Effects of multidisciplinary inpatient rehabilitation on everyday life physical activity and gait in patients with multiple sclerosis

Abstract

Background: Multiple sclerosis is a progressive neurological disease that affects the central nervous system, resulting in various symptoms. Among these, impaired mobility and fatigue stand out as the most prevalent. The progressive worsening of symptoms adversely alters quality of life, social interactions and participation in activities of daily living. The main objective of this study is to bring new insights into the impact of a multidisciplinary inpatient rehabilitation on supervised walking tests, physical activity (PA) behavior and everyday gait patterns.

Methods: A total of 52 patients, diagnosed with multiple sclerosis, were evaluated before and after 3 weeks of inpatient rehabilitation. Each measurement period consisted of clinical assessments and 7 days home monitoring using foot-mounted sensors. In addition, we considered two subgroups based on the Expanded Disability Status Scale (EDSS) scores: 'mild' (EDSS < 5) and 'severe' (EDSS ≥ 5) disability levels.

Results: Significant improvements in fatigue, quality of life and perceived mobility were reported. In addition, walking capacity, as assessed by the 10-m walking test, two-minute walk test and timed-up-and-go test, improved significantly after rehabilitation. Regarding the home assessment, mildly disabled patients significantly increased their locomotion per day and complexity of daily PA pattern after rehabilitation, while severely disabled patients did not significantly change. There were distinct and significant differences in gait metrics (i.e., gait speed, stride length, cadence) between mildly and severely disabled patients, but the statistical models did not show a significant overall rehabilitation effect on these gait metrics.

Conclusion: Inpatient rehabilitation showed beneficial effects on self-reported mobility, self-rated health questionnaires, and walking capacity in both mildly and severely disabled patients. However, these improvements do not necessarily translate to home performance in severely disabled patients, or only marginally in mildly disabled patients. Motivational and behavioral factors should also be considered and incorporated into treatment strategies.

Fig. 1

Study design overview. Measurement pre-rehabilitation: 7 consecutive days within 1–4 weeks before the multidisciplinary inpatient rehabilitation (MIR), depending on patients’ availabilities; measurement post-rehabilitation: 7 consecutive days immediately after the MIR

Fig. 2

Data aggregation procedure for the gait metrics assessed in daily life. WB: walking bout

Fig. 3

Patient-reported questionnaires and functional tests pre- and post- rehabilitation. The boxplots on the left (dark and light blue) correspond to the scores obtained for mildly disabled pwMS, whereas the boxplots on the right (dark and light orange) summarize the values obtained for severely disabled pwMS. FSMC Fatigue Scale for Motor and Cognitive Functions, EQ-VAS patient’s self-rated health on a vertical visual analogue scale, MSWS-12 Twelve Item Multiple Sclerosis Walking Scale, TUG timed-up and go, 10mWT 10 m walking test, 2MWT 2 min walking test, EDSS Expanded Disability Status Scale

Fig. 4

Physical activity (PA) and gait metrics pre- and post- rehabilitation. Loc percentage locomotion per day, LPA percentage of light PA per day, MVPA percentage of moderate-to-vigorous PA per day, Hn information entropy, PLZC permutation Lempel–Ziv complexity;

Fig. 5

Distribution of gait speed at home (small color dot) for each patient before and after the rehabilitation period. Each dot corresponds to the average walking speed during one walking bout. The large black squares represent the average values of the 10 m walking test assessed in supervised condition