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The primary aim is to characterize the prevalence, severity and quality of musculoskeletal nociceptive pain in adult patients with neuromuscular disorders (NMD). The secondary objectives are to evaluate whether severity and distribution of muscle pain is associated with muscle function, and to assess whether muscle pain is associated with alterations of muscle elasticity and muscle stiffness. Results of patients with neuromuscular disorders will be compared to age- and gender-matched healthy volunteers. Approx. 70 patients with neuromuscular disorders and 20 healthy volunteers will be enrolled, including patients with the following neuromuscular disorders: histologically confirmed inclusion body myositis (IBM), genetically confirmed late-onset Pompe disease (LOPD), genetically confirmed spinal muscular atrophy type 3 (SMA3), genetically confirmed facio-scapulo-humeral muscle dystrophy (FSHD), genetically confirmed myotonic dystrophy type 1 or type 2 (DM1, DM2). The duration of patient recruitment will be around 12 months.
The explorative, cross-sectional low-interventional pilot study evaluates the prevalence, severity and quality of musculoskeletal nociceptive pain in participants with defined neuromuscular disorders (NMD). Adult participants with the following neuromuscular disorders will be included: histologically confirmed inclusion body myositis (IBM), genetically confirmed late-onset Pompe disease (LOPD), genetically confirmed spinal muscular atrophy type 3 (SMA3), genetically confirmed facio-scapulo-humeral muscle dystrophy (FSHD) and genetically confirmed myotonic dystrophy type 1 or type 2 (DM1, DM2). 20 healthy participants will be enrolled as a control group. The Beck depression inventory fast screen (BDI-FS) will be used as a screening. If there is a possibility of major depression (with a BDI ≥4), patients will be excluded from the study. So only patients with BDI-FS score ≤3 at screening will be enrolled. Patients will be asked to complete the following validated disease-related and quality-of-life questionnaires: German Pain Inventory (module A and abbreviated module S and L and V), Brief Pain Inventory (BPI) and Fatigue Severity and Disability Scale (FSS). Demographic and disease related data will be obtained. A neuromuscular examination will be conducted. A clinical evaluation of muscle strength using the MRC-Scale (Medical Research Council-Scale) will be performed on both sides deltoid muscles, biceps brachii muscles, triceps brachii muscles, hip flexors, hip extensors, quadriceps femoris muscles, foot extensor and foot flexor muscles as well as axial muscles and neck flexors and extensors. The Quick Motor Function Test (QMFT) with 16 items will be performed to assess muscle and movement functions of the participants. To ensure a high level of objective measurement, muscle strength will also be assessed by using handheld dynamometry. The following muscle groups will be tested: arm abduction, elbow flexion, elbow extension, hip flexion, hip extension, knee extension, knee flexion, foot extension, foot flexion. A six-minute-walk test (6MWT) will be performed once. Additionally, first signs of muscle pain or muscle cramps will be recorded (including the quality and intensity of pain). The Borg scale to rate dyspnea will be administered before starting the 6MWT and after completing the 6MWT. For diagnosis of myofascial pain, a Pressure Pain Threshold test by using a pressure algometer is included for the trapezius, deltoid and supraspinatus muscles, the rectus femoris muscles, and the tibialis anterior muscles until the patient feels any sensation of pain. Measurement of muscle stiffness, muscle tone, relaxation periods and viscoelasticity of selected muscles will be assessed by a myotonometer. Data collected in this study will be reported using summary tables, figures, and patient data listings. Differences between the patients and the healthy volunteers will be analyzed.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Neuromuscular disease (NMD) Patients | The patient has one of the following neuromuscular diagnoses:
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| Healthy control | no known neuromuscular disorder |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Beck depression inventory fast screen | Diagnostic Test | Beck depression inventory fast screen questionnaire to detect severe depression for eligibility. |
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| Measure | Description | Time Frame |
|---|---|---|
| Prevalence of musculoskeletal pain in defined neuromuscular diseases | The primary aim is to characterize the prevalence of musculoskeletal pain in adult patients with neuromuscular disorders (NMD). | Only at baseline visit |
| Measure | Description | Time Frame |
|---|---|---|
| Association between musculoskeletal pain and muscle function, assessed by Medical research council (MRC) grading (0-5) | Assessed by Medical research council (MRC) grading (0-5) | Only at baseline visit |
| Association between musculoskeletal pain and muscle function, assessed by quick motor function test (QMFT) |
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Inclusion Criteria
The participant is willing and able to provide signed informed consent.
The participant is able and willing to perform study-related assessments.
The participant is ≥18 years of age
The participant has one of the following diagnoses:
Exclusion Criteria
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Approximately 70 patients with defined NMD (see inclusion criteria) will be enrolled. For a control group, 20 healthy volunteers will be enrolled. All patients must be ≥ 18 years of age.
