Trekking Poles to Aid Multiple Sclerosis (TRAMS): A Comparison of Psychosocial Impact and Function with Walking Assistive Devices in Persons with MS

Background: Walking difficulty is the most common physical functional complaint reported by persons with Multiple Sclerosis (MS). Initial discussions about the use of assistive devices (AD) to mitigate this difficulty is often met with resistance and denial of the need for an AD because of the perceived psychosocial impact of their use.

Objectives: To compare the psychosocial impact of, and walking function with, three AD in persons with MS: a single-point cane (SPC), a narrow-based four-point cane (FPC), and a trekking pole (TP)

Methods: Fourteen persons with a confirmed diagnosis of MS (12 women and 2 men; ages 33-64, mean=52.3 years), and Extended Disability Severity Scale (EDSS) score of 2.5-6 (mean=4.2) completed the study. Baseline data (i.e. without an AD) included the 12-item MS Walking Scale (MSWS-12), Activity-specific Balance Confidence Scale (ABC), 5-item Modified Fatigue Impact Scale (MFIS-5), and 6-minute Walk Test (6MWT) distance. The difference in a visual analog scale of fatigue (ΔVAS-F) given immediately before and after the 6MWT measured fatigue induced by the 6MWT. Participants were provided with the SPC, FPC or TP in a randomized, cross-over order. At the baseline and each follow-up point, participants were trained in the use of the respective AD, and were provided it for use. Participants returned within 1-2 weeks and repeated the testing battery using the AD (MSWS-12, ABC, MFIS-5, 6MWT) and also completed the Psychosocial Impact of Assistive Devices Scale (PIADS) from which three subscales were derived: Competence (PIADS-COMP), Self-esteem (PIADS-SE) and Adaptability (PIADS-ADAPT). Within-subject differences between conditions were examined with repeated-measures ANOVAs with planned pairwise comparisons.

Results: Participants walked farther in the 6MWT with the SPC (p=.003) and the TP (p=.006) compared to the FPC. No difference in ΔVAS-F was induced by the 6MWT between AD conditions (p=.162). There were improvements in MSWS-12 between the SPC (p=.005) and TP (p=.003) compared to baseline. The MFIS-5 was better (i.e. lower) with the TP compared to the baseline. There were no differences in ABC (p=.103) between conditions. Differences were found in all three PIADS subscales. PIADS-COMP was significantly better with the SPC (p=.004), but not the TP (p=.062) compared to the FPC. PIADS-SE was significantly better with the TP (p=.014), but not the SPC (p=.062) compared to the FPC. The PIADS-ADAPT was significantly better with the TP (p=.025), but not the SPC (p=.052), compared to the FPC.

Conclusions: The SPC and TP generally resulted in the best improvements in walking and fatigue. Participants reported more competence with the SPC, and better self-esteem and adaptability with the TP. Both the SPC and TP may be viable options for persons with MS that need an AD. The TP should be considered for persons for whom self-esteem and adaptability are important considerations.