Assessment of Multiple Aspects of Upper Extremity Function Independent From Ambulation in Patients With Multiple Sclerosis.

Background: Upper extremity function (UEF) is often compromised in multiple sclerosis (MS), although its importance is regularly underrecognized relative to ambulation. We explored the concurrent presence of impairment in UEF and ambulation by examining various aspects of UEF across different levels of ambulation.
Methods: The cohort consisted of 247 patients with clinically definite MS or clinically isolated syndrome according to the revised 2010 McDonald criteria. The Nine-Hole Peg Test and the Expanded Disability Status Scale were used to stratify patients into clinically different subgroups. For UEF, cerebellar function (finger-to-nose test), pyramidal function (pronator drift test), and the ability to perform a task of activities of daily living (drinking-from-cup test) were examined. Patient-reported limitations of UEF in daily life were assessed using the Arm Function in Multiple Sclerosis Questionnaire.
Results: Patients in more severely impaired ambulation groups displayed poorer performance on all UEF measures. Although most patients had normal to mild (n = 147) or moderate (n = 46) ambulatory impairment, 87.7% exhibited some level of UEF impairment as defined using the Nine-Hole Peg Test. Most patients had mild UEF impairment (n = 174), accounting for the largest proportion in all ambulation groups (51.9%-77.8%).
Conclusions: A distinct pattern of impairment was found for ambulation and multiple aspects of UEF. Independent assessment of multiple aspects of disability may be helpful in treatment decision-making and could support the development of rehabilitation strategies that specifically target UEF impairment.
Competing Interests: FINANCIAL DISCLOSURES: Dr van Munster has received travel support from Novartis Pharma AG, Sanofi Genzyme, Teva Pharmaceuticals, and Merck Serono; honoraria for lecturing and consulting from Novartis Pharma AG, Biogen Idec, and Merck Serono; and compensation for serving on a scientific advisory board from Biogen Idec, Roche, Merck Serono, and Sanofi Genzyme. Dr Burggraaff has received travel support from Novartis Pharma AG. Dr Kamm has received honoraria for lectures as well as research support from Biogen, Novartis, Almirall, Bayer Schweiz AG, Teva Pharmaceuticals, Merck, Sanofi Genzyme, Roche, Celgene, and the Swiss MS Society. Dr D’Souza has received travel support from Bayer AG, Hoffmann-La Roche, Teva Pharmaceuticals, and Sanofi Genzyme and research support from the University Hospital Basel. Drs Dorn, Walsh, and Dahlke are employees of Novartis Pharma AG. Dr Uitdehaag has received consultancy fees from Biogen Idec, Genzyme, Merck Serono, Novartis, Roche, and Teva Pharmaceuticals. Dr Steinheimer and M. Diederich declare no conflicts of interest. In the past 3 years, Dr Kappos’ institution (University Hospital Basel) received and used exclusively for research support for the Department of Neurology steering committee, advisory board, and consultancy fees from Actelion, Alkermes, Almirall, Bayer, Biogen, df-mp, Excemed, GeNeuro SA, Genzyme, Merck, Minoryx, Mitsubishi Pharma, Novartis, Receptos, Roche, Sanofi Aventis, Santhera, Teva Pharmaceuticals, and Vianex and royalties from Neurostatus products. For department educational activities, the institution received honoraria from Allergan, Almirall, Bayer, Biogen, Excemed, Genzyme, Merck, Novartis, Pfizer, Sanofi Aventis, Teva Pharmaceuticals, and UCB.
(© 2023 Consortium of Multiple Sclerosis Centers.)