Physical Capacity and Rehabilitation of Patients With Multiple Sclerosis

Study Overview
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Brief Summary
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The purpose of this study is to assess the physical capacity of patients with multiple sclerosis and the effects of rehabilitation, encompassing physical therapy and physical activity as it is carried out in the day hospital of (the Physical and Rehabilitation Medicine department) at Garches Hospital. We will compare the results of assessments carried out before and after a standard rehabilitation program.

Detailed Description
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Single center, retrospective and prospective study. In order to assess the efficiency of the of usual rehabilitation proposed to patients in the day hospital, assessments are systematically performed before and after the rehabilitation program: Assessment of muscular strength and fatigue: Assessments of voluntary force will be those usually performed in the context of the evaluation of patients. The isokinetic dynamometer CON-TREX ® is a device that provides a quantified result of the torque developed in a predetermined joint area with a constant speed which is also defined in advance. The assessment includes an assessment of the strength in isometric contraction (at 40 and 90 degrees of knee flexion) and concentric contraction (30, 60 and 90 degrees per second). Fatigue is evaluated by two self-administered questionnaires: the Fatigue Severity Scale and Modified Fatigue Impact Scale. Effort test: The aerobic capacity of patients will be assessed by a triangular maximal exercise test. The effort test is performed on a cycle ergometer from a triangular incremental exercise. Beforehand, blood pressure and ECG are recorded to establish that the patient can safely achieve a gradual stress test. Heart rate, blood pressure, oxygen consumption, the feeling (Borg scale) and ECG are recorded immediately before and immediately after the end of the test and every minute for at least 5-10 minutes during the recovery phase. Clinical assessment: The Timed Up and Go test will be used to assess the patient's capacity of postural transition. This is a timed quantitative assessment of the duration needed to change from sitting in a chair, get up and walk three meters, make a U-turn and come back to sit down. The 10 meters test quantifies the walking speed of patients (meters / second) over 10 meters A test of ascending and descending10 stairs is also performed, as well as the 6 minutes walking test. In addition to these functional assessments, clinical tests are conventionally performed such as the measurement of muscle strength (Medical Research Council scale), range of motion, spasticity (modified Ashworth scale) and an assessment of the balance and posture. The SEP-59 questionnaire will be used to assess the patients quality of life.

Official Title
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Observational Study of the Physical Capacity of Patients With Multiple Sclerosis and Evaluation of the Effects of Usual Rehabilitation in the Day Hospital

Conditions
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Multiple Sclerosis (MS)

Intervention / Treatment
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* Other: Rehabilitation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Multiple Sclerosis with EDSS ≤ 6 (Expanded Disability Status Scale) Patient ≥ 18 years old Patient able to comply with the recommended monitoring No relapse within the last three months More than six months elapsed since last medical care in day hospital No recent modification (six month) of medications for MS More than three months elapsed since last change of associated treatments (Fampyra, botulinum toxin) Exclusion Criteria: Patients under any form of guardianship or curatorship Breastfeeding Orthopedic complications with repercussions on walking activities No affiliation to a social security scheme (beneficiary or assignee)

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Assessment<br>One part of this study is to quantify physical capacity of patients with Multiple sclerosis. Thirty patients will be enrolled in this study and performed assessments. | |
| Rehabilitation<br>A second part of this study is to quantify the benefit of a usual rehabilitation program in the day hospital. Thirty patients will be enrolled in this study and receive rehabilitation. They will be assessed before and after the rehabilitation program (physiotherapy and physical activity) | Other: Rehabilitation<br>* Physiotherapy and physical activity<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Assessment of the strength and fatigue | Assessment realised with an isokinetic dynamometer | Within 10 weeks from the start of the rehabilitation program | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 6 minutes walking test | Patients were instructed to walk as far as possible in a 50 meters corridor during 6 minutes | Within 10 weeks from the start of the rehabilitation program | 
| Evaluation of aerobic capacity during an effort test | Aerobic capacity (VO2max) | Within 10 weeks from the start of the rehabilitation program | 
| Assessment of the balance of patients | Berg Balance Scale | Within 10 weeks from the start of the rehabilitation program | 
| Assessment of Spasticity with the Modified Ashworth Scale (MAS), |  | Within 10 weeks from the start of the rehabilitation program | 
| 10 meters Walk test | Patients have to walk over a 14 meter walkway and time required to traverse the middle 10 meters of the walk was recorded to avoid acceleration and deceleration effects | Within 10 weeks from the start of the rehabilitation | 
| Timed up and go test | Patients have to get up from a chair, walk 3 meters, turn around and return to sitting as quickly as possible | Within 10 weeks from the start of the rehabilitation | 
| Time to ascend and descend stairs | Participants were instructed to ascend and descend 10 stairs using the hand rail | Within 10 weeks from the start of the rehabilitation | 
| Assessment of Strength with the Medical Research Council (MRC), |  | Within 10 weeks from the start of the rehabilitation | 
| Assessment of Quality of Life with SEP-59 Scale |  | Within 10 weeks from the start of the rehabilitation | 
| Assessment of the balance of patients | Postural control assessment : eyes opened and eyes closed | Within 10 weeks from the start of the rehabilitation | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Multiple Sclerosis, Physical therapy, Physical capacity, Fatigue