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Law Library Blog (April 2021): Legal Beagle's Blog Archive, Roger Williams University School Of Law

Law Library Newsletters/Blog

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Nursing Fatigue In Intensive Care Units: A Clinical Inquiry, Elizabeth A. Gambill

The Eleanor Mann School of Nursing Student Works

Registered Nurses (RN) working in Intensive Care Units (ICU) report increased physical and emotional fatigue from a combination of various environmental factors. Fatigue is suspected as contributing to low retention rates of ICU RNs. A meeting was arranged with an ICU nursing director in an acute care facility in Northern Arkansas revealing the need for a clinical inquiry into the prevalence of fatigue. A review of literature further analyzed the impact of fatigue, management practices, safety culture in the workplace, the Occupational Fatigue/Exhaustion and Recovery (OFER) scale, the Copenhagen Burnout Inventory (CBI), and the Moral Distress Scale- Revised (MDS-R). The …

Prevalence And Characteristics Of Self-Reported Hypothyroidism And Its Association With Nonorgan-Specific Manifestations In Us Sarcoidosis Patients: A Nationwide Registry Study, Bashar N. Alzghoul, Farah N. Amer, Diana Barb, Ayoub Innabi, Mamoun T. Mardini, Chen Bai, Bara Alzghoul, Tamara Al-Hakim, Noopur Singh, Mindy Buchanan, Leslie Serchuck, Diana Gomez Manjarres, Whitney W. Woodmansee, Lisa A. Maier, Divya C. Patel

Internal Medicine Faculty Publications

Little is known about the prevalence, clinical characteristics and impact of hypothyroidism in patients with sarcoidosis. We aimed to determine the prevalence and clinical features of hypothyroidism and its relation to organ involvement and other clinical manifestations in patients with sarcoidosis.

We conducted a national registry-based study investigating 3835 respondents to the Sarcoidosis Advanced Registry for Cures Questionnaire between June 2014 and August 2019. This registry is based on a self-reported, web-based questionnaire that provides data related to demographics, diagnostics, sarcoidosis manifestations and treatment. We compared sarcoidosis patients with and without self-reported hypothyroidism. We used multivariable logistic regression and adjusted …

Sarcoidosis Presenting As Fatigue And Weakness, Syed Muhammad Zubair, Naveed Haroon Rashid

Section of Pulmonary & Critical Care

Sarcoidosis is a systemic granulomatous disorder of unknown cause that occurs in both men and women of all races. It typically presents in patients after 20 years of age. Sarcoidosis most frequently involves the lung, but up to 30 percent of patients present with extra-thoracic manifestations. It can involve multiple organs to a variable extent and degree. In areas, where tuberculosis is endemic, the diagnosis of sarcoidosis may be overlooked and misdiagnosed because of clinical and radiographic resemblance. Herein, we present a case of a middle-aged man who visited multiple physicians with constitutional symptoms and was treated symptomatically but did …

Sleep And Function In Patients With Multiple Sclerosis, Nawar Aljundi, Kelsey Arvai, Michael Mitchell, Jennifer Martin, Abdulghani Sankari, M. Safwan Badr

Medical Student Research Symposium

Introduction: Fatigue is a core symptom of Multiple Sclerosis (MS) and impairs function and quality of life in this patient population. Studies show that sleep-disordered breathing is also common in persons with MS and may exacerbate fatigue symptoms. Within a larger study of patients with spinal cord injuries and disorders, we evaluated the relationships among sleep-disordered breathing (SDB) severity, sleep quality, and functional outcomes in patients with MS. Our objective was to examine the impact of SDB severity on the severity of fatigue and functional impairment in this population.

Methods: Twenty-five subjects (average age=57(11), min=35, max=79; 80% male; average …

Applications Of The Critical Power Model To Dynamic Constant External Resistance Exercise: A Brief Review Of The Critical Load Test, Haley C. Bergstrom, Taylor K. Dinyer, Pasquale J. Succi, Caleb C. Voskuil, Terry J. Housh

Kinesiology and Health Promotion Faculty Publications

The study and application of the critical power (CP) concept has spanned many decades. The CP test provides estimates of two distinct parameters, CP and W′, that describe aerobic and anaerobic metabolic capacities, respectively. Various mathematical models have been used to estimate the CP and W′ parameters across exercise modalities. Recently, the CP model has been applied to dynamic constant external resistance (DCER) exercises. The same hyperbolic relationship that has been established across various continuous, whole-body, dynamic movements has also been demonstrated for upper-, lower-, and whole-body DCER exercises. The asymptote of the load versus repetition relationship is defined as …

