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People with Parkinson's (PwP) are suffering from reduced exercise capacity. However, little information is known about clinical correlates of exercise capacity in this population This study aimed to evaluate correlations between motor and non-motor symptoms with exercise capacity in PwP. A total of 50 individuals with Parkinson's disease participated in the study. Exercise capacity was measured by 6 minutes' walk test (6MWT). Besides, the Movement Disorder Society-Unified Parkinson's Disease Rating Scale-Part III used to evaluate disease motor severity, Berg Balance Scale to assess balance, Montréal Cognitive Assessment to evaluate cognitive status, hospital anxiety and depression scale to assess depression and anxiety, Modified Fatigue Impact scale to evaluate fatigue, and the Pittsburgh Sleep Quality Index to evaluate sleep quality. The results showed that exercise capacity, when measured by the 6MWT, can be significantly predicted by balance, disease motor severity, anxiety, and age (R2 = 0.61 P <.0001). These results suggest that exercise capacity in PwP is multifactorial and can potentially be predicted by balance, motor severity, anxiety, and age. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the motor and non-motor factors associated with sit-to-stand performance in people with Multiple Sclerosis (PwMS). Observational cross-sectional study. A total of 88 individuals with MS participated in this study. Standing performance was measured using the five-times-sit-to-stand test (FTSTS). The Berg Balance Scale to assess balance, the 10-Meter Walking Test (10-MWT) was used to assess walking speed; the Patient Determined Disease Steps (PDDS) was used to assess disability level. Furthermore, Brief International Cognitive Assessment for MS (BICAMS) was used to assess cognitive status, Hospital Anxiety and Depression scale (HADS) to assess depression and anxiety, and the Modified Fatigue Impact scale (MFIS) to evaluate fatigue. Spearman correlation coefficient was used to determine the relationship between all these variables and the FTSTS. Furthermore, multiple linear regression was conducted to determine predictive factors of the FTSTS. FTSTS score was correlated significantly with BBS, PDDS, BICAMS, 10-MWT and MFIS (r ranged from 0.3 to 0.52; P <.05). However, there was no significant correlation observed between the FTSTS and HADS-depression or HADS-anxiety. Considering the multiple regression analysis, the following factors were significantly predictive of the FTSTS: 10-MWT, MFIS and the BICAMS-z score (R2: 0.433, P <.0001). The study concludes that sit to stand is multifactorial and is potentially associated with walking speed, cognitive function and fatigue. These factors should be considered by healthcare professionals in interpreting the sit-to-stand performance of PwMS and in designing rehabilitation interventions. [ABSTRACT FROM AUTHOR]

The Patient Determined Disease Steps (PDDS) is a patient-reported outcome that measures disease severity in People with Multiple Sclerosis (PwMS). It is crucial to have instruments in various languages to ease the use and interpretation of clinical and research findings among PwMS. To translate the PDDS into the Arabic language and explore its reliability and criterion validity with the EDSS, and convergent validity with fatigue, walking, and balance assessments. Backward and forward translation methods were used to generate the PDDS translated version (PDDS-A). A total of 115 PwMS, mean age: 33.7 (SD, 10.6) completed the PDDS-A, the EDSS, and the Modified Fatigue Impact Scale Arabic version (MFIS-A). A sub-sample N = 89 performed walking and balance assessments. The PDDS-A was reevaluated after 2–3 weeks to measure its test-retest reliability. There was a strong correlation between the PDDS-A and EDSS (rho = 0.864). PDDS-A was moderately associated with the MFIS-A total score (rho = 0.598) and its subcomponents (physical: rho = 0.642, and cognitive: rho = 0.474). The PDDS-A showed significant correlations with walking endurance and speed, and balance. There was excellent test-retest reliability: 0.942 (95% CI 0.896–0.968). The PDDS-A is a reliable and valid tool that can be used among Arabic-speaking PwMS. [ABSTRACT FROM AUTHOR]

