title: Habitual functional electrical stimulation therapy improves gait kinematics and walking performance, but not patient-reported functional outcomes, of people with multiple sclerosis who present with foot-drop.
abstract: BACKGROUND
  People with Multiple Sclerosis (pwMS) often experience a disturbed gait function such as foot-drop. The objective of this pilot study was to investigate the medium term effects of using Functional Electrical Stimulation (FES) to treat foot-drop over a period 12 weeks on gait and patient reported outcomes of pwMS.
  
  
  RESULTS
  Nine pwMS aged 35 to 64 (2 males, 7 females) were assessed on four occasions; four weeks before baseline, at baseline and after six weeks and twelve weeks of FES use. Joint kinematics and performance on the 10 meter and 2 minute walk tests (10WT, 2 minWT) were assessed with and without FES. Participants also completed the MS walking Scale (MSWS), MS impact scale (MSIS29), Fatigue Severity Score (FSS) and wore an activity monitor for seven days after each assessment. Compared to unassisted walking, FES resulted in statistically significant improvements in peak dorsiflexion in swing (p = 0.006), 10MWT (p = 0.006) and 2 minWT (p = 0.002). Effect sizes for the training effect, defined as the change from unassisted walking at baseline to that at 12 weeks, indicated improved ankle angle at initial contact (2.6°, 95% CI -1° to 4°, d = 0.78), and a decrease in perceived exertion over the 2 min walking tests (-1.2 points, 95% CI -5.7 to 3.4, d = -0.86). Five participants exceeded the Minimally Detectable Change (MDC) for a training effect on the 10mWT, but only two did so for the 2 minWT. No effects of the use of FES for 12 weeks were found for MSWS, MSIS29, FSS or step count.
  
  
  CONCLUSIONS
  Although FES to treat foot-drop appears to offer the potential for a medium term training effect on ankle kinematics and walking speed, this was not reflected in the patient reported outcomes. This observed lack of relationship between objective walking performance and patient reported outcomes warrants further investigation.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01977287.
authors.affiliation: Rehabilitation Sciences, Queen Margaret University, Musselburgh, United Kingdom.
authors.forename: Marietta L
authors.initials: ML
authors.lastname: van der Linden
authors.affiliation: Slateford Physiotherapy Clinic, NHS Lothian, Edinburgh, United Kingdom.
authors.forename: Julie E
authors.initials: JE
authors.lastname: Hooper
authors.affiliation: Kenilworth Medical Centre, NHS Lanarkshire, Cumbernauld, United Kingdom.
authors.forename: Paula
authors.initials: P
authors.lastname: Cowan
authors.affiliation: Anne Rowling regenerative neurology clinic, Edinburgh, United Kingdom.
authors.forename: Belinda B
authors.initials: BB
authors.lastname: Weller
authors.affiliation: Rehabilitation Sciences, Queen Margaret University, Musselburgh, United Kingdom.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Mercer
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D004599:Electric Stimulation Therapy; D005260:Female; D005684:Gait; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000503:physiopathology / Q000628:therapy*; D010865:Pilot Projects; D011597:Psychomotor Performance; D057566:Self Report; D016896:Treatment Outcome; D016138:Walking