Modulators Of Change-Of-Direction Economy After Repeated Sprints In Elite Soccer Players, Filippo Dolci, Andrew E. Kilding, Tania Spiteri, Paola Chivers, Ben Piggott, Andrew Maiorana, Nicolas H. Hart

IHR Papers and Journal Articles

Purpose: To investigate the acute effect of repeated-sprint activity (RSA) on change-of-direction economy (assessed using shuttle running economy [SRE]) in soccer players and explore neuromuscular and cardiorespiratory characteristics that may modulate this effect.

Methods: Eleven young elite male soccer players (18.5 [1.4] y old) were tested on 2 different days during a 2-week period in their preseason. On day 1, lower-body stiffness, power and force were assessed via countermovement jumps, followed by an incremental treadmill test to exhaustion to measure maximal aerobic capacity. On day 2, 2 SRE tests were performed before and after a repeated-sprint protocol with …

The Sleep Of Shift Workers In A Remote Mining Operation: Methodology For A Randomized Control Trial To Determine Evidence-Based Interventions, Gemma Maisey, Marcus Cattani, Amanda Devine, Johnny Lo, Ian C. Dunican

Research outputs 2014 to 2021

© Copyright © 2021 Maisey, Cattani, Devine, Lo and Dunican. Shiftwork may adversely impact an individual’s sleep-wake patterns and result in sleep loss ( < 6 h. following night shift), due to the circadian misalignment and the design of rosters and shifts. Within a mining operation, this sleep loss may have significant consequences due to fatigue, including an increased risk of accidents and chronic health conditions. This study aims to (i) determine the efficacy of an intervention that comprises a sleep education program and biofeedback through a smartphone app on sleep quality, quantity, and alertness (ii) determine the prevalence of risk for a potential sleep disorder, and (iii) quantify and describe the sleep habits and behaviors of shift workers in a remote mining operation. This study consists of a randomized controlled trial whereby eighty-eight shift workers within a remote mining operation are randomized to a control group or one of three different treatment groups that are: (i) a sleep education program, (ii) biofeedback on sleep through a smartphone app, or (iii) a sleep education program and biofeedback on sleep through a smartphone app. This study utilizes wrist-activity monitors, biomathematical modeling, and a survey instrument to obtain data on sleep quantity, quality, and alertness. A variety of statistical methods will determine the prevalence of risk for a potential sleep disorder and associations with body mass index, alcohol, and caffeine consumption. A generalized linear mixed model will examine the dependent sleep variables assessed at baseline and post-intervention for the control group and intervention groups, as well as within and between groups to determine changes. The findings from this study will contribute to the current understanding of sleep and alertness behaviors, and sleep problems and disorders amongst shift workers. Importantly, the results may inform fatigue policy and practice on interventions to manage fatigue risk within the mining industry. This study protocol may have a broader application in other shiftwork industries, including oil and gas, aviation, rail, and healthcare.

Physiological Measurements For Real-Time Fatigue Monitoring In Train Drivers: Review Of The State Of The Art And Reframing The Problem, Bojana Bjegojevic, Maria Chiara Leva, Nora Balfe, Sam D. Cromie, Luca Longo

Conference papers

The impact of fatigue on train drivers is one of the most important safety-critical issues in rail. It affects drivers’ performance, significantly contributing to railway incidents and accidents. To address the issue of real-time fatigue detection in drivers, most reliable and applicable psychophysiological indicators of fatigue need to be identified. Hence, this paper aims to examine and present the current state of the art in physiological measures for real-time fatigue monitoring that could be applied in the train driving context. Three groups of such measures are identified: EEG, eye-tracking and heart-rate measures. This is the first paper to provide the …

The Bench Press Grip Width Does Not Affect The Number Of Repetitions Performed At Different Velocity Loss Thresholds, Alejandro Pérez-Castilla, Ivan Jukic, G. Gergory Haff, Amador García-Ramos

