Prevalence of Upper Extremity Involvement Across ICF Domains Among Persons with Multiple Sclerosis
Objectives: To estimate prevalence of upper extremity (UE) involvement among persons with MS (pwMS) across the ICF domains of UE impairment, capacity and performance.
Methods: Twenty-seven subjects were recruited at a community-based comprehensive MS center. UE impairment was measured using grip strength and 8 self-reported UE symptoms. Capacity was measured using the Box and Block Test (BBT), 9-Hole Peg Test (9HPT), and UE performance test for the elderly (TEMPA). Performance was measured using the DASH. Means and s.d. were calculated for each quantitative measure; % of patients whose measures were >2 s.d. worse than age-, gender-, or age- and gender-specific norms (depending on measure) were determined.
Results: Across a wide range of EDSS scores (2 to 7), 85% of pwMS in the study self-reported at least one UE symptom. Weakness was the most commonly reported symptom. Over half reported UE tingling, loss of sensation, trouble doing everyday tasks with affected limb(s), numbness, and weakness. UE spasms (19%) and stiffness (26%) were reported less frequently. Compared to gender- and age-specific norms, 33% and 19% of subjects were >2 sd below norms for right and left grip strength, respectively. For capacity measures, 70% and 59% for the 9HPT and 93% and 89% for the BBT were >2 sd above gender- and age-specific norms for dominant and non-dominant hands, respectively. TEMPA was developed for elderly adults so norms are based on 60+ year-olds. Nonetheless, between 44% and 93% of subjects had times to complete each task that were >2 sd above gender-specific means for the 60-69 year old norms. The DASH was the measure of performance; 30% of subjects were >2 sd above norms.
Conclusions: Persons with MS have considerable upper extremity involvement across ICF domains of impairment, capacity and performance.