Background: Patient‐generated index (PGI) is one of the individualized measures used to measure the quality of life (QOL) in people with different chronic conditions including multiple sclerosis (MS). However, the psychometric properties of the Arabic version of the PGI have not been fully established in Jordanian living with MS. Therefore, the objective of this study is to identify what matters to Jordanian living with MS and to contribute evidence toward the psychometric properties of the Arabic version of the PGI. Methods: A total of 75 participants with MS completed three QOL measures; PGI, the patient determined disease steps (PDDS), and EQ‐5D. Generalized estimating equations were used to compare the total score of three QOL measures. Bland–Altman plot and Spearman's correlation coefficient were used to study the relationships and differences between the PGI and the other study measures (PDDS and EQ‐5D). Results: Only 66 (88%) of the participants were able to complete the PGI. Overall, 36 areas of QOL concern were nominated by the participants using the PGI with the top three areas were emotional function (47%), involuntary movement reaction functions (45.5%), and walking (44 %). The average global score of the PGI was lower (34 ± 22) than the global score of the EQ‐5D (69 ± 23), and the PDDS (68 ± 24). PGI had a moderate correlation with EQ‐5D and PPDS. Conclusion: The Arabic version of the PGI is a feasible, acceptable, and valid measure among Jordanians with MS. PGI also captures more important areas that contribute to QOL than EQ‐5D and PDDS. PGI could improve the decision making and guide healthcare professionals to provide appropriate intervention programs to reduce the burdens from MS disease and improve QOL. [ABSTRACT FROM AUTHOR]

Objective. To identify the risk factors, etiologies, length of stay, severity, and predictors of disability among patients with the first ischemic stroke in Jordan. Methods. A retrospective cohort study of 142 patients who were admitted to the Neurology Department at King Abdullah University Hospital between July/2017 and March/2018 with a first ischemic stroke. Etiology was classified according to the TOAST criteria. Severity was represented by NIHSS score, disability by mRS score, and prolonged length of stay as hospitalizations more than 75th percentile of the cohort's median length of stay. Analysis of the sample demographics and descriptive statistics were done, including frequencies of prevalence of independent variables (risk factors) and frequencies of stroke and etiology work-up. Chi-square and univariate analysis of variance "ANOVA" were used to investigate the relationship between risk factors and type of stroke. Finally, logistic regression analysis was used to measure the contribution of each of the independent variables. IRB approval was obtained as necessary. Results. The mean age for the cohort was 66.5 years. The most common risk factors were hypertension (78.8%), diabetes mellitus (60.5%), and ischemic heart disease (29.4%). The most common stroke etiology was small-vessel occlusion (54.2%). Median length of stay was 4 days. Prolonged length of stay was observed in 23.23% of patients, which was associated with several factors, the most common of which were persistent dysphagia (57.5%), nosocomial infection (39.3%), and combined dysphagia and nosocomial infection (21.2%). The mean admission NIHSS score was 7.94, and on discharge was 5.76. In-hospital mortality was 2.81%, while 50% of patients had a favorable outcome on discharge (mRS score between 0-2). The mean discharge mRS score for the cohort was 2.47 (SD ± 1.79). Large artery atherosclerosis was associated with the highest residual disability with a mean score of 3.67 (SD ± 1.88), while the stroke of undetermined etiology was associated with the lowest residual disability with a mean score of 1.60 (SD ± 1.78). Significant predictors of mRS score were smoking (t 3.24, P < 0.001), age (t 1.98, P < 0.049), and NIHSS score (t 9.979, P 0.000). Conclusion. Ischemic strokes have different etiologies that are associated with different levels of impact on the patient's clinical status and prognosis. Large artery atherosclerosis was associated with the highest residual disability. Regarding predictors of prognosis, current smoking status, age above 50, gender, and NIHSS on admission appear to be the strongest predictors of prognosis. Finally, higher NIHSS score on admission resulted in a longer hospital stay. [ABSTRACT FROM AUTHOR]