Research outputs 2014 to 2021

© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This study aimed (I) to compare the number of repetitions that can be completed to failure (XRM) and before reaching a 15%, 30%, or 45% velocity loss threshold (XVLT) in the bench press exercise performed using different grip widths, and (II) to examine the inter-individual variability in the percentage of completed repetitions with respect to the XRM when the set volume is prescribed based on a fixed number of repetitions (FNR) and several velocity loss thresholds (VLT). Nineteen men performed four separate sessions in a random order where there was a …

Burnout And Fatigue: A Potential Downside Of The Critical Care Nursing Profession, Samantha L. Ford

MSN Capstone Projects

Studies show that burnout and fatigue increase healthcare cost and decreases organizational profit due to increased rates of employee turnover, decreased employee satisfaction, a decrease in the quality of care provided to patients, and the development of a toxic work environment. The three principal factors of job-related burnout and fatigue will be addressed within the context of this paper including emotional exhaustion, depersonalization, and personal accomplishment.

Critical care nurses suffer from feeling emotionally depleted to the point they feel as though they can no longer give anymore of themselves to the patients they care for, which is a result of …

Exercise To Improve Cancer-Related Fatigue, Jennifer Watson

MSN Capstone Projects

For the average patient, medical professionals typically recommend exercise to enhance the health of their patients in multiple ways. Oncology patients, however, often have different issues that the treating physicians are more concerned about, so physical activity gets placed on the back burner. The need for exercise in oncology patients is certainly a decision that should be part of an individualized treatment plan, but it is reasonable to believe that most of these patients will benefit from participating in an exercise program. With the high demanding need to decrease chemotherapy side effects and improve lives of those undergoing it, this …

Investigating The Psychological Impact Of Covid-19 Among Healthcare Workers: A Meta-Analysis, Kavita Batra, Tejinder Pal Singh, Manoj Sharma, Ravi Batra, Nena Schvaneveldt

Environmental & Occupational Health Faculty Publications

© 2020 by the authors. Licensee MDPI, Basel, Switzerland. Previous meta-analyses were conducted during the initial phases of the COVID-19 pandemic, which utilized a smaller pool of data. The current meta-analysis aims to provide additional (and updated) evidence related to the psychological impact among healthcare workers. The search strategy was developed by a medical librarian and bibliographical databases, including Medline, Embase, CINAHL, PsycINFO, and Scopus were searched for studies examining the impact of the COVID-19 pandemic on the psychological health of healthcare workers. Articles were screened by three reviewers. Heterogeneity among studies was assessed by I2 statistic. The random-effects model …

Prevalence Of Motor Impairment In Residents Of New South Wales, Australia Aged 55 Years And Over: Cross-Sectional Survey Of The 45 And Up Cohort, R. D. Herbert, Janet L. Taylor, S. R. Lord, S. C. Gandevia

Research outputs 2014 to 2021

BACKGROUND: The population prevalence of many diseases is known. However, little is known of the population prevalence of motor impairments. METHODS: The aim of this study was to determine the point prevalence of specific motor impairments (weakness, fatigue, contracture, impaired balance and impaired coordination) in the population aged 55 years and older resident in New South Wales, Australia in 2018. 55,210 members of the 45 and Up cohort were invited to participate in a follow-up survey that included questions on motor impairment. Responses were received from 20,141 people (36%). Calibrated estimates of prevalence of specific motor impairments, and of having …

Physical Activity For Rheumatoid Arthritis Patients: Benchmark Study, Lauren Nicholson

MSN Capstone Projects

Rheumatoid arthritis (RA) is an autoimmune inflammatory condition that affects the joints; without proper treatment and management, RA leads to the destruction of joint function. The standard of care for RA includes medications such as biologic therapy and disease-modifying anti-rheumatic drugs. An often-overlooked area of disease management is the implementation of exercise programs for patients with RA. Exercise is known to decrease systemic inflammation, symptoms of depression, and combat fatigue – all common symptoms reported by patients with RA.

