Perceived and physiological strains of societal participation in people with multiple sclerosis: a real-time assessment study.
Arianne S Gravesteijn, Maaike Ouwerkerk, Isaline C J M Eijssen and 2 others
PMID 38910543WHAT IT FOUND
For people with MS, how strenuous an activity feels does not predict how hard their heart works.
Perceived strain was linked to fatigue, not physiology. Clinicians should treat fatigue and perceived effort directly, rather than assuming physical exertion drives the complaint.
Key findings
01There was no significant relationship between perceived strain and physiological strain (%HRR) during societal participation.
02Higher fatigue levels resulted in higher perceived strain, independent of physiological strain.
03Activities like healthcare utilization were perceived as highly strenuous but showed low physiological strain, while driving was perceived as low strain but showed high physiological strain.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Heart rate may not be the most appropriate indicator of physiological strain, as it can be affected by stress, medication, or autonomic dysfunction common in MS. The Fitbit may underestimate heart rate compared to gold-standard ECG. Predicted maximal heart rate using the Karvonen formula (220-age) may have underestimated HRmax, leading to underestimated physiological strain. The broad pre-specified domains (e.g., 'recreation') make it difficult to pinpoint specific sources of strain. The 1-10 perceived strain scale differs from standard exercise scales (0-10 or 6-20), limiting comparison with other studies.
Declared interests
Funded by the Dutch MS Research Foundation. The funding organization had no role in data acquisition, analysis, interpretation, or manuscript drafting. Authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that perceived strain is irrelevant or that patients are exaggerating. The study shows that perceived strain is a valid, distinct construct driven by factors like fatigue, not just physical workload. Ignoring perceived strain because physiological strain is low misses the patient's actual experience of effort.