BACKGROUND Multiple sclerosis often leads to fatigue and changes in physical behavior (PB). Changes in PB are often assumed as a consequence of fatigue, but effects of interventions that aim to reduce fatigue by improving PB are not sufficient. Since the heterogeneous nature of MS related symptoms, levels of PB of fatigued patients at the start of interventions might vary substantially. Better understanding of the variability by identification of PB subtypes in fatigued patients may help to develop more effective personalized rehabilitation programs in the future. This study aimed to identify PB subtypes in fatigued patients with multiple sclerosis based on multidimensional PB outcome measures. METHODS Baseline accelerometer (Actigraph) data, demographics and clinical characteristics of the TREFAMS-ACE participants (n = 212) were used for secondary analysis. All patients were ambulatory and diagnosed with severe fatigue based on a score of ≥35 on the fatigue subscale of the Checklist Individual Strength (CIS20r). Fifteen PB measures were used derived from 7 day measurements with an accelerometer. Principal component analysis was performed to define key outcome measures for PB and two-step cluster analysis was used to identify PB types. RESULTS Analysis revealed five key outcome measures: percentage sedentary behavior, total time in prolonged moderate-to-vigorous physical activity, number of sedentary bouts, and two types of change scores between day parts (morning, afternoon and evening). Based on these outcomes three valid PB clusters were derived. CONCLUSIONS Patients with severe MS-related fatigue show three distinct and homogeneous PB subtypes. These PB subtypes, based on a unique set of PB outcome measures, may offer an opportunity to design more individually-tailored interventions in rehabilitation. TRIAL REGISTRATION Clinical trial registration no ISRCTN 82353628 , ISRCTN 69520623 and ISRCTN 58583714 .

中文翻译：

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患有多发性硬化症的疲劳患者的三种不同的身体行为类型。

背景技术多发性硬化症通常导致疲劳和身体行为（PB）的改变。PB的变化通常被认为是疲劳的结果，但是旨在通过改善PB减轻疲劳的干预措施的效果还不够。由于MS相关症状的异质性，在干预开始时，疲劳患者的PB水平可能会有很大变化。通过识别疲劳患者中的PB亚型更好地了解变异性，可能有助于将来开发更有效的个性化康复计划。这项研究旨在基于多维PB结局指标来确定多发性硬化症疲劳患者的PB亚型。方法基线加速度计（活动记录仪）数据，TREFAMS-ACE参与者（n = 212）的人口统计学和临床​​特征用于二级分析。所有患者均需门诊，并根据检查单人强度（CIS20r）疲劳子量表的得分≥35被诊断为严重疲劳。使用加速度计从7天的测量中得出了15个PB量度。进行主成分分析以定义PB的关键结局指标，并使用两步聚类分析来识别PB类型。结果分析揭示了五项主要的结局指标：久坐行为的百分比，长时间进行中度到剧烈运动的总时间，久坐的发作次数以及日间部分（早晨，下午和晚上）的两种变化得分。基于这些结果，得出了三个有效的PB簇。结论患有严重MS相关性疲劳的患者表现出三种不同且均一的PB亚型。这些基于PB结果测量的独特方法的PB亚型，可能为设计更个性化的康复干预措施提供机会。试验注册临床试验注册号为ISRCTN 82353628，ISRCTN 69520623和ISRCTN 58583714。