Standard of care for patients with RA does not currently include lifestyle management factors such as diet, exercise, and cessation of …

Fatigue In Primary Care: Doctor, Why Am I So Tired?, Nina Mingioni, Md

Clinical Education Teaching Tools

Learning Objectives:

1. Identify top causes of fatigue in women
2. Develop an evidence-based approach to assessing a patient with fatigue
3. Reflect on the evidence for available screening tools for fatigue

Effects Of Caffeine On Neuromuscular Function In A Non-Fatigued State And During Fatiguing Exercise, Ricardo N. O. Mesquita, Neil J. Cronin, Heikki Kyröläinen, Jukka Hintikka, Janne Avela

Research outputs 2014 to 2021

New Findings:

What is the central question of the study? What are the effects of caffeine on neuromuscular function in a non-fatigued state and during fatiguing exercise? What is the main finding and its importance? In a non-fatigued state, caffeine decreased the duration of the silent period evoked by transcranial magnetic stimulation. Caffeine-induced reduction of inhibitory mechanisms in the central nervous system before exercise was associated with an increased performance. Individuals who benefit from caffeine ingestion may experience lower perception of effort during exercise and an accelerated recovery of M-wave amplitude postfatigue. This study elucidates the mechanisms of action of …

Fatigue In Young People With Duchenne Muscular Dystrophy, Basmah El-Aloul, Kathy N Speechley, Yi Wei, Piotr Wilk, Craig Campbell

Paediatrics Publications

AIM: To describe fatigue in Duchenne muscular dystrophy (DMD) from patients' and parents' perspectives and to explore risk factors for fatigue in children and adolescents with DMD.

METHOD: A multicentre, cross-sectional study design was used. Seventy-one patients (all males; median age 12y, age range 5-17y) identified via the Canadian Neuromuscular Disease Registry, and their parents completed questionnaires. Subjective fatigue was assessed using the Pediatric Quality of Life Inventory Multidimensional Fatigue Scale by child self-report and parent proxy-report.

RESULTS: Patients with DMD across ages and disease stages experienced greater fatigue compared to typically developing controls from published data. Sleep disturbance symptoms …

Large Reductions In Match Play Physical Performance Variables Across A Professional Football Season With Control For Situational And Contextual Variables, Matthew Springham, Sean Williams, Mark Waldron, Darren Burgess, Robert Usher Newton

Research outputs 2014 to 2021

This investigation examined match play physical performance across a professional football season using a multicamera computerized tracking system. A linear mixed-effects model, controlling for situational and contextual variables, identified decreases in team average total distance (TD): season quarter 1 (Q1) (11,047 m) > season quarter 2 (Q2) (10,473 m) ( = ; ES = ), season quarter 3 (Q3) (10,449 m) ( < 0.001; ES = ), and season quarter 4 (Q4) (10,385 m) ( < 0.001; ES = ); work rate (WR): Q1 (115 m/min) > Q3 (108 m/min) ( < 0.001; ES = ), Q4 (107 m/min) ( < 0.001; ES = ); Q2 (109 m/min) > Q4 (107 m/min) ( = 0.003; ES = ); high-speed running distance (HSR): Q1 (1,051 m) > Q2 (813 m) ( = 0.006; ES = ); number of high-speed runs (NHSR): Q1 (87) > Q2 (65) ( …

Transcranial Direct Current Stimulation To Optimise Participation In Stroke Rehabilitation – A Sham-Controlled Cross-Over Feasibility Study, Christopher Etherton-Beer, Yee Lui, Miranda Radalj, Ann-Maree Vallence, Barby Singer

Research outputs 2014 to 2021

Background: Fatigue and attentional decline limit the duration of many therapy sessions in older adults poststroke. Transcranial direct current stimulation (tDCS) may facilitate participation in rehabilitation, potentially via reduced fatigue and improved sustained attention poststroke. Objective: To evaluate whether tDCS results in an increase in the number of completed rehabilitation therapy sessions in stroke survivors. Methods: Nineteen participants were randomly allocated to receive 10 sessions of 2-mA anodal (excitatory) tDCS, or sham tDCS, applied to the left dorsolateral prefrontal cortex (DLPFC) for 20 minutes within 1 hour prior to the first rehabilitation therapy session of the day. After a 2-day …

Power Output, Cadence, And Torque Are Similar Between The Forward Standing And Traditional Sprint Cycling Positions, Paul F. J. Merkes, Paolo Menaspà, Chris R. Abbiss

Research outputs 2014 to 2021

Purpose:

Compare power output, cadence, and torque in the seated, standing, and forward standing cycling sprint positions.

