Objectives Provide sample TUG and TUG C data for pwMS and a healthy - - PDF document

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Objectives Provide sample TUG and TUG C data for pwMS and a healthy - - PDF document

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6/18/2015 Exploration of Timed Up and Go scores with and without a Cognitive Challenge in People with MS and a Healthy Reference Group Laura Comber, BSc, MISCP PhD Candidate Department of Clinical Therapies University of Limerick Objectives

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Exploration of Timed Up and Go scores with and without a Cognitive Challenge in People with MS and a Healthy Reference Group

Laura Comber, BSc, MISCP PhD Candidate Department of Clinical Therapies University of Limerick

Objectives

  • Provide sample TUG and TUG‐C data for pwMS and a

healthy reference group

  • Examine within group differences in these

populations for these measures

  • Examine differences between these populations in

these measures

  • Examine differences between people with MS who

fall and those who do not in these measures

  • Present preliminary results of instrumented TUG and

TUG‐C data from a healthy reference group

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Contents

Background Methodology Results Key Points

Background

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Falls in People with MS

  • 56% in a 3 month period (Nilsagård et al 2014)
  • Effect on the individual

– Injurious Falls (Peterson et al 2008) – Fear of Falling (Peterson et al 2007) – Activity Curtailment (Peterson et al 2007)

  • Balance impairment and falls

– Pooled OR 1.07 (95%CI 1.04‐1.10) (Gunn et al 2013)

  • Gait, Turning, Postural Transitions

– Gunn et al 2014 – Matsuda et al 2012 – Nilsagård et al 2009

Why Choose the TUG?

  • Timed Up and Go

– Objective/Quick to administer – Elicits dynamic activity – MS Evaluation Database to Guide Effectiveness – IMSFPRN (Cattaneo et al 2014)

  • Timed Up and Go‐Cognitive

– PwMS dual tasking difficulties (Sosnoff et al 2011) – Dual task cost

  • Predictive Validity?
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Methodology

Study Recruitment

  • Healthy Reference Group

– University of Limerick – Undergraduate Physiotherapy Students – N=50

  • People with MS

– St Vincent’s University Hospital – MS Society of Ireland – N=51

Inclusion Criteria Exclusion Criteria EDSS 3.0‐6.5 Unable to provide consent Over 18 years of age Pregnant Women

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TUG Administration

  • Seated on a standard armchair with back rested against chair
  • Permitted to use usual aid
  • Walk as quickly and as safely as possible to the line
  • Turn, walk back and sit down again
  • 1 Practice trial and 3 timed trials performed

3 metres

  • TUG‐Cognitive: Subtracting out loud backwards in 3s from

random numbers between 20 and 100

  • Follow Up: Three months of prospective falls diaries
  • Fortnightly Text/Email Reminders

Smartphone Falls Prediction

  • App Development

– University of Limerick 2014

  • Smartphone Variables

– 4 Parameters in 3 Dimensions – 12 Summary Statistics – 5 Phases in 2 Conditions – 960 Variables

“GO”

Walk 1 Walk 2 Turn 1 Turn 2

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Statistical Analysis

  • Frequency analysis

– Mean, Standard Deviation – Median, Interquartile Range

  • Tests of Normality

– Skewed Data

  • Non‐Parametric Tests

– Wilcoxon Signed Rank – Mann‐Whitney U

Results

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Study Population

Healthy Reference (n=50) People with MS (n=51)

Mean Age 22.8±4.96 53.26±10.19 Males: Females 14:36 16:35 Mean TUG 5.78±0.78 13.55±7.59 Mean TUG‐C 5.98±1.0 16.44±9.83 Mean Disease Duration N/A 13.67±8.99 Walking Aid Users N/A 35/51 (69%) Retrospective Fallers N/A 22/51 (43%) Prospective Fallers N/A 9/27 (33%)

Within Group TUG and TUGC Difference

Healthy Ref (n=50) PwMS (n=51) Mean TUG 5.78±0.78 13.55±7.59 Median (IQR) 5.76 (1.18) 11.36 (5.94) Mean TUGC 5.98±1.0 16.44±9.83 Median (IQR) 5.98 (1.51) 13.5 (5.79) Wilcoxon p value p=0.004 p<0.001 Mean TUG Score (s)

p=0.004 p<0.001

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TUG Difference Healthy Ref Vs PwMS

TUG Score (s) Healthy (n=50) PwMS (n=51) Mean±SD

5.78±0.78 13.55±7.59

Median (IQR)

5.76 (1.18) 11.36 (5.94)

Mann‐ Whitney U

p<0.001

TUGC Difference Healthy Ref Vs PwMS

TUG‐C Score (s) Healthy (n=50) PwMS (n=51) Mean±SD

5.98±1.0 16.44±9.8

Median (IQR)

5.98 (1.51) 13.5 (5.79)

Mann‐ Whitney U

p<0.001

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Dual Task Cost% Difference Healthy Ref Vs PwMS

Healthy (n=50) PwMS (n=51) Mean±SD

97.5±9.2 86.6±17.7

Median (IQR)

97.16 (8.90) 86.66 (19.18)

Mann‐ Whitney U

p<0.001 Dual Task Cost %

TUG Difference Fallers Vs Non Fallers

Faller (n=22) Non‐Faller (n=29) Mean±SD 13.24±4.5 13.79±9.4 Median (IQR) 12.95 (5.82) 11.06 (5.14) Mann‐ Whitney U p=0.403

Retrospective Recall

TUG Score (s)

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TUGC Difference Fallers Vs Non Fallers

