6/18/2015 Trekking Poles to Aid Multiple Sclerosis (TRAMS): A Comparison of Psychosocial Impact and Function with Walking Assistive Devices in Persons with Multiple Sclerosis Do na ld A. Ba ro ne , DO E va n T . Co he n, PT , MA, PhD, NCS Sa ra So lima n, DO Christine Be swic k, BA, CCRP E ric Go ldwa sse r, DO/ PhD Ca ndida te Adil Ma nzo o r, BS Aliso n Ca rua na , BS Nisha nt Pa rikh, BS TRAMS • Wa lking diffic ulty is the mo st c o mmo n physic a l func tio na l c o mpla int re po rte d b y pe rso ns with Multiple Sc le ro sis (MS) (e .g . Minde n e t a l, 2006) • I nitia l disc ussio n a b o ut the use o f a ssistive de vic e s (AD)to mitig a te this diffic ulty is o fte n me t with re sista nc e a nd de nia l o f the ne e d due to pe rc e ive d psyc ho so c ia l impa c t o f the ir use Minde n, S. L ., F ra nke l, D., Ha dde n, L ., Pe rlo ff, J., Srina th, K . P., & Ho a g lin, D. C. (2006). T he So nya Slifka lo ng itudina l multiple sc le ro sis study: me tho ds a nd sa mple c ha ra c te ristic s. Multiple S c le ro sis , 12 (1), 24-38. 1
6/18/2015 TRAMS Ob je c tive : T o c o mpa re the psyc ho so c ia l impa c t o f, a nd wa lking func tio n with, 3 AD in pe rso ns with MS: o Sing le po int c a ne (SPC) o Na rro w-b a se d fo ur po int c a ne (F PC) o T re kking po le (T P) TRAMS • I nitia l sub je c t re c ruitme nt ta rg e te d pa tie nts fro m o ur MS c linic with c o nfirme d MS dia g no sis b y Mc Do na ld c rite ria (2010) a nd pe rc e ive d wa lking diffic ulty no t re q uiring mo re tha n unila te ra l suppo rt 2
6/18/2015 TRAMS • At the study sc re e ning visit, E DSS e va lua tio n wa s pe rfo rme d a nd pa tie nts with E DSS sc o re s up to a nd inc luding 6.0 we re e lig ib le fo r inc lusio n Study Variables • Six-Minute Wa lk T e st (6WMT ) dista nc e • Psyc ho so c ia l I mpa c t o f Assistive De vic e s Sc a le (PI ADS) o 26-ite m q ue stio nna ire o “Ho w is yo ur _______ a ffe c te d b y using the ________” • 12-ite m Multiple Sc le ro sis Wa lking Sc a le (MSWS-12) • Ac tivity-Spe c ific Ba la nc e Co nfide nc e Sc a le (ABC) • 5-I te m Mo difie d F a tig ue I mpa c t Sc a le (MF I S-5) • Visua l Ana lo g Sc a le o f F a tig ue (VASF ) 3
6/18/2015 Methods – Study Design Assessed for eligibility (n=19) Enrollment Excluded (n=3) ► Not meeting inclusion criteria (n=3) ► Declined to participate (n=0) ► Other reasons (n=0) Randomized to AD order group (n=16): Allocation SPC>FPC>TP; SPC>TP>FPC; FPC>SPC>TP; FPR>TP>SPC; TP>SPC>FPC; TP>FPC>SPC Allocated to group (n=16) ► Received allocated intervention (n=14) ► Did not receive allocated intervention (n=2) • 1 unrelated injury • 1 unable to safely use all ADs Analysed (n=14) Analysis ► Excluded from analysis (n=0) Method: Analyses • Within-sub je c t diffe re nc e s b e twe e n AD c o nditio ns we re a na lyze d fo r e a c h study va ria b le o Da ta wa s a na lyze d with re pe a te d-me a sure s ANOVAs o r F rie dma n’ s te sts (a s a ppro pria te ) with pla nne d pa irwise c o mpa riso ns 4
6/18/2015 Results: Participant Characteristics F o urte e n pe rso ns with MS • 12 wo me n a nd 2 me n • Ag e ra ng e 33-64 ye a rs (me a n 52.3) • E DSS ra ng e 2.5-6 (me dia n 4.25, I QR 2) Results: Walking Performance 6 ‐ Minute Walk Test • Pa rtic ipa nts wa lke d fa rthe r during a 6MWT with the SPC a nd the T P c o mpa re d to the F PC p=.003 p=.006 450 400 350 300 Meters 250 200 150 100 50 0 None SPC FPC TP Assistive Device 5
6/18/2015 Results: Psychosocial Impact PIADS ‐ Adaptability PIADS ‐ Competence PIADS ‐ Self ‐ Esteem • • • Be tte r with the Be tte r with the Be tte r with the T P, b ut no t the SPC, b ut no t the T P, b ut no t the SPC, c o mpa re d T P, c o mpa re d to SPC, c o mpa re d to the F PC. the F PC. to the F PC. p=.014 p=.025 p=.004 1.0 1.0 1.0 0.8 0.8 0.8 0.6 0.6 0.6 0.4 0.4 0.4 0.2 0.2 0.2 0.0 0.0 0.0 ‐ 0.2 ‐ 0.2 ‐ 0.2 ‐ 0.4 ‐ 0.4 ‐ 0.4 ‐ 0.6 ‐ 0.6 ‐ 0.6 SPC FPC TP SPC FPC TP SPC FPC TP Assistive Device Assistive Device Assistive Device Results: Fatigue 5 ‐ Item Modified Fatigue Change in Visual Analog Impact Scale Fatigue Scale • • Be tte r (i.e . lo we r) with T P No diffe re nc e induc e d b y c o mpa re d to the the 6MWT b e twe e n AD b a se line c o nditio ns 20 p=.018 60 18 50 16 14 40 12 10 30 8 20 6 4 10 2 0 0 None SPC FPC TP None SPC FPC TP Assistive Device Assistive Device 6
6/18/2015 Results: Self ‐ Report of Walking and Balance Activities ‐ Specific Balance 12 ‐ Item MS Walking Scale Confidence Scale • • Be tte r (i.e . lo we r) with T P No diffe re nc e induc e d b y a nd SPC c o mpa re d to the the 6MWT b e twe e n AD b a se line c o nditio ns p=.003 100 100 90 90 p=.005 80 80 70 70 60 60 50 50 40 40 30 30 20 20 10 10 0 0 None SPC FPC TP None SPC FPC TP Assistive Device Assistive Device Conclusions and Recommendations • T he SPC a nd T P g e ne ra lly re sulte d in the b e st wa lking func tio n a nd lo we st fa tig ue . • Pa rtic ipa nts re po rte d hig he r c o mpe te nc e with the SPC, a nd b e tte r se lf-e ste e m a nd a da pta b ility with the T P. • Bo th the SPC a nd T P ma y b e via b le o ptio ns fo r pe rso ns with MS tha t ne e d a n AD. • T he T P sho uld b e c o nside re d fo r pe rso ns fo r who m se lf- e ste e m a nd a da pta b ility a re impo rta nt c o nside ra tio ns. 7
6/18/2015 Acknowledgements T ha nks to • Our te a m o f suppo rting me dic a l stude nts fro m Ro wa n Unive rsity’ s Sc ho o l o f Oste o pa thic Me dic ine • T he pa rtic ipa nts who vo lunte e re d the ir time a nd e ne rg y 8
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