Methods:

On three separated occasions (ie, one for each position), 11 recreational male road cyclists performed a 14 seconds sprint before and directly after a high-intensity lead-up. Power output, cadence, and torque were measured during each sprint. Results: No significant differences in peak and mean power output were observed between the forward standing (1125.5 ± 48.5 W and 896.0 ± 32.7 W, respectively) and either the seated or standing positions (1042.5 ± 46.8 W and 856.5 ± 29.4 W; 1175.4 ± 44.9 W …

Psychological Symptoms In Chinese Nurses May Be Associated With Predisposition To Chronic Disease: A Cross-Sectional Study Of Suboptimal Health Status, Jinxiu Zhu, Wenjuan Ying, Li Zhang, Gangyi Peng, Weiju Chen, Enoch Odame Anto, Xueqing Wang, Nan Lu, Shanshan Gao, Guihai Wu, Jingyi Yan, Jianfeng Ye, Shenglin Wu, Chengzhi Yu, Minghui Yue, Xiru Huang, Nuo Xu, Pengxiang Ying, Yanhong Chen, Xuerui Tan, Wei Wang

Research outputs 2014 to 2021

© 2020, The Author(s). Background: Suboptimal health status (SHS) is a reversible state between ideal health and illness and it can be effectively reversed by risk prediction, disease prevention, and personalized medicine under the global background of predictive, preventive, and personalized medicine (PPPM) concepts. More and more Chinese nurses have been troubled by psychological symptoms (PS). The correlation between PS and SHS is unclear in nurses. The purpose of current study is to investigate the prevalence of SHS and PS in Chinese nurses and the relationship between SHS and PS along with predisposing factors as well as to discuss the …

Sleep And Stress In The Acute Phase Of Concussion In Youth, Arthur C. Maerlender, Caitlin Masterson, Jessica L. Calvi, Todd Caze, Ross Mathiasen, Dennis Molfese

Center for Brain, Biology, and Behavior: Faculty and Staff Publications

This study sought to address the complex interplay between both biological and psychological perceptions of stress and sleep in the acute stages following a mild traumatic brain injury. A secondary goal was to identify potential targets for intervention. Eleven acutely injured youth (mean age 12 years) were studied at home with overnight actigraphy, salivary cortisol and melatonin assays, and subjective ratings of stress and fatigue (injured group). Nine matched control youth also were assessed (control group). Results suggested longer sleep latencies (time to fall asleep) and higher levels of fatigue in the injured group exist (p ¼ 0.025 and p …

The Effect Of Yoga On Fatigue In Breast Cancer Patients Undergoing Radiotherapy, Magdalene Bredehoeft, Karli Ribsam

Physician Assistant Capstones, 2016 to 2019

Objective: Assess the effect of yoga on levels of fatigue among women with breast cancer currently undergoing radiotherapy. Design: Systematic literature review. Methods: Searches were done on PubMed, utilizing the terms “yoga,” “fatigue,” “breast cancer,” and “radiotherapy.” Limits that led to inclusion of studies included: published after 2008, studies researching breast cancer, and studies that were randomized controlled trials. Results: Randomized controlled trials studied were by Chandwani et al. (2010), Chandwani et al. (2014), and Vadiraga et al. (2009). Conclusion: Yoga can improve quality of life among women with breast cancer undergoing radiotherapy, specifically by decreasing levels of fatigue. We …

Perseverance, Faith And Stoicism: A Qualitative Study Of Medical Student Perspectives On Managing Fatigue, Taryn S Taylor, Alexandra L Raynard, Lorelei Lingard

Obstetrics & Gynaecology Publications

CONTEXT: Fatigue risk management (FRM) strategies offer a potential solution to the widespread problem of fatigued trainees in the clinical workplace. These strategies assume a shared perception that fatigue is hazardous. Despite the growing body of evidence suggesting that fatigue leads to burnout and medical errors, previous research suggests that residents perceive fatigue as a personal, surmountable burden rather than an occupational hazard. Before we can implement FRM, we need a better understanding of when and how such problematic notions of fatigue are adopted by medical trainees. Thus, we sought to explore how third-year medical students understand and manage the …

