Psychometric Properties of a Core Set of Measures of Balance for People With Cerebellar Ataxia Secondary to Multiple Sclerosis

Winser, Stanley John; Smith, Catherine M.; Hale, Leigh; Claydon, Leica S.; Whitney, Susan L.; Klatt, Brooke N; Mottershead, John; Zaydan, Islam M.; Heyman, Rock

doi:10.1016/j.apmr.2016.07.023

Cited by 29 publications

(34 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Various clinical balance and ataxia scales have been tested in MS cohorts and measured for potential correlation with EDSS or ability to predict falls, but results have been inconsistent and have not been applied to early MS cohorts with low overall disability. 32,33 As noted, our data demonstrate that balance impairment notably contributes to ambulatory dysfunction early in MS. These results align with previous work demonstrating that persons with MS exhibit several abnormalities of balance control (e.g., decreased ability to maintain position, slow movement toward limits of stability, and delayed responses to postural displacements), which all contribute to gait dysfunction and increased fall risk.…”

Section: Discussionsupporting

confidence: 73%

Detection of subtle gait disturbance and future fall risk in early multiple sclerosis

et al. 2020

View full text Add to dashboard Cite

ObjectiveTo test the hypothesis that higher-challenge gait and balance tasks are more sensitive than traditional metrics to subtle patient-reported gait dysfunction and future fall risk in early multiple sclerosis (MS).MethodsPersons with early MS (n = 185; ≤5 years diagnosed) reported gait function (MS Walking Scale) and underwent traditional disability metrics (Expanded Disability Status Scale [EDSS], Timed 25 Foot Walk). Patients and healthy controls (n = 50) completed clinically feasible challenge tasks of gait endurance (2-Minute Walk Test), standing balance (NIH Toolbox), and dynamic balance (balance boards; tandem walk on 2 ten-foot boards of different widths, 4.5 and 1.5 in). MRI assessed global and regional brain volumes, total T2 lesion volume (T2LV), infratentorial T2LVs and counts, and cervical cord lesion counts. Falls, near falls, and fall-related injuries were assessed after 1 year. We examined links between all tasks and patient-reported gait, MRI markers, and fall data.ResultsPatients performed worse on higher challenge balance, but not gait, tasks compared with healthy controls. Worse patient-reported gait disturbance was associated with worse performance on all tasks, but only dynamic balance was sensitive to mild patient-reported gait difficulty. Balance tasks were more correlated with MRI metrics than were walking tasks or EDSS score. Thirty percent of patients reported either a fall or near fall after 1 year, with poor dynamic balance as the only task independently predicting falls.ConclusionsBalance plays a leading role in gait dysfunction early in MS. Clinically feasible higher-challenge balance tasks were most sensitive to patient-reported gait, MRI disease markers, and risk of future falls, highlighting potential to advance functional outcomes in clinical practice and trials.

show abstract

Section: Discussionsupporting

confidence: 73%

Detection of subtle gait disturbance and future fall risk in early multiple sclerosis

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Elements within each domain of the mini-BESTest capture elements of static and/or dynamic balance. The ICARS is a clinical test that detects ataxia in five domains: posture, gait, kinetic, speech, and oculomotor function [ 39 , 40 ]. The ICARS has been reported as a reliable measure of ataxia in persons MS [ 41 ].…”

Section: Methodsmentioning

confidence: 99%

“…The following domains of the Mini-BESTest improved significantly: anticipatory ( p = 0.010, CI = [0.32, ∞)), reactive postural control ( p = 0.0085, CI = [1.08,∞)), and dynamic gait ( p = 0.005, CI = [0.97, ∞)). Total ICARS scores demonstrated a significant reduction in ataxia ( p = 7.11e-5, (-∞, -14.34]), where the minimal detectable change is > -5 points over a twelve month period in patients with spinocerebellar ataxias [ 40 , 43 ]). Significant improvements in specific ICARS domains were observed in posture and gait ( p = 1.09e-4, (-∞, -5.49]) and kinetic ( p = 0.001, CI = (-∞, -8.84]).…”

