The Effect of the Level of Hand Fatigability on Multiple Sclerosis on General Fatigue and Functionality
Condition: Fatigue; Functionality; Multiple Sclerosis; Dexterity
MeSH terms: Multiple Sclerosis; Sclerosis; Fatigue
Study type: Interventional

Summary: 
      The objective of this study is to investigate the effect of the level of hand fatigability on
      general fatigue and functionality by comparing Relapsing-Remitting Multiple Sclerosis
      individuals with age and sex-matched healthy individuals. 23 RRMS and 23 healthy people (mean
      age 40.08, 21 females, mean time since diagnosis 9.43 years, mean Expanded Disability Status
      Scale 3.23) were included in the study. To examine participants' fatigability level; for
      gross and pinch-grip Dynamic and Static Fatigue Index, for manual dexterity and functionality
      level Scale for the Assessment and Rating of Ataxia (SARA), Nine Hole Peg Test (NHPT) and
      Dexterity Questionnaire-24 (DextQ-24) were used. While Fatigue Severity Scale (FSS) and
      Fatigue Impact Scale (FIS) were used to examine general fatigue, Beck Depression Inventory
      (BDI) was used to assess emotional status. The mean age of healthy individuals with RRMS was
      40.08 ± 9.81 years, and the EDSS means of individuals with RRMS was 3.23 ± 1.47. 21 of both
      groups were female and 2 were male. It was determined that the difference between MS
      individuals and healthy individuals' SARA, NHPT, FSS and FIS averages, initial and final
      strength values was statistically significant (p≤0.05), and the decrease in force in
      individuals with RRMS was higher than in healthy individuals. However, there was no
      difference between RRMS and healthy individuals in terms of fatigability levels examined with
      the Dynamic and Static Fatigue Index (p>0.05). While the relationship of Static and Dynamic
      Fatigue Index with FSS and FIS was not statistically significant, the relationship was
      significant with DextQ-24's dressing, daily activities and TV/CD/DVD subsections (p<0.05). In
      individuals with early RRMS, there is a decrease in the repetitive (dynamic) and continuous
      (static) contractions of the rough and pinch grip strength, and this decrease is related to
      the negative impact on the daily living activities and functionality of the individuals. In
      particular, motor fatigue should be addressed from the early stages of rehabilitation
      programs that will be planned to maintain the active participation of individuals with RRMS
      in their daily living activities. To show motor fatigue with indices, further studies with
      different fatigue indices and individuals with RRMS at different EDSS levels are needed.
    

Detailed description: 
      Introduction Multiple sclerosis (MS) is the most common neurological disease that causes
      disability in young adults. It usually progresses with exacerbations and remissions and
      causes various problems by affecting the central nervous system in different localizations.

      Fatigue is one of the most common symptoms of MS and has the greatest impact on the patient's
      quality of life . Fatigability, which is defined as motor and muscle fatigue during motor
      tasks, is the exercise-induced decrease in the muscle's ability to produce power or force
      during sustainable tasks . In individuals with MS, fatigability levels are higher than in
      healthy individuals, as the nervous system cannot provide the necessary activation stimulus
      during maximum voluntary or continuous contractions . From the early stages of the disease,
      individuals with MS face problems such as decreased grip strength, and difficulty in holding
      small objects, which reduce dexterity and complicate daily living activities .

      When fatigue studies in MS are examined; It was observed that the studies focused mostly on
      the lower extremity and walking, and the studies on the upper extremity were also quite
      limited . To the best of our knowledge, our study is the first in its field to evaluate rough
      and pinching hand fatigability, general fatigue, and functionality levels in
      Relapsing-Remitting MS (RRMS) patients and compare them with age- and sex-matched healthy
      individuals.

