- •Knee position sense, dynamic balance, and dual task performance decreased in the early follicular phase in females with multiple sclerosis.
- •Static balance did not change in both groups during the menstrual cycle.
- •Dynamic balance and gait performance differed between females with multiple sclerosis and control group.
- •Each phase of the menstrual cycle should be taken into consideration in the follow-up of physiotherapy evaluations in females with multiple sclerosis.
Sex hormones have been thought to play an important role in disease progression and inflammatory activity in females with multiple sclerosis. The aim of this study was to investigate knee position sense, balance, and dual task performance in different phases of menstrual cycle in females with multiple sclerosis.
The study included 14 females diagnosed with MS and 13 healthy females with regular menstrual cycles who did not use oral contraceptives. The disability level was determined using the Expanded Disability Status Scale. The mental state was assessed using the Mini-Mental State Examination. Knee position sense was evaluated with an Acumar dual digital inclinometer (Acu360, Acumar, Lafayette, IN, USA). The balance was measured with the Biodex Balance System (Biodex Medical Systems, Shirley, NY, USA). Time taken to complete the Timed Up and Go test (TUG) under 3 conditions (TUG without task, TUG with counting backward from 100 by 3s or listing the names starting with the letter “A” [TUGcognitive], and TUG while carrying three glasses of water on a tray [TUGmotor]) was measured. Measurements were conducted in the early follicular, ovulation, and luteal phases.
As a result, it was found that knee position sense, dynamic balance, and dual task performance decreased in the early follicular phase in both the group of females with multiple sclerosis and the control group (p<0.05). The change of dynamic balance and gait performance in the three phases of the menstrual cycle were different between the groups (p<0.05).
As a result, it was found that knee position sense, dynamic balance, and dual task performance in females with multiple sclerosis changed throughout the menstrual cycle. The change in dynamic balance and gait performance differed from the control group during the menstrual cycle. Therefore, we think that each phase of the menstrual cycle should be taken into consideration in the follow-up of physiotherapy evaluations in females with multiple sclerosis.
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- The changing demographic pattern of multiple sclerosis epidemiology.Lancet Neurol. 2010; 9: 520-532https://doi.org/10.1016/S1474-4422(10)70064-8
- Increased spontaneous ex vivo apoptosis and subset alterations in peripheral blood T cells from patients with multiple sclerosis.J. Clin. Immunol. 2006; 26: 101-112https://doi.org/10.1007/s10875-006-9007-5
- Gender issues in multiple sclerosis.Int. Rev. Neurobiol. 2007; 79: 377-392https://doi.org/10.1016/S0074-7742(07)79017-7
- The immune response during the luteal phase of the ovarian cycle: increasing sensitivity of human monocytes to endotoxin.Fertil. Steril. 2001; 76: 555-559https://doi.org/10.1016/s0015-0282(01)01971-9
- The influence of sex hormones on cytokines in multiple sclerosis and experimental autoimmune encephalomyelitis: a review.Mult. Scler. 2005; 11: 349-359https://doi.org/10.1191/1352458505ms1174rr
- Impact of sex hormones on immune function and multiple sclerosis development.Immunology. 2019; 156: 9-22https://doi.org/10.1111/imm.13004
- Women’s involvement in clinical trials: historical perspective and future implications.Pharm. Pract. (Granada). 2016; 14 (0-0)https://doi.org/10.18549/PharmPract.2016.01.708
- The effect of the menstrual cycle on exercise metabolism.Sports Med. 2010; 40: 207-227https://doi.org/10.2165/11317090-000000000-00000
- Effect of hormonal changes on the neurological status in the menstrual cycle of patient with multiple sclerosis.Clin. Neurol. Neurosurg. 2019; 186105499https://doi.org/10.1016/j.clineuro.2019.105499
- Association between the menstrual cycle and anterior cruciate ligament injuries in female athletes.Am. J. Sports Med. 2000; 28: 131https://doi.org/10.1177/03635465000280011101
- Neuromuscular performance and knee laxity do not change across the menstrual cycle in female athletes.Knee Surg. Sports Traumatol. Arthrosc. 2006; 14: 817-822https://doi.org/10.1007/s00167-006-0047-4
- The influence of menstrual cycle on ankle proprioception.Isokinet. Exerc. Sci. 2008; 16: 119-123https://doi.org/10.3233/IES-2008-0306
- The influence of ovulation on postural stability (Biodex Balance System) in young female.J. Exerc. Rehabil. 2018; 14: 638-642https://doi.org/10.12965/jer.1836266.133