Faller (n=22) Non‐Faller (n=29) Mean±SD 14.82±6.3 17.66±11.8 Median (IQR) 13.66 (4.31) 12.99 (11.02) Mann‐ Whitney U p=0.955

Retrospective Recall

TUG‐C Score (s)

TUG Difference Fallers Vs Non Fallers

Faller (n=9) Non‐Faller (n=18) Mean±SD 17.46±5.2 11.77±9.7 Median (IQR) 18.44 (8.89) 8.96 (3.15) Mann‐ Whitney U p=0.001 TUG Score (s)

Prospective Monitoring

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TUGC Difference Fallers Vs Non Fallers

Faller (n=9) Non‐Faller (n=18) Mean±SD 25.48±12.4 13.74±9.96 Median (IQR) 25.53 (19.11) 11.22 (5.38) Mann‐ Whitney U p=0.004 TUGC Score (s)

Prospective Monitoring

DTC% Difference Fallers Vs Non Fallers

Faller (n=9) Non‐Faller (n=18) Mean±SD 80.56±32.4 85.59±12.8 Median (IQR) 88.73 (50.21) 85.44 (18.39) Mann‐ Whitney U p=0.860

Prospective Monitoring

Dual Task Cost %

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Preliminary Smartphone Data

  • 50 University Students
  • Mean Age 22.8±4.96
  • Cognitive Challenge

– Walk 1 Length (mean 0.11, p<0.001) – Go Phase (mean 0.07, p=0.004)

  • PwMS data collection ongoing
  • Creation of multivariate TUG/TUGC dataset

“GO”

Walk 1 Walk 2 Turn 1 Turn 2

Key Points

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Summary

  • Significant Differences in TUG and TUGC exist

between healthy populations and pwMS

  • Limited sample sizes suggest significant differences

exist between fallers and non‐fallers when prospective falls diaries are used

– Research ongoing

  • Instrumented TUG/TUGC data may be useful in

identifying pwMS at risk of falls

– Research ongoing

Prospective Falls Monitoring

  • Retrospective Vs Prospective
  • Falls Diaries IMSFPRN (Coote et al 2014)

– 3 Months

  • Small sample size (n=27)
  • Ongoing study
  • ROC and AUC analysis
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Acknowledgements

  • Funded by Education and Health Sciences Faculty Seed Fund

and MS Ireland through the Ireland Fund

  • Dr Susan Coote, UL Clinical Therapies
  • Dr Rose Galvin, UL Clinical Therapies
  • Pepijn Van de Ven, UL Engineering
  • Prof. Ailish Hannigan, UL GEMS
  • Dr Chris McGuigan, SVUH
  • Gillian Quinn, SVUH
  • UL MS Research Team (www.msrearch.ie )
  • Study Participants

Contact Information Laura.comber@ul.ie Twitter: @lauracomber

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Questions References

  • Cattaneo, D., Jonsdottir, J. and Coote, S. (2014) 'Targeting dynamic balance in falls‐

prevention interventions in multiple sclerosis: recommendations from the International MS Falls Prevention Research Network', International Journal of MS Care, 16(4), 198‐202.

  • Coote, S., Sosnoff, J. J. and Gunn, H. (2014) 'Fall incidence as the primary outcome in

multiple sclerosis falls‐prevention trials: recommendation from the International MS Falls Prevention Research Network', International Journal of MS Care, 16(4), 178‐184.

  • Gunn, H., Creanor, S., Haas, B., Marsden, J. and Freeman, J. (2014) 'Frequency,

characteristics, and consequences of falls in multiple sclerosis: findings from a cohort study', Archives Of Physical Medicine And Rehabilitation, 95(3), 538‐545.

  • Gunn, H. J., Newell, P., Haas, B., Marsden, J. F. and Freeman, J. A. (2013) 'Identification of

risk factors for falls in multiple sclerosis: a systematic review and meta‐analysis', Physical Therapy, 93(4), 504‐513.

  • Matsuda, P. N., Shumway‐Cook, A., Ciol, M. A., Bombardier, C. H. and Kartin, D. A. (2012)

'Understanding falls in multiple sclerosis: association of mobility status, concerns about falling, and accumulated impairments', Physical Therapy, 92(3), 407‐415.

  • Nilsagård, Y., Denison, E., Gunnarsson, L.‐G. and Boström, K. (2009) 'Factors perceived as

being related to accidental falls by persons with multiple sclerosis', Disability & Rehabilitation, 31(16), 1301‐1310.

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References

  • Nilsagård, Y., Gunn, H., Freeman, J., Hoang, P., Lord, S., Mazumder, R. and

Cameron, M. (2014) 'Falls in people with MS—an individual data meta‐ analysis from studies from Australia, Sweden, United Kingdom and the United States', Multiple Sclerosis Journal, 95(3), 538‐545.

  • Peterson, E. W., Cho, C. C. and Finlayson, M. L. (2007) 'Fear of falling and

associated activity curtailment among middle aged and older adults with multiple sclerosis', Multiple Sclerosis, 13(9), 1168‐1175.

  • Peterson, E. W., Cho, C. C., von Koch, L. and Finlayson, M. L. (2008)

'Injurious falls among middle aged and older adults with multiple sclerosis', Archives Of Physical Medicine And Rehabilitation, 89(6), 1031‐ 1037.

  • Sosnoff, J. J., Boes, M. K., Sandroff, B. M., Socie, M. J., Pula, J. H. and Motl,
  • R. W. (2011) 'Walking and thinking in persons with multiple sclerosis who

vary in disability', Archives Of Physical Medicine And Rehabilitation, 92(12), 2028‐2033.