Multipl Skleroz Hastalarında İkili Görev Performansının Düşme Riskini Öngörme Yeteneğinin İncelenmesi

Abstract

The objective of this study was to comprehensively evaluate the ability of dual-task skills in the upper and lower extremities to predict fall risk from the Multiple Sclerosis patient's perspective. The study included 49 MS patients with a mean age of 47.43 ± 11.05 years. The median EDSS score for the patients was determined to be 3.0 (1-6). Following the recording of participants’ demographic information, the Timed Up and Go Test (TUG) and the 10-Meter Walk Test (10MWT) were used for the single-task assessment of lower extremity function; and the 9-Hole Peg Test (9HPT) was used for the single-task assessment of upper extremity function. In dual tasks, cup carrying was used as a motor additional task, and phonetic and semantic word generation along with serial 3 and 7 subtraction tasks were used as cognitive additional tasks. Fear of falling was assessed with the International Falls Efficacy Scale (FES-I), and perceived dual-task difficulties were assessed with the Dual-task Impact on Daily-living Activities (DIDA-Q). Falls were prospectively recorded over 3 months using a fall diary. The results of the study showed that TUG+motor (AUC: 0.639; Sensitivity: 60.86%; Specificity: 75%; Cut-off value: 11.19), TUG+phonetic (AUC: 0.606; Sensitivity: 66.66%; Specificity: 60%; Cut-off value: 12.12), TUG+semantic (AUC: 0.62; Sensitivity: 66.66%; Specificity: 64%; Cut-off value: 12.33), 10MWT+phonetic (AUC: 0.605; Sensitivity: 66.66%; Specificity: 56%; Cut-off value: 11.40), 10MWT+serial 3 (AUC: 0.613; Sensitivity: 73.91%; Specificity: 60%; Cut-off value: 11.75) 10MWT+serial 7 (AUC: 0.608; Sensitivity: 69.56%; Specificity: 60%; Cut-off value: 12.17), 9HPT+phonetic (dominant extremity AUC: 0.608; Sensitivity: 65.21%; Specificity: 60%; Cut-off value: 34.89; non-dominant extremity AUC: 0.604; Sensitivity: 43.47%; Specificity: 88%; Cut-off value: 48.82) 9HPT+semantic (dominant extremity AUC: 0.620; Sensitivity: 56.52%; Specificity: 80%; Cut-off value: 39.46, non-dominant extremity AUC: 0.613; Sensitivity: 73.91%; Specificity: 56%; Cut-off value: 34.73) 9HPT+serial 7 (dominant extremity AUC: 0.630; Sensitivity: 72.72%; Specificity: 56%; Cut-off value: 39.01, non-dominant extremity AUC: 0.629; Sensitivity: 63.63%; Specificity: 72%; Cut-off value: 50.4) for dual tasks and DIDA-Q (AUC: 0.621; Sensitivity: 58.33%; Specificity: 68%; Cut-off value: 23) and FES-I (AUC: 0.654; Sensitivity: 79.16%; Specificity: 56%; Cut-off value: 24) scales were found to have moderate discrimination ability in predicting fall risk. A comparison of single-task and dual-task conditions revealed that the TUG and 10MWT tests, which evaluate mobility, were capable of differentiating fall risk in both conditions. However, the 9HPT, which assesses upper extremity function, could only differentiate fall risk in the dual-task condition, not in the single-task condition. The results of our study indicate that performance-based walking and upper extremity function dual-task assessments in MS patients, and self-report scales assessing dual-task difficulties and fear of falling, have significant potential in predicting fall risk.