Three distinct physical behavior types in fatigued patients with multiple sclerosis

H. E. M. Braakhuis*, M. A. M. Berger, G. A. van der Stok, J. van Meeteren, V. de Groot, H. Beckerman, J. B. J. Bussmann, V. de Groot, H. Beckerman, A. Malekzadeh, L. E. van den Akker, M. Looijmans, S. A. Sanches, J. Dekker, E. H. Collette, B. W. van Oosten, C. E. Teunissen, M. A. Blankenstein, I. C. J. M. Eijssen, M. RietbergM. Heine, O. Verschuren, G. Kwakkel, J. M. A. Visser-Meily, I. G. L. van de Port, E. Lindeman, L. J. M. Blikman, J. van Meeteren, J. B. J. Bussmann, H. J. Stam, R. Q. Hintzen, H. G. A. Hacking, El Hoogervorst, S. T. F. M. Frequin, H. Knoop, B. A. de Jong, G. Bleijenberg, F. A. J. de Laat, M. C. Verhulsdonck, E. T. H. L. van Munster, C. J. Oosterwijk, G. J. Aarts

*Corresponding author for this work

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Background Multiple sclerosis often leads to fatigue and changes in physical behavior (PB). Changes in PB are often assumed as a consequence of fatigue, but effects of interventions that aim to reduce fatigue by improving PB are not sufficient. Since the heterogeneous nature of MS related symptoms, levels of PB of fatigued patients at the start of interventions might vary substantially. Better understanding of the variability by identification of PB subtypes in fatigued patients may help to develop more effective personalized rehabilitation programs in the future. This study aimed to identify PB subtypes in fatigued patients with multiple sclerosis based on multidimensional PB outcome measures. Methods Baseline accelerometer (Actigraph) data, demographics and clinical characteristics of the TREFAMS-ACE participants (n = 212) were used for secondary analysis. All patients were ambulatory and diagnosed with severe fatigue based on a score of >= 35 on the fatigue subscale of the Checklist Individual Strength (CIS20r). Fifteen PB measures were used derived from 7 day measurements with an accelerometer. Principal component analysis was performed to define key outcome measures for PB and two-step cluster analysis was used to identify PB types. Results Analysis revealed five key outcome measures: percentage sedentary behavior, total time in prolonged moderate-to-vigorous physical activity, number of sedentary bouts, and two types of change scores between day parts (morning, afternoon and evening). Based on these outcomes three valid PB clusters were derived. Conclusions Patients with severe MS-related fatigue show three distinct and homogeneous PB subtypes. These PB subtypes, based on a unique set of PB outcome measures, may offer an opportunity to design more individually-tailored interventions in rehabilitation.
Original languageEnglish
Number of pages9
JournalJournal of NeuroEngineering and Rehabilitation
Issue number1
Publication statusPublished - 23 Aug 2019

Bibliographical note

The TREFAMS study is supported by Fonds NutsOhra (grant no. 89000005).
Part of the current study is financially supported by Rijndam Rehabilitation,
Rotterdam, The Netherlands


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