Abstract
Background It is unknown how impairments caused by multiple sclerosis (MS) affect upper limb capacity, performance, and community integration.
Objective The aim of this study was to investigate the extent to which impairments explained the variance in activity level and participation level measures of the International Classification of Functioning, Disability and Health (ICF) and the extent to which upper limb capacity measures explained perceived performance on the activity level in people with MS and different dexterity levels.
Design This was a cross-sectional study.
Methods A total of 105 people with MS (median Expanded Disability Status Scale=6.5) were assessed with measures on the ICF body functions and structures level (strength, active range of motion of the wrist, tactile sensitivity, tremor, spasticity, and pain), activity level (Nine-Hole Peg Test [NHPT], Action Research Arm Test, and Manual Ability Measure-36 [MAM-36]), and participation level (Community Integration Questionnaire). The sample was divided into low- and high-dexterity subgroups on the basis of the median score on the NHPT.
Results In the total group, muscle strength, tactile sensitivity of the thumb, and intention tremor explained 53% to 64% of the variance in activity level measures. In the low-dexterity subgroup, muscle strength and active range of motion explained 43% to 71% of the variance in activity level measures. In the high-dexterity subgroup, only 35% of the variance in the MAM-36 was explained by muscle strength. Capacity measures (NHPT and Action Research Arm Test) were moderately to highly associated with perceived performance (MAM-36) in the low-dexterity subgroup.
Limitations Some outcome measures showed ceiling effects in people with MS and a high dexterity level.
Conclusions Upper limb muscle strength is the most important impairment affecting capacity and perceived performance in daily life. Associations among outcome measures differ in people with MS and different dexterity levels.
Footnotes
Dr Lamers, Dr Cattaneo, Ms Bertoni, and Dr Feys provided concept/idea/research design and project management. Dr Lamers, Dr Cattaneo, Dr Chen, Ms Bertoni, and Dr Feys provided writing and data analysis. Dr Lamers and Ms Bertoni provided data collection. Dr Cattaneo and Dr Feys provided fund procurement, facilities/equipment, and institutional liaisons. Dr Van Wijmeersch provided participants. Dr Lamers, Dr Cattaneo, Dr Chen, Ms Bertoni, and Dr Van Wijmeersch provided consultation (including review of manuscript before submission). The authors thank the participants of this study as well as Veronik Truyens (head of the Rehabilitation and MS Center, Overpelt, Belgium), Greet Adriaenssens (head of the De Mick Rehabilitation Center, Brasschaat, Belgium), and Angelo Montesano (head of Larice Lab, Don Carlo Gnocchi Foundation, Milan, Italy), for facilitation of the study. The authors gratefully acknowledge physical therapists and occupational therapists (Letizia Spina, Lore Kerkhofs, and Joke Raats) as well as student Nick Maesen for assistance with data collection.
This study was approved by the Ethics Committee of Hasselt University, Diepenbeek, Belgium; Don Carlo Gnocchi Foundation, Milan, Italy; and the local committees of the Rehabilitation and MS Center, Overpelt, Belgium, and the De Mick Rehabilitation Center, Brasschaat, Belgium. The study was conducted in accordance with the ethical standards included in the 1964 Declaration of Helsinki.
Dr Lamers is supported by a PhD fellowship from the Research Council of Hasselt University (BOF grant). Ms Bertoni is supported by a grant from the Italian Ministry of Health.
- Received November 29, 2013.
- Accepted August 24, 2014.