      It is stated that the EDSS, which we use to evaluate the disability levels of RRMS patients,
      is not sensitive enough to evaluate functional parameters such as dexterity and cognition in
      MS . Therefore, other specific assessment methods such as the Ataxia Rating and Rating Scale
      (SARA), the Nine-Hole Peg Test (NHPT), and the Skill Questionnaire-24 (DextQ-24) were used to
      determine the level of functioning. SARA is an internationally accepted scale that is
      frequently used in the evaluation of ataxia. NHPT is the gold standard of performance-based
      assessment, which detects the patient's progress over time and is sensitive to changes in
      treatment . DextQ-24, which was developed to measure manual dexterity and consists of 24
      questions, is divided into five subgroups washing/care, dressing, food and kitchen, daily
      activities, TV/CD/DVD. The lowest total score is 24, and the highest is 96. An increase in
      the score means a decrease in dexterity. Beck Depression Inventory (BDI) is a valid and
      reliable depression scale for neurological diseases .

      The Fatigue Severity Scale (FSS) was used to determine the severity of the fatigue levels of
      individuals during the day, and the Fatigue Impact Scale (FIS) was used to determine the
      effects of fatigue on activities of daily living. The Turkish validity and reliability study
      of both scales was conducted by Armutlu et al. Static and dynamic fatigue levels in the
      coarse and pinch grip were assessed with a Jamar® digital hand dynamometer and pinch meter,
      respectively, in the standard measuring position recommended by the American Association of
      Hand Therapists . For the Dynamic Fatigue Index, a maximum of 15 voluntary contractions were
      requested from the participant. No rest was given between contractions and the number of
      remaining contractions was reported to the participant. The highest value of the first 3
      contractions (MVC1) and the highest value of the last 3 contractions (MVC2) were recorded and
      the dynamic fatigue index was calculated with the formula 100*[1-(MVC2/MVC1)]. For the Static
      Fatigue Index, after a one-minute rest break, the participant was asked to maintain the
      maximum voluntary contraction for 30 seconds and the participant was not informed about the
      remaining time. Assuming that the participant can sustain the maximum voluntary contraction
      for 30 seconds, taking into account the area generated in the graph (Hypothetical Area Under
      the Force Curve [HAUC]) and the area calculated by the time the participant can walk (Actual
      Area Under the Power Curve [AUC]) Static Fatigue Index 100*[1- (AUC/HAUC)] formula.

      The multi-dimensional evaluation of MS, which threatens all aspects of life and causes
      limitations in daily living activities, from the early period has an important place in the
      treatment and rehabilitation of individuals with MS. Determination of hand fatigability is
      essential to understand the decrease in performance in daily life in individuals with MS and
      to understand its reflection on upper extremity functionality and to plan targeted
      rehabilitation. Our study draws attention to the fact that hand fatigability may increase in
      activities that require repetitive and continuous contraction in individuals with RRMS from
      the early period and its relationship with upper extremity functionality. For a clearer
      distinction of fatigability, studies with different and more objective assessments of fatigue
      index and more studies with different types and different EDSS levels in individuals with
      RRMS are needed.
    

Intervention name(s): Nine-Hole Peg Test (NHPT)
Intervention type(s): Diagnostic Test
Intervention description(s): Ataxia Rating and Rating Scale (SARA) for coordination Nine-Hole Peg Test (NHPT) and Dexterity Questionnaire-24 (DextQ-24) for manuel dexterity Beck Depression Inventory (BDI) for depression level The Fatigue Severity Scale (FSS) and Fatigue Impact Scale (FIS) for general fatigue level Static and dynamic fatigue levels for hand fatigability
Other intervention name(s): Ataxia Rating and Rating Scale (SARA); Dexterity Questionnaire-24 (DextQ-24); Beck Depression Inventory (BDI); The Fatigue Severity Scale (FSS); Fatigue Impact Scale (FIS); Static and dynamic fatigue levels
Allocation: Non-Randomized
Intervention model: Crossover Assignment
Intervention model description: age-gender matched patient and healthy groups
Masking: None (Open Label)
Primary purpose: Other
Keywords: multiple sclerosis; fatigue; hand fatigability; manuel dexterity