Fatigue und Fatigability bei Multipler Sklerose –
                    Leistungsbeurteilung

Dettmers, Christian; Schmidt, Roger; Jöbges, Michael

doi:10.1055/a-1199-2594

Cited by 3 publications

(3 citation statements)

References 19 publications

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“…Initially characterized as an inflammatory demyelinating disease of the central nervous system, neurodegenerative processes lead to progressive disability during later stages [ 1 ]. In Germany, persons with MS (pwMS) frequently attend inpatient rehabilitation facilities for several weeks to improve their ability to work in a multidisciplinary setting [ 2 ]. ‘Visible’ symptoms such as mobility impairments play an obvious role in pwMS’s ability to participate in the job market.…”

Section: Introductionmentioning

confidence: 99%

Multimodal agility-based exercise training (MAT) versus strength and endurance training (SET) to improve multiple sclerosis-related fatigue and fatigability during inpatient rehabilitation: a randomized controlled pilot and feasibility study [ReFEx]

Wolf,

Nielsen,

Saliger

et al. 2023

BMC Neurol

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Background Multimodal agility-based exercise training (MAT) is a group-based exercise training framework for persons with multiple sclerosis (pwMS) with a potential to impact fatigue and fatigability. In a mixed-methods design, this study evaluated the feasibility of implementing MAT in an inpatient rehabilitation setting and the feasibility of a randomized controlled trial (RCT) study protocol with ‘traditional’ strength and endurance training (SET) as an active control condition. Secondarily, preliminary outcome data was acquired. Methods PwMS with low to moderate disability and self-reported fatigue were randomly allocated to either MAT or SET when starting inpatient rehabilitation (4–6 weeks). The MAT-participants exercised in a group following a MAT-manual (sessions were gym- (5x/week) and pool-based (3x/week)). SET-participants exercised individually 5x/week on a cycle ergometer, and 3x/week on strength training machines. Feasibility assessments focused on processes, resources, management, time, and scientific domains. Assessed clinical outcomes at admission and discharge included perceived fatigue, motor and cognitive fatigability, cognitive performance, motor function, and balance confidence. Perceived fatigue was reassessed 1, 4, and 12 weeks after discharge. Feasibility was determined regarding predetermined progression criteria. Results Twenty-two participants were randomized. Both groups performed the minimum number of sessions (> 18), and retention was adequate (73–91%). SET-participants performed more sessions than MAT-participants (30.8 vs. 22.7) and stayed longer in the facility (34.2 vs. 31.6 days). Non-eligibility of admitted pwMS was high (74% non-eligible), mainly due to high EDSS and inability to attend pool-based sessions. Consequently, recruitment (1.8/month) was slower than the predetermined progression criterium. Baseline assessments took longer than required (only 50% completed within 3 days). Short-term fatigue reduction was similar for both groups. Motor fatigability also improved in both groups, whereas cognitive fatigability deteriorated. In MAT, average improvement in walking endurance (43.9 m) exceeded minimal important change values for individuals (> 26.9 m). Conclusions Progressing to a definitive RCT necessitates adaptation of eligibility criteria. In the present design it will also be difficult to attain similar dosing of interventions. A multicenter RCT focused only on gym-based MAT might be another option to assess the effect of MAT. The primary outcome measure should be able to measure change in perceived fatigue more robustly. Trial registration German Clinical Trials Register: DRKS00023943, date of registration: 23 September 2021.

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Section: Introductionmentioning

confidence: 99%

Multimodal agility-based exercise training (MAT) versus strength and endurance training (SET) to improve multiple sclerosis-related fatigue and fatigability during inpatient rehabilitation: a randomized controlled pilot and feasibility study [ReFEx]

Wolf,

Nielsen,

Saliger

et al. 2023

BMC Neurol

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

“…1 In Germany, persons with MS (pwMS) frequently attend inpatient rehabilitation facilities, for example, to improve their working capacity. 2 Notably, 25% of pwMS have impaired working capacity because of 'invisible' symptoms such as fatigue. 3 4 Fatigue can be defined as 'a subjective sensation of lack of energy and exhaustion', 5 while the term fatigability refers to objectively measurable performance decrements (eg, during walking).…”

Section: Introductionmentioning

confidence: 99%

Experiences of fatigued persons with multiple sclerosis with multimodal agility-based exercise training and the ReFEx study protocol: a qualitative extension of a feasibility study

