Understanding the Effects of Fatigue on Gait in Persons with Multiple Sclerosis
Gait disturbances and mobility impairments are commonly reported by persons with multiple sclerosis (PWMS), resulting in decreased quality of life (Larocca, 2011). Seventy percent of PWMS report that difficulty walking is the most significant challenge associated with their disease (Larocca, 2011). In addition, one-third of PWMS experience fatigue, which may be associated with motor and/or mood disturbances and is also a significant disabling symptom (Comi, 2001). Fatigue in MS is associated with the disease itself, and is not always related to motor dysfunction (Alvarenga-Filho, 2015).
Objectives: The purpose of this review was to examine the effect of fatigue on walking in individuals with MS.
Methods: A systematic literature review was performed to examine the effects of fatigue on walking in individuals with multiple sclerosis. The search included human-based studies in English published between January 1st, 2004 and April 4th, 2017. Articles were collected using three search engines: Ovid Medline, PubMed, and Cinahl, using the following search terms: “fatigue”, “walking”, AND “multiple sclerosis. After duplicates were removed, the initial search yielded 183 articles. Expert opinion title searches were employed to reduce the number of articles to 46. Detailed abstract and brief article reviews yielded 12 articles that met the inclusion criteria. Critical appraisal of the 12 remaining articles, resulted in the exclusion of three additional articles due to walking not being their primary intervention, Eight articles were ultimately included in this systematic review of literature. The internal validity of these eight articles was assessed using the PEDro scale.
Eight articles were included in the final review. PEDro Scale scores for these 8 articles ranged from 3-6/11. There were a total 449 participants in the 8 studies; 338 had MS ranging from mild to moderate severity based on Expanded Disability Status Score (EDSS) scores. Five of the eight articles compared subjects with MS to healthy age- matched control participants during performance of the 6MWT. Three of the eight articles compared participants with mild MS to those with moderate MS during performance of the 6MWT.
Conclusions: Subjective reports of fatigue did not correlate with changes in mean walking speed during 6MWT, however; age, disease severity and the energy cost of walking were inversely related to walking speed and distance walked. Subjective reports of fatigue to do not adequately explain changes in gait in PWMS during a 6MWT.