- Altered postural control during the luteal phase in women with premenstrual symptoms.Neuroendocrinology. 2005; 81: 150-157https://doi.org/10.1159/000086592
- Premenstrual syndrome, neuroactive steroids and the brain.Gynecol. Endocrinol. 1999; 13: 206-220https://doi.org/10.3109/09513599909167557
- Effect of estrogen on musculoskeletal performance and injury risk.Front. Physiol. 2019; 9: 1834https://doi.org/10.3389/fphys.2018.01834
- Pregnancy, sex and hormonal factors in multiple sclerosis.Mult. Scler. 2014; 20: 527-536https://doi.org/10.1177/1352458513519840
- A pilot study of the effect upon multiple sclerosis of the menopause, hormone replacement therapy and the menstrual cycle.J. R. Soc. Med. 1992; 85: 612-613https://doi.org/10.1177/014107689208501008
- Menstrually related worsening of symptoms in multiple sclerosis.J. Neurol. Sci. 1997; 149: 95-97https://doi.org/10.1016/s0022-510x (97)05396-3
- Estrogen modulation of K+ channel activity in hypothalamic neurons involved in the control of the reproductive axis.Steroid. 2002; 67: 447-456https://doi.org/10.1016/s0039-128x (01)00181-7
- What compensatory motor strategies do patients with multiple sclerosis develop for balance control?.Rev. Neurol. 2007; 163: 1054-1064https://doi.org/10.1016/s0035-3787(07)74178-4
- Relation between walking speed and muscle strength is affected by somatosensory loss in multiple sclerosis.J. Neurol. Neurosurg. Psychiatry. 2002; 73: 313-315https://doi.org/10.1136/jnnp.73.3.313
- Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria.Lancet Neurol. 2018; 17: 162-173https://doi.org/10.1016/S1474-4422(17)30470-2
- Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS).Neurology. 1983; 33 (1444): 1444https://doi.org/10.1212/wnl.33.11.1444
- Screening for cognitive impairment in multiple sclerosis: an evaluation of the mini-mental state examination.Arch. Neurol. 1990; 47: 297-301https://doi.org/10.1001/archneur.1990.00530030069018
- The visual analogue pain intensity scale: what is moderate pain in millimetres?.Pain. 1997; 72: 95-97https://doi.org/10.1016/s0304-3959(97)00005-5
- The salivary ferning test and ovulation in clomiphene citrate-stimulated cycles.J. Med. Assoc. Thai. 2007; 90: 876-883
Company, L.I., 2006. Acumar™ dual digital inclinometers user's manual. Copyright USA. http://www.limef.com/Downloads/AcumarRangeomotionIllustrations_manual.pdf.
- A prospective evaluation of balance, gait, and strength to predict falling in women with multiple sclerosis.Arch. Phys. Med. Rehabil. 2011; 92: 1840-1846https://doi.org/10.1016/j.apmr.2011.06.004
- Validity of the timed up and go test as a measure of functional mobility in persons with multiple sclerosis.Arc. Phys. Med. Rehabil. 2016; 97: 1072-1077https://doi.org/10.1016/j.apmr.2015.12.031
- The effect of dual task on clinical balance performance in ataxia patients.Turk. J. Phys. Med. Rehab. 2016; 27: 1-7
- The concepts of power analysis.second ed. Statistical Power Analysis for the Behavioral Sciences. 2. 1988: 1-17 (New York)
- The effects of menstrual cycle on the knee joint position sense: preliminary study.Knee Surg. Sports Traumatol. Arthrosc. 2005; 13: 649-653https://doi.org/10.1007/s00167-004-0604-7
- Menstrual cycle and knee joint position sense in healthy female athletes.Knee Surg. Sports Traumatol. Arthrosc. 2012; 20: 1647-1652https://doi.org/10.1007/s00167-011-1811-7
- The role of gender and sex hormones in determining the onset and outcome of multiple sclerosis.Mult. Scler. 2014; 20: 520-526https://doi.org/10.1177/1352458513519181
- The effects of the menstrual cycle on the static balance in healthy young women.J. Phys. Ther. Sci. 2017; 29: 1964-1966https://doi.org/10.1589/jpts.29.1964
- Fluctuations of state anxiety, spinal structure, and postural stability across the menstrual cycle in active women.J. Med. Sci. 2016; 46: 977-984
- Reliability of spatial–temporal gait parameters during dual-task interference in people with multiple sclerosis. A cross-sectional study.Gait Posture. 2014; 40: 715-718https://doi.org/10.1016/j.gaitpost.2014.06.015
- Psychometric properties of dual-task balance and walking assessments for individuals with neurological conditions: a systematic review.Gait Posture. 2017; 52: 110-123https://doi.org/10.1016/j.gaitpost.2016.11.007
- Estrogen’s impact on cognitive functions in multiple sclerosis.Int. J. Neurosci. 1996; 86: 23-31https://doi.org/10.3109/00207459608986695
- Sex hormone (FSH, estrogen and testosterone) changes in follicular and luteal phases and sexual dysfunction in women with multiple sclerosis.Par. J. Med. Sci. 2015; 12: 23-30https://doi.org/10.29252/jmj.12.4.8
Published online: June 01, 2020
Accepted: May 21, 2020
Received in revised form: May 19, 2020
Received: March 26, 2020
The study protocol was registered at http://clinicaltrials.gov (NCT04286828).
© 2020 Elsevier B.V. All rights reserved.