Habitual Functional Electrical Stimulation Therapy Improves Gait Kinematics and Walking Performance, but Not Patient-Reported Functional Outcomes, of People with Multiple Sclerosis who Present with Foot-Drop
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Date
2014-08-18Author
van der Linden, Marietta
Hooper, Julie
Cowan, P.
Weller, B.
Mercer, Tom
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van der Linden, M., Hooper, J., Cowan, P., Weller, B. & Mercer, T. (2014) Habitual Functional Electrical Stimulation Therapy Improves Gait Kinematics and Walking Performance, but Not Patient-Reported Functional Outcomes, of People with Multiple Sclerosis who Present with Foot-Drop. PLoS ONE, 9(8): e103368.
Abstract
Background: People with Multiple Sclerosis (pwMS) often experience a disturbed gait function such as foot-drop. The
objective of this pilot study was to investigate the medium term effects of using Functional Electrical Stimulation (FES) to
treat foot-drop over a period 12 weeks on gait and patient reported outcomes of pwMS.
Methods and Findings: Nine pwMS aged 35 to 64 (2 males, 7 females) were assessed on four occasions; four weeks before
baseline, at baseline and after six weeks and twelve weeks of FES use. Joint kinematics and performance on the 10 meter
and 2 minute walk tests (10WT, 2 minWT) were assessed with and without FES. Participants also completed the MS walking
Scale (MSWS), MS impact scale (MSIS29), Fatigue Severity Score (FSS) and wore an activity monitor for seven days after each
assessment. Compared to unassisted walking, FES resulted in statistically significant improvements in peak dorsiflexion in
swing (p = 0.006), 10MWT (p = 0.006) and 2 minWT (p = 0.002). Effect sizes for the training effect, defined as the change from
unassisted walking at baseline to that at 12 weeks, indicated improved ankle angle at initial contact (2.6u, 95% CI 21u to 4u,
d = 0.78), and a decrease in perceived exertion over the 2 min walking tests (21.2 points, 95% CI 25.7 to 3.4, d =20.86).
Five participants exceeded the Minimally Detectable Change (MDC) for a training effect on the 10mWT, but only two did so
for the 2 minWT. No effects of the use of FES for 12 weeks were found for MSWS, MSIS29, FSS or step count.
Conclusion: Although FES to treat foot-drop appears to offer the potential for a medium term training effect on ankle
kinematics and walking speed, this was not reflected in the patient reported outcomes. This observed lack of relationship
between objective walking performance and patient reported outcomes warrants further investigation.