Arch Phys Med Rehabil. 2003 Sep;84(9):E10
Francois A. Bethoux, MD; Deborah M. Miller, PhD; Darlene Stough, RN
Cleveland Clinic Foundation, Cleveland, OH
Objective:
To evaluate whether intrathecal baclofen (ITB) therapy causes a decrease in gait speed in ambulatory patients with multiple sclerosis (MS).
Design:
Longitudinal pre-post intervention study (24-wk follow-up).
Setting:
Spasticity clinic within a large outpatient comprehensive care center for MS.
Participants:
Patients with intractable lower-extremity spasticity, definitively diagnosed with MS and able to walk at least 25ft with or without support.
Intervention:
Implantation of a programmable ITB infusion system.
All patients received inpatient and/or outpatient physical therapy after surgery.
Main Outcomes Measure:
Gait speed calculated from the Timed 25-Foot Walk.
Results:
8 patients were analyzed (75% women; mean age, 37.4+/-6.1y; mean disease duration, 9.7+/-7.9y; median Expanded Disability Status Scale [EDSS] score, 6.5).
There was no significant change in EDSS score during the study.
There was statistically significant improvement of Modified Ashworth Scale scores between baseline and all follow-up visits.
There was no statistically significant change in gait speed.
Average gait speed was.48+/-.35m/s at baseline,.46+/-.41m/s at 4 weeks,.41+/-.37m/s at 12 weeks, and.48+/-.40m/s at 24 weeks.
Conclusions:
Our results suggest that ITB therapy improves severe spasticity, but does not affect gait speed measured on a short distance in ambulatory MS patients, up to 6 months after surgery.
Further study is needed to assess the effect of ITB on gait endurance, gait quality, and patient quality of life.