Wolf,

Folkerts,

Zimmer

et al. 2024

BMJ Open

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Objectives(1) To explore experiences of fatigued persons with multiple sclerosis (pwMS) with a new multimodal agility-based exercise training (MAT) framework and (2) to investigate the demands of the Rehabilitation, Fatigue, and Exercise (ReFEx) study protocol, which compares high-frequency MAT and ‘traditional’ strength and endurance training (SET) to identify possible adaptations for a powered randomised controlled trial (RCT).DesignA qualitative interview study nested within a feasibility RCT, comparing MAT and SET.SettingNeurological inpatient rehabilitation centre in Germany.ParticipantsTwenty-two pwMS were recruited for the feasibility study. Six were selected from MAT and SET, respectively, for semistructured face-to-face interviews prior to discharge, following a purposive sampling strategy. Participants had low physical disability but were at least moderately fatigued.InterventionsDuring inpatient rehabilitation (4–6 weeks) MAT participants attended group-based and manual-based MAT sessions in the gym (5×/week, 30 min) and the pool (3×/week, 30 min). SET participants exercised individually on a cycle ergometer (5×/week, 22 min) and on strength training machines (3×/week, 30 min).ResultsThree key categories emerged from the interviews: (1)facilitatorsregarding MAT were variety and playfulness, group setting and challenging exercises.Barriersregarding MAT were feeling overburdened, feeling pressured in the group setting and the wish to perform ‘traditional’ strength training (not part of MAT). (2) MATbenefitswere of physical and psychological nature, with improved balance stated the most. (3)Demandsdescribed the perceived exertion during MAT and SET, reflecting that there is no accumulation of fatigue during the intervention.ConclusionsMAT is appreciated by pwMS and includes facilitators less attainable with ‘traditional’ SET. Evaluation of MAT in a powered RCT is indicated, if rest breaks postsession, and screening for negative self-evaluation and social comparison are considered. Future (qualitative) research should investigate the important factors of inpatient rehabilitation contributing to fatigue reduction in pwMS.Trial registration numberDRKS00023943; German Clinical Trials Register.

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Einfluss sportlichen Trainings auf die Fatigue bei Patient*innen mit Multipler Sklerose

Meyer,

Schmidt

2024

MSK – Muskuloskelettale Physiotherapie

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ZusammenfassungDie Fatigue ist eines der häufigsten Symptome der Multiplen Sklerose (MS). Gekennzeichnet durch unverhältnismäßige Erschöpfung nach physischer oder kognitiver Belastung führt sie zu massiven Beeinträchtigungen in sämtlichen Lebensbereichen. Die Therapie der MS-assoziierten Fatigue stützt sich vor allem auf nicht-medikamentöse Maßnahmen. Sportliches Training kann sich positiv auf verschiedene Symptome der MS auswirken. Hinsichtlich der Fatigue wird empfohlen, Betroffene über die Effekte körperlichen Trainings aufzuklären. Bislang bestehen allerdings nur wenige Erkenntnisse über eine optimale Trainingsgestaltung.Ziel dieser Arbeit ist es, anhand aktueller Forschungserkenntnisse den Einfluss sportlichen Trainings auf die Fatigue bei Patient*innen mit MS zu analysieren und anhand dessen mögliche Trainingsempfehlungen abzuleiten. Dafür wurden die Fachdatenbanken PubMed, Cochrane Library, PEDro und BISp Surf systematisch nach randomisierten kontrollierten Studien (RCTs), welche die Auswirkungen sportlichen Trainings auf die Fatigue bei Patient*innen mit MS analysierten, durchsucht. Eine Bewertung der methodischen Qualität der Arbeiten erfolgte anhand der PEDro-Skala. Die Effektgröße wurde mittels Cohen's d kalkuliert. Neun RCTs (n=564) wurden eingeschlossen. Die durchschnittliche methodische Qualität lag mit 6,9 Punkten auf der PEDro-Skala bei „gut“.Die Ergebnisse der Studien zeigten, dass sportliches Training die Fatigue bei Patient*innen mit MS reduzieren kann. Das Ausmaß der Linderung fällt je nach Art der Belastung allerdings unterschiedlich aus. Krafttrainingsformen zeigten die höchste Effektivität. Um die langfristige Aufrechterhaltung der positiven Effekte zu gewährleisten, ist ein kontinuierliches Training erforderlich.Die Aussagekraft der Ergebnisse ist durch die hohe Heterogenität der Arbeiten sowie die begrenzte Vergleichbarkeit der verwendeten Assessments limitiert. Aufgrund unzureichender Daten über die optimale Gestaltung von Belastungsparametern und individuelle Einflussfaktoren ist aktuell eine spezifizierte Trainingsempfehlung nur eingeschränkt möglich und bedarf weiterer Forschung.

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Fatigue und Fatigability bei Multipler Sklerose – Leistungsbeurteilung

Cited by 3 publications

References 19 publications

Multimodal agility-based exercise training (MAT) versus strength and endurance training (SET) to improve multiple sclerosis-related fatigue and fatigability during inpatient rehabilitation: a randomized controlled pilot and feasibility study [ReFEx]

Multimodal agility-based exercise training (MAT) versus strength and endurance training (SET) to improve multiple sclerosis-related fatigue and fatigability during inpatient rehabilitation: a randomized controlled pilot and feasibility study [ReFEx]

Experiences of fatigued persons with multiple sclerosis with multimodal agility-based exercise training and the ReFEx study protocol: a qualitative extension of a feasibility study

Einfluss sportlichen Trainings auf die Fatigue bei Patient*innen mit Multipler Sklerose

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