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From the University of Rochester Medical Center, Departments of Neurology (Drs. Schwid, Thornton, Goodman, and McDermott, and S. Pandya, K. Manzur, and M. Petrie) and Biostatistics (Dr. McDermott), Rochester, NY; and the University of Wisconsin Medical Center, Department of Neurology (Dr. Sanjak), Madison, WI.
Address correspondence and reprint requests to Dr. Steven R. Schwid, University of Rochester Medical Center, 601 Elmwood Avenue, Box 605, Rochester, NY 14642.
OBJECTIVE: To determine the test–retest reliability of strength and fatigue measurements in patients with MS and in healthy control subjects, and to examine associations among motor fatigue, strength, and ambulatory impairment in MS patients.
BACKGROUND: Motor fatigue, defined as the loss of the maximal capacity to generate force during exercise, and weakness are common in patients with MS. Method:— Twenty ambulatory MS patients and 20 age- and sex-matched healthy control subjects participated in the study. Test–retest reliability was assessed in two identical testing sessions, separated by 3 to 5 days. Maximal voluntary isometric strength was determined by fixed myometry of seven muscle groups on each side. Motor fatigue was assessed using three exercise protocols: sustained maximal contractions (static fatigue), repetitive maximal contractions, and walking as far as 500 m. Four analysis models for static fatigue were examined for their test–retest reliability and their ability to discriminate between normal fatigue and pathologic fatigue from MS.
RESULTS: Test–retest reliability in MS patients was excellent for isometric strength and very good for static fatigue. Test–retest reliability was lower for exercise protocols that involved repetitive contractions or ambulation. Compared with healthy control subjects, MS patients were weak in lower extremity muscles, but upper extremity strength was relatively preserved. Fatigue was greater in MS patients, even in muscles that were not clearly weak. There were no significant associations between strength and fatigue in any of the muscles tested. A fatigue analysis model based on the area under the force-versus-time curve gave the best combination of reliability and sensitivity to detect differences between MS patients and healthy control subjects.
CONCLUSIONS: Strength and motor fatigue can be measured reliably in patients with MS. MS patients experience more fatigue than healthy control subjects during sustained contractions, repetitive contractions, and ambulation. Motor fatigue appears to be distinct from weakness because the degree of fatigue was not associated with the degree of weakness in individual muscles. Quantitative assessment of strength and fatigue may be useful to monitor changes in motor function over time in MS patients.
Key words: MS—Fatigue—Strength—Weakness—Motor dysfunction—Myometry.
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