioning on attendance and goal attainment of physical therapy intervention.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A362, which includes background, methods, results, and discussion in the authors' own voices).