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| Name | Affiliation | Role |
|---|---|---|
| Stephan Wenninger, PD Dr. med. | Neurologist | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Friedrich-Baur-Institute | München | Bavaria | 80336 | Germany |
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| German Pain Inventory | Diagnostic Test | German Pain Inventory questionnaire for evaluation of pain. Module A, abbreviated questions of module S (sociodemographic questions S1, S2, S3, S4, S5 and S8) and module L (quality of life) and V (therapies) will be used. |
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| Brief Pain Inventory | Diagnostic Test | Validated questionnaire for pain. |
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| Fatigue Severity and Disability Scale (FSS) | Diagnostic Test | Validated questionnaire for perceived fatigue |
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| Quick Motor Function Test | Diagnostic Test | An evaluator observes the performance of a patient and scores the items separately on a 5-point ordinal scale (ranging from 0 to 4). A total score is obtained by adding the scores of all items and ranges between 0 and 64 points. |
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| Handheld Dynamometry (HHD) | Diagnostic Test | To ensure a high level of objective measurement, muscle strength will also be assessed by handheld dynamometry. The following muscle groups will be tested: Arm abduction, elbow flexion, elbow extension, hip flexion, hip extension, knee extension, knee flexion, foot extension, foot flexion. |
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| Six-minute walk test (6MWT) | Diagnostic Test | It is a sub-maximal exercise test used to assess aerobic capacity and endurance. The distance covered over a time of 6 minutes is used as the outcome by which to compare changes in performance capacity. |
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| Pressure pain threshold | Diagnostic Test | For diagnosis of myofascial pain, pressure algometers are designed and conventionally used to measure deep pressure pain thresholds or tenderness resistance (Park, Kim et al. 2011), and the reliability of pressure pain thresholds according to raters or measurement frequencies has been proven to be relatively high (Chung, Um et al. 1992). The threshold is then determined as the arithmetic mean of the 3 series (in kPa). The measurement will be stopped immediately as the patient feels sensations of "burning", "stinging", "drilling" or "aching. Pressure algometry measurements will be performed on the trapezius, deltoid and supraspinatus muscles, the rectus femoris muscles, and the tibialis anterior muscles. |
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| Myotonometer Assessment | Diagnostic Test | Muscle stiffness, muscle tone, relaxation periods and viscoelasticity will be assessed by a myotonometer of selected muscles (non-invasive measurement). The method of measurement consists of recording damped natural oscillation of soft biological tissue in the form of an acceleration signal and the subsequent simultaneous computation of the parameters of State of Tension, Biomechanical and Viscoelastic properties. Measurements will be performed on the trapezius, deltoid and supraspinatus muscles, the rectus femoris muscles, and the tibialis anterior muscles. |
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| Vital signs | Diagnostic Test | Vital signs (blood pressure, heart rate, respiratory rate) will be measured before and after the six-Minute-Walk-Test (6MWT). |
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| Borg Scale | Diagnostic Test | the Borg scale will be assessed, which is a self-reported questionnaire designed to subjectively assess dyspnea and exertion during activity (Borg 1982). The Borg scale rates dyspnea on a scale of 0 to 10 incorporating nonlinear spacing of verbal descriptors of the level of intensity of dyspnea. A higher Borg score indicates more severe dyspnea. The Borg scale will be administered before starting the 6MWT (≤ 5 minutes) and after completing the 6MWT (≤ 5 minutes). |
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Assessed by quick motor function test (QMFT) |
| Only at baseline visit |
| Association between musculoskeletal pain and muscle function, assessed by Pressure Pain Threshold (PPT) | Assessed by Pressure Pain Threshold (PPT) | Only at baseline visit |
| Association between musculoskeletal pain and muscle function, assessed by a Myotonometer | Assessed by a Myotonometer (incl. relaxation time, stiffness, muscle tone, relaxation periods and viscoelasticity) | Only at baseline visit |
| Assessment of Questionnaire: Beck depression inventory fast screen | Association between Depression and musculoskeletal pain | Only at baseline visit |
| Assessment of Questionnaire: Brief Pain Inventory | Association between Depression and musculoskeletal pain | Only at baseline visit |
| Assessment of Questionnaire: Fatigue Severity Scale (FSS) | Association between Depression and musculoskeletal pain | Only at baseline visit |
| Characterization of musculoskeletal pain (quality and severity) assessed by the German Pain Questionnaire | Characterization of quality and severity of musculoskeletal pain | Only at baseline visit |
| Characterization of musculoskeletal pain (quality and severity) assessed by the Brief Pain Inventory (BPI) | Characterization (quality and severity) of musculoskeletal pain | Only at baseline visit |
| ID | Term |
|---|---|
| D006009 | Glycogen Storage Disease Type II |
| D009223 | Myotonic Dystrophy |
| D014897 | Spinal Muscular Atrophies of Childhood |
| D018979 | Myositis, Inclusion Body |
| D059226 | Nociceptive Pain |
| ID | Term |
|---|---|
| D020140 | Lysosomal Storage Diseases, Nervous System |
| D020739 | Brain Diseases, Metabolic, Inborn |
| D001928 | Brain Diseases, Metabolic |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D008661 | Metabolism, Inborn Errors |
| D030342 | Genetic Diseases, Inborn |
| D009358 | Congenital, Hereditary, and Neonatal Diseases and Abnormalities |
| D006008 | Glycogen Storage Disease |
| D002239 | Carbohydrate Metabolism, Inborn Errors |
| D016464 | Lysosomal Storage Diseases |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
| D009136 | Muscular Dystrophies |
| D020966 | Muscular Disorders, Atrophic |
| D009135 | Muscular Diseases |
| D009140 | Musculoskeletal Diseases |
| D020967 | Myotonic Disorders |
| D020271 | Heredodegenerative Disorders, Nervous System |
| D019636 | Neurodegenerative Diseases |
| D009468 | Neuromuscular Diseases |
| D009134 | Muscular Atrophy, Spinal |
| D013118 | Spinal Cord Diseases |
| D016472 | Motor Neuron Disease |
| D009220 | Myositis |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| ID | Term |
|---|---|
| D000070857 | Walk Test |
| D055986 | Vital Signs |
| ID | Term |
|---|---|
| D005080 | Exercise Test |
| D006334 | Heart Function Tests |
| D003935 | Diagnostic Techniques, Cardiovascular |
| D019937 | Diagnostic Techniques and Procedures |
| D003933 | Diagnosis |
| D010808 | Physical Examination |
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