- •Upper limb impairment affects over 60% of individuals.
- •Upper limb impairment adversely affects employment and the ability to perform daily activities.
- •Seeing an occupational therapist was associated with using assistive devices to aid function.
Individuals with multiple sclerosis (MS) frequently suffer from impaired sensory function, reduced strength and tremor in the upper limbs, which may interfere with upper limb function. However, upper limb impairment in MS is under-recognized and understudied. We aimed to evaluate the prevalence of upper limb impairment in a large sample of persons with MS; the association between upper limb function and employment status in MS; and the frequency of use of assistive devices aimed at addressing upper limb impairments.
We surveyed participants in the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry regarding upper limb function using the ABILHAND questionnaire, and asked about use of assistive devices intended to improve the performance on upper limb activities. We evaluated the association between ABILHAND scores and current employment status using multivariable logistic regression analysis, and the association between ABILHAND scores and the use of an assistive device.
Of 7463 eligible respondents, 5846 (78.3%) were female and mean (SD) age of 57.4 (10.2) years. The median (IQR) score on the ABILHAND was 45 (39–46). Higher levels of disability, as measured by the PDDS, correlated moderately with lower (worse) scores on the ABILHAND (r=−0.50; 95%CI: −0.48, −0.52). Over half of participants reported that they possessed an assistive device to aid upper limb function (3914, 56.0%). Older age, female sex, greater ambulatory disability, higher levels of fatigue, sensory impairment, spasticity and cognitive impairment, and visiting an occupational therapist were independently associated with increased odds of using an assistive device. After accounting for disability, perceived cognitive impairment, and fatigue, impaired upper limb function was associated with decreased odds of being employed (OR/1 point rise in ABILHAND 0.97; 95%CI: 0.96, 0.98).
Upper limb impairment is common in older MS patients, and adversely affects the ability to perform many common daily activities.
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- Can the ABILHAND handle manual ability in MS?.Mult. Scler. 2013; 19: 806-815
- Unilateral and bilateral upper limb dysfunction at body functions, activity and participation levels in people with multiple sclerosis.Mult. Scler. J. 2015; 21: 1566-1574
- Rates of access to assistive equipment and medical rehabilitation services among people with disabilities.Disabil. Rehabil. 2003; 25: 487-490
- Beyond the reach of traditional analyses: using Rasch to evaluate the DASH in people with multiple sclerosis.Mult. Scler. 2011; 17: 214-222
- Determinants of on-the-job-barriers in employed persons with multiple sclerosis: the role of disability severity and cognitive indices.Work. 2014; 47: 509-520
- Describing and predicting the possession of assistive devices among persons with multiple sclerosis.Am. J. Occup. Ther. 2001; 55: 545-551
- High concurrent presence of disability in multiple sclerosis.J. Neurol. 2007; 254: 767
- Use of cognitive aids and other assistive technology by individuals with multiple sclerosis.Disabil. Rehabil. Assist. Technol. 2009; 4: 1-8
- Hand dexterity and direct disease related cost in multiple sclerosis.J. Neurol. Sci. 2014; 341: 51-54
- Assessment of upper extremity function in multiple sclerosis: review and opinion.Postgrad. Med. 2014; 126: 102-108
- Factors affecting older adults' use of adaptive equipment: review of the literature.Am. J. Occup. Ther.: Off. Publ. Am. Occup. Ther. Assoc. 2001; 55: 303-310
- Validity of performance scales for disability assessment in multiple sclerosis.Mult. Scler. 2007; 13: 1176-1182
- Validation of the NARCOMS registry: diagnosis.Mult. Scler. 2007; 13: 770-775
- ABILHAND: a Rasch-built measure of manual ability.Arch. Phys. Med. Rehabil. 1998; 79: 1038-1042
- The ABILHAND questionnaire as a measure of manual ability in chronic stroke patients. Rasch-based validation and relationship to upper limb impairment.Stroke. 2001; 32: 1627-1634
- The guide to occupational therapy practice. American Occupational Therapy Association.Am. J. Occup. Ther.: Off. Publ. Am. Occup. Ther. Assoc. 1999; 53: 247-322
Pellegrino L., Stranieri G., Tiragallo E., Tacchino A., Brichetto G., Coscia M., , et al. 2015. Analysis of upper limb movement in Multiple Sclerosis subjects during common daily actions. Conference proceedings:… Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference 2015: 6967–6970.
- Prevalence and characteristics of tremor in the NARCOMS multiple sclerosis registry: a cross-sectional survey.BMJ Open. 2015; 5: e006714
- Reliability and validity of two self-report measures of impairment and disability for MS. North American Research Consortium on Multiple Sclerosis Outcomes Study Group.Neurology. 1999; 52: 63-70
- Living with multiple sclerosis: longitudinal changes in employment and the importance of symptom management.J. Neurol. 2010; 257: 926-936
- Management of impairment, disability, and handicap due to multiple sclerosis.Mayo Clin. Proc. 1997; 72: 1184-1196
Published online: February 18, 2017
Accepted: February 17, 2017
Received in revised form: February 10, 2017
Received: December 10, 2016
© 2017 Elsevier B.V. All rights reserved.