Today's Fibromyalgia, Mckenzie K. Glennon

Student Publications

Fibromyalgia is a chronic musculoskeletal disorder which results in widespread pain, fatigue, cognitive difficulties, and emotional distress (CDC, 2017). It is also associated with abnormal pain processing. About 2% of US adults have Fibromyalgia, and the disease is more common in middle-aged women, particularly those who have other illnesses like Lupus or Rheumatoid Arthritis (CDC, 2017). The exact cause of the disease is unknown, but it is likely a combination of genetics, infections and physical and emotional trauma. Since the exact cause of Fibromyalgia is unknown, treatment options vary. Medication, stress management techniques and an exercise plan are all examples …

Demographic, Clinical, And Treatment Characteristics Of The Juvenile Primary Fibromyalgia Syndrome Cohort Enrolled In The Childhood Arthritis And Rheumatology Research Alliance Legacy Registry., Jennifer E. Weiss, Kenneth N. Schikler, Alexis D. Boneparth, Mark Connelly, Carra Registry Investigators

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: To describe the demographic, clinical, and treatment characteristics of youth diagnosed with juvenile primary fibromyalgia syndrome (JPFS) who are seen in pediatric rheumatology clinics.

METHODS: Information on demographics, symptoms, functioning, and treatments recommended and tried were obtained on patients with JPFS as part of a multi-site patient registry (the Childhood Arthritis and Rheumatology Research Alliance Legacy Registry). Data were summarized using descriptive statistics. In a subset of patients completing registry follow-up visits, changes in symptoms, pain, and functioning were evaluated using growth modeling.

RESULTS: Of the 201 patients with JPFS enrolled in the registry, most were Caucasian/White (85%), non-Hispanic …

Heart Rate Variability Monitoring During Strength And High-Intensity Interval Training Overload Microcycles, Christoph Schneider, Thimo Wiewelhove, Christian Raeder, Andrew Flatt, Olaf Hoos, Laura Hottenrott, Oliver Schumbera, Michael Kellmann, Tim Meyer, Mark Pfeiffer, Alexander Ferrauti

Department of Health Sciences and Kinesiology Faculty Publications

Objective: In two independent study arms, we determine the effects of strength training (ST) and high-intensity interval training (HIIT) overload on cardiac autonomic modulation by measuring heart rate (HR) and vagal heart rate variability (HRV).

Methods: In the study, 37 well-trained athletes (ST: 7 female, 12 male; HIIT: 9 female, 9 male) were subjected to orthostatic tests (HR and HRV recordings) each day during a 4-day baseline period, a 6-day overload microcycle, and a 4-day recovery period. Discipline-specific performance was assessed before and 1 and 4 days after training.

Results: Following ST overload, supine HR, and vagal HRV (Ln RMSSD) …

Managing The Effects Of Poor Sleep Quality In Nurses, Emily Huene, Sarah Rausch, Georgia Vasiu, Hannah Lopez, Rachael Valentz, Msn, Rn, Ccrn

Nursing Undergraduate Work

Staffing shortages, high turnover rates, and prolonged work shifts has caused decreased sleep quality in nurses due to fatigue. The fatigued nurse causes concern for safety, coordination and agility, patient avoidance, lack of compassion, impaired cognitive function, risk for chronic diseases, and patient care errors. This systematic research review was designed to identify evidence-based practice nursing interventions currently being used to manage the effects of reduced sleep quality. Methods for performing this systematic research review were to search multiple databases using keywords, scanning article titles and abstracts, and critiquing for relevance and quality. Findings from this systematic review found multiple …

Development And Validation Of The Fsiq-Rms: A New Patient-Reported Questionnaire To Assess Symptoms And Impacts Of Fatigue In Relapsing Multiple Sclerosis, Stacie Hudgens, René Schüler, Jonathan Stokes, Sonya Eremenco, Elke Hunsche, Thomas P. Leist

Department of Neurology Faculty Papers

Objectives: A new patient-reported outcome (PRO) instrument to measure fatigue symptoms and impacts in relapsing multiple sclerosis (RMS) was developed in a qualitative stage, followed by psychometric validation and migration from paper to an electronic format.

Methods: Adult patients with relapsing-remitting multiple sclerosis (RRMS) were interviewed to elicit fatigue-related symptoms and impacts. A draft questionnaire was debriefed in cognitive interviews with further RRMS patients, and revised. Content confirmation interviews were conducted with patients with progressive-relapsing multiple sclerosis (PRMS) and relapsing secondary-progressive multiple sclerosis (RSPMS). Psychometric analyses used data from adult patients with different RMS subtypes and matched non-RMS controls in …