Section: Methodsmentioning

confidence: 99%

Targeted ballet program mitigates ataxia and improves balance in females with mild-to-moderate multiple sclerosis

et al. 2018

View full text Add to dashboard Cite

BackgroundMultiple sclerosis (MS) is a disease of the central nervous system that causes ataxia and deficits in balance. Exercise-based therapies have been identified as integral to the recovery of motor function in MS, but few studies have investigated non-traditional movement interventions. We examined a targeted ballet program (TBP) designed to mitigate ataxia and improve balance in females with mild-to-moderate relapsing-remitting MS.Methods and findingsTwelve females with mild-to-moderate disability due to MS were assessed for study eligibility for the study. Ten participants met the inclusion criteria. Two were lost to unrelated health complications. Eight participants completed the TBP. The TBP met twice a week for 60 minutes for 16 weeks. Assessments included (a) the International Cooperative Ataxia Rating Scale (ICARS), (b) the Mini-Balance Evaluations Systems Test (Mini-BESTest), (c) smoothness of movement during a five-meter walk, and (d) balance in a step to stand task before and after the TBP. There were no TBP-related adverse events. Single-tailed paired samples t-tests and Wilcoxon tests were conducted. Improvements were observed in ICARS (p = 7.11E-05), Mini-BESTest (p = 0.001), smoothness of movement in the left (p = 0.027) and right (p = 0.028) sides of the body, and balance in a step-to-stand task in the back (p = 0.025) direction. Results yielded 42% and 58% improvements in the mean Mini-BESTest and ICARS scores, respectively.ConclusionsThis study adds to current research by providing support for a TBP intervention targeting ataxia and balance in MS. The TBP was well tolerated, improved balance, and mitigated ataxia. Clinical improvements were larger than those of previous studies on physical rehabilitation in MS with similar outcome measures.Trial registrationISRCTN ISRCTN67916624.

show abstract

“…In contrast to the previously published study ( 6 ), we used SARA to estimate disease severity. SARA is a reliable, valid and sensitive measuring tool for estimating disease severity amongst patients with cerebellar ataxia ( 9 , 10 ). Besides, we also used SARA scores to subcategorise our patients based on their independence in ADL, which arguably exhibits better accuracy.…”

Section: Discussionmentioning

confidence: 99%

“…Patients who scored <10 were categorized into the independent to minimally dependent group, and those who scored >10 were placed under the moderate to maximally dependent group ( 8 ). SARA has been reported to have high inter-rater reliability ( 9 ), test–retest reliability ( 9 ), and construct validity ( 10 ) for estimating disease severity in patients with cerebellar ataxia. The Short Form (36) Health Survey (SF-36) was used to measure HRQoL.…”

Section: Methodsmentioning

confidence: 99%

Cost of Cerebellar Ataxia in Hong Kong: A Retrospective Cost-of-Illness Analysis

et al. 2020

View full text Add to dashboard Cite

Background: Cerebellar ataxia affects the coordination and balance of patients. The impact of this disease increases burden in patients, caregivers and society. Costs and the burden of this disease have not been investigated in Hong Kong. Objectives: (1) To estimate the socioeconomic cost of cerebellar ataxia in Hong Kong for the base year 2019, (2) to assess the health-related quality of life (HRQoL) and severity of ataxia, and (3) to establish the correlation between the severity and cost of cerebellar ataxia and to examine the correlation between the severity of cerebellar ataxia and HRQoL. Methods: A retrospective cross-sectional study was conducted amongst 31 patients with cerebellar ataxia. Cost-related data were obtained through self-reported questionnaires. The severity of ataxia was assessed using the Scale for Assessment and Rating of Ataxia, and HRQoL was assessed using the Short Form (36) Health Survey (SF-36). Pearson correlation was used for normally distributed data, whereas Spearman correlation was used otherwise. Results: The mean severity of ataxia was 21 out of 40. The average direct and indirect costs of a patient with ataxia in 6 months were HKD 51,371 and HKD 93,855, respectively. The mean difference between the independent to minimally dependent in activities of daily living (ADL) group and the moderate to maximally dependent in ADL group for direct and indirect costs was HKD 33,829 and HKD 51,444, respectively. Significant expenditure was related to production lost (42%), caregiver salary (17%), and in-patient care (16%). The physical functioning (r = −0.58) and general health (r = −0.41) of SF-36 were negatively correlated with disease severity (p < 0.05). A significant, positive correlation was found between disease severity and direct cost (Spearman's rho = 0.39) and the cost of hiring a caregiver (Spearman's rho = 0.43). Conclusion: The mean cost for 6 months for patients with cerebellar ataxia in Hong Kong is HKD 146,832. Additional support, including employment, access to specialist consultants, informal home care and community participation, are some areas that should be addressed. Future study on a larger population with a prospective design is necessary to confirm the aforementioned claims.

show abstract

Psychometric Properties of a Core Set of Measures of Balance for People With Cerebellar Ataxia Secondary to Multiple Sclerosis

Cited by 29 publications

References 28 publications

Detection of subtle gait disturbance and future fall risk in early multiple sclerosis

Detection of subtle gait disturbance and future fall risk in early multiple sclerosis

Targeted ballet program mitigates ataxia and improves balance in females with mild-to-moderate multiple sclerosis

Cost of Cerebellar Ataxia in Hong Kong: A Retrospective Cost-of-Illness Analysis

Contact Info

Product

Resources

About