Muscle Quality of Knee Extensors Based on Several Types of Force in Multiple Sclerosis Patients with Varying Degrees of Disability

Abstract

Background and Objectives: Multiple sclerosis (MS) tends to affect muscle performance, mainly in the lower extremities. The degree of disability is associated with the loss of strength and muscle mass, to varying extents. Muscle quality (MQ) expresses the amount of force produced relative to the activated muscle mass. The purpose of this study was to compare the MQ of the knee extensors in the main manifestations of strength (isometric, dynamic strength, and power) among patients with differing degrees of neurological disability and evolutionary forms of the disease. We also establish reference values for MQ in MS patients (pwMS). Materials and Methods: In total, 250 pwMS were evaluated according to the Expanded Disability Status Scale (EDSS). The maximum dynamic and isometric forces and muscle power manifested a load of 60% of the maximum dynamics of the knee extensors. The lean mass of the thigh and hip was determined by densitometry, and the MQ was calculated for the three types of force evaluated. Results: The pwMS with relapsing remitting MS (RRMS) presented isometric MQ values that were 15.8% better than those of pwMS with primary progressive MS (PPMS) and 13.8% better than those of pwMS with secondary progressive MS (SPMS). For pwMS with SPMS, the dynamic MQ was 16.7% worse than that of patients with RRMS, while the power MQ was 29.5% worse. By degree of disability (<4 >7.5 EDSS score), patients with better MQ had mild EDSS scores, and patients with severe EDSS scores had 24.8%, 25.9%, and 40.3% worse isometric, dynamic, and power MQ scores, respectively, than those with RRMS. Based on these results, reference values for MQ in pwMS were established. Conclusions: The pwMS with different types of MS do not show differences in lean mass or strength but do show differences in MQ. In pwMS with different EDSS grades, there are no differences in lean mass, but there are differences in strength based on MQ, especially power MQ.