Getting the Balance Right: A randomised controlled trial of physiotherapy and Exercise Interventions for ambulatory people with multiple sclerosis

Department of Physiotherapy, University of Limerick, Limerick, Ireland.
BMC Neurology (Impact Factor: 2.49). 02/2009; 9:34. DOI: 10.1186/1471-2377-9-34
Source: PubMed

ABSTRACT People with Multiple Sclerosis have a life long need for physiotherapy and exercise interventions due to the progressive nature of the disease and their greater risk of the complications of inactivity. The Multiple Sclerosis Society of Ireland run physiotherapy, yoga and exercise classes for their members, however there is little evidence to suggest which form of physical activity optimises outcome for people with the many and varied impairments associated with MS.
This is a multi-centre, single blind, block randomised, controlled trial. Participants will be recruited via the ten regional offices of MS Ireland. Telephone screening will establish eligibility and stratification according to the mobility section of the Guys Neurological Disability Scale. Once a block of people of the same strand in the same geographical region have given consent, participants will be randomised. Strand A will concern individuals with MS who walk independently or use one stick to walk outside. Participants will be randomised to yoga, physiotherapy led exercise class, fitness instructor led exercise class or to a control group who don't change their exercise habits.Strand B will concern individuals with MS who walk with bilateral support or a rollator, they may use a wheelchair for longer distance outdoors. Participants will be randomised to 1:1 Physiotherapist led intervention, group intervention led by Physiotherapist, group yoga intervention or a control group who don't change their exercise habits. Participants will be assessed by physiotherapist who is blind to the group allocation at week 1, week 12 (following 10 weeks intervention or control), and at 12 week follow up. The primary outcome measure for both strands is the Multiple Sclerosis Impact Scale. Secondary outcomes are Modified Fatigue Impact Scale, 6 Minute Walk test, and muscle strength measured with hand held dynamometry. Strand B will also use Berg Balance Test and the Modified Ashworth Scale. Confounding variables such as sensation, coordination, proprioception, range of motion and other impairments will be recorded at initial assessment.
Data analysis will analyse change in each group, and the differences between groups. Sub group analysis may be performed if sufficient numbers are recruited.

Download full-text


Available from: Maria Kehoe, Aug 26, 2015
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To assess the effectiveness of organised MDR in adults with MS. MDR was defined as an inpatient, outpatient, home or community based pro- gramme, delivered by two or more disciplines in conjunction with physician consultation, and targeted towards improvements at the level of activity and/or participation. METHODS The Cochrane MS Group methods search strategy identified all randomised (RCT) and controlled (CCT) clinical trials that compared MDR with routinely available local services or lower levels of intervention, or trials comparing interventions in different settings or at different levels of intensity. Three reviewers selected trials and rated their methodological quality independently. Methodo- logical quality criteria (n = 17) proposed by van Tulder and colleagues 12 were used to assess internal validity, and descriptive and statistical criteria (details are available in the full review). Quantitative analysis was not possible because of the use of diverse outcomes and other clinical heterogeneity. Therefore, qualitative synthesis of ''best evidence'' was presented based on levels of evidence proposed by van Tulder and colleagues. 2
    Postgraduate medical journal 08/2008; 84(993):385. DOI:10.1136/jnnp.2007.127563 · 1.55 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Our previous research indicated that an Internet intervention was effective in increasing self-reported physical activity in persons with multiple sclerosis (MS). The present study examined the efficacy of the same Internet intervention in persons with MS by using both objective and self-report measures of physical activity. Participants (N = 21) wore an accelerometer around the waist for 7 days and then completed the International Physical Activity Questionnaire (IPAQ) and Godin Leisure-Time Exercise Questionnaire (GLTEQ) before and after receiving the 12-week Internet intervention. The Internet intervention resulted in moderate increases in accelerometer activity counts (d = 0.68) and steps counts (d = 0.60), and this was paralleled by small increases in IPAQ (d = 0.43) and GLTEQ (d = 0.34) scores. The number of weeks that persons logged on was correlated with change in accelerometer activity counts (r = 0.42) and step counts (r = 0.37) but not change in IPAQ (r = 0.10) or GLTEQ (r = 0.08) scores. The novel contribution of this study was the observation that an Internet intervention was efficacious for increasing physical activity in persons with MS by using both objective and self-report measures.
    The Journal of Rehabilitation Research and Development 01/2011; 48(9):1129-36. DOI:10.1682/JRRD.2010.09.0192 · 1.69 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Modulation of neurodegeneration by physical activity is an active topic in contemporary research. The purpose of this study was to investigate changes in the brain's microstructure in multiple sclerosis (MS) after facilitation physiotherapy. Eleven patients with MS were examined using motor and neuropsychological testing and multimodal MRI at the beginning of the study, with second baseline measurement after 1 month without any therapy, and after a 2-month period of facilitation physiotherapy. Eleven healthy controls were examined at the beginning of the study and after 1 month. Fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (λ (ax)), and radial diffusivity (λ (rad)) were calculated for the whole corpus callosum (CC) in the midsagittal slice of T1W 3D MPRAGE spatially normalized images. Data were analyzed using linear mixed-effect models, paired, and two-sample tests. At the baseline, patients with MS showed significantly lower values in FA (p < 0.001), and significantly higher values in MD (p < 0.001), λ (ax) (p = 0.003), and λ (rad) (p < 0.001) compared to control subjects. The FA, MD, λ (ax), and λ (rad) did not change between the first and second baseline examinations in either group. Differences 2 months after initiating facilitation physiotherapy were in FA, MD, and in λ (rad) significantly higher than differences in healthy controls (p < 0.001 for FA, p = 0.02 for MD, and p = 0.002 for λ (rad)). In MS patients, FA in the CC significantly increased (p < 0.001), MD and λ (rad) significantly decreased (p = 0.014 and p = 0.002), and thus approached the values in healthy controls. The results of the study show that facilitation physiotherapy influences brain microstructure measured by DTI.
    Neuroradiology 05/2011; 53(11):917-26. DOI:10.1007/s00234-011-0879-6 · 2.37 Impact Factor
Show more