BACKGROUND: Balance and gait impairments are common disorders in people with multiple sclerosis (MS). The Activities-specific Balance Confidence scale (ABC) is one of the important measures of balance confidence that can be used in people with MS. The Arabic version of the ABC was developed and validated in other than MS population. OBJECTIVE: To examine the psychometric properties of the Arabic Activities-specific Balance Confidence scale (A-ABC) among patients with MS. METHODS: A multicenter, reliability design was used to administer the A-ABC to a convenience sample of people with MS. The test-retest reliability of the A-ABC item and total scores were examined using the intraclass correlation coefficient (ICC) and 95% confidence interval (CI). Additionally, the validity of the A-ABC with Arabic Berg Balance Scale (A-BBS), Arabic Dynamic Gait Index (A-DGI), and Barthel Index (BI) was assessed using Spearman Correlation Coefficient (r). Moreover, the minimal detectable change for the A-ABC was established in people with MS. RESULTS: Eighty nine patients with MS (mean [SD] age = 38 [10]; female = 58) were enrolled. The internal consistency of the A-ABC was 0.96 while the minimal detectable change was 11.28. The A-ABC (mean [SD] = 61 [29]) had significant correlations with A-BBS (r = 0.76, P < 0.05), A-DGI (r = 0.65, P < 0.05), BI (r = 0.63, P < 0.05), and age (r = –0.37, P < 0.05). Fifty-two patients (58%) completed the A-ABC twice with one week interval. Excellent test-retest reliability of the A-ABC item (ICC≥0.90) and total scores [ICC = 0.98; 95% CI (0.96–0.99)] was found. CONCLUSIONS: The Arabic Activities-specific Balance Confidence scale showed very good psychometric properties and can be utilized with Arabic-speaking patients with multiple sclerosis. [ABSTRACT FROM AUTHOR]

Background. Fear of falling (FOF) is an important risk indicator for health-related outcomes and quality of life in patients with multiple sclerosis (MS). However, factors associated with FOF in MS are not well investigated. Objectives. This study was done to explore predictors of FOF in this population. Methods. Seventy relapsing remitting patients with MS were evaluated. Fear of falling was assessed using the Fall Efficacy Scale--International (FES-I). Motor outcomes included: 30-second chair stand test (30s-CST), Berg Balance Scale (BBS), 10-Meter Walk Test (10MWT), and 6-Minute Walk Test (6MWT). Cognitive status was determined using the Montréal Cognitive Assessment (MOCA) and Symbol Digit Modalities Test (SDMT). Affective factors including depression, fatigue, and sleep were also assessed using the Beck Depression Inventory (BDI), Modified Fatigue Impact Scale (MFIS), and Pittsburgh Sleep Quality Index (PSQI), respectively. Results. Fear of falling was significantly correlated with all motor and affective measures used. However, a stepwise regression found that only BBS from motor measures, MOCA from cognitive measures, and sleep disorders from affective factors were significantly predictive of the FOF. Conclusions. Fear of falling in patients with MS is multifactorial and includes motor and nonmotor factors. Thus, therapies that aim to reduce risk of falling in this population should address motor functions, cognitive abilities, and sleep quality. [ABSTRACT FROM AUTHOR]

Background and Purpose: People with multiple sclerosis (MS) who undergo rehabilitation need to perform new motor skills or relearn old motor skills. It is not clear whether people with MS retain the ability to improve motor performance or learning. Furthermore, factors that influence motor performance in people with MS need to be investigated. This study explored motor performance in people with MS using virtual reality (VR). The effect of fatigue and cognitive function on motor performance improvement in people with MS was investigated. Methods: Twenty MS participants and 20 controls were recruited into the study. To assess motor performance, each participant was asked to perform a VR game for five times (blocks). The main outcome was time to complete the VR game and number of recorded errors. To assess fatigue level and cognitive function, participants were asked to complete the Arabic versions of the Modified Fatigue Impact Scale (MFIS) and the Montréal Cognitive Assessment (MOCA), respectively. Results: MS participants and controls demonstrated a practice‐related improvement in performance as shown by the main effect of block for each of the outcome measures (p < .001, time required to complete VR game; p < .001, errors recorded). Strong and significant negative correlations between recorded errors and MOCA (r = .75, p < .001) and between recorded errors and MFIS (r = .55, p = .011) were found in people with MS. Conclusions: Ability to improve motor performance in people with MS is preserved and related to cognitive function and fatigue impact. Health‐care professionals should be made aware of the negative impact of cognitive function and fatigue on motor performance. A multicomponent intervention that targets these factors is advisable. Future research, however, is required to determine the content and potential benefits of such an intervention in the MS population. [ABSTRACT FROM AUTHOR]