Background: Therapeutic plasma exchange (TPE) is frequently used in glucocorticosteroid (GCS)-refractory multiple sclerosis (MS) relapses. Data regarding predictors of treatment response are scarce. The objective of this study was to analyze predictive factors for response to TPE in GCS-refractory MS patients. Methods: A total of 118 MS patients in two tertiary MS centers were analyzed. Primary outcome was TPE response defined as marked, mild, or no improvement. Secondary outcome was change in expanded disability status scale (ΔEDSS). ΔEDSS and relapse activity within 6 months after TPE were studied. Results: Marked or mild improvement was observed in 78.8% of patients. ΔEDSS correlated significantly inversely with time from relapse to start of TPE (τ = –0.239, p = 0.001), age (τ = 0.182, p = 0.009) and disease duration (τ = –0.167, p = 0.017). In multivariate analysis, TPE response was predicted by diagnosis of relapsing MS [odds ratio (OR): 3.1], gadolinum-enhancement on magnetic resonance imaging (OR 3.2), age (OR 0.5 per 5 years older) and time from relapse onset to TPE (OR 0.7 per 7 days longer). Conclusion: Patients with longer disease duration and higher EDSS pre and post-TPE were more likely to show further disability progression or relapses within 6 months after TPE. No sustained effects were observed during the follow-up period.

ObjectiveSeveral recent studies show a growing popularity of therapeutic climbing (TC) for patients with various conditions. This could be an attempt to fill the gap left by traditional exercises that do not always address physical, mental, and social well‐being. This review provides an overview of the physical, mental, and social effects and safety aspects of climbing for different indications.Literature SurveyA literature search was conducted on July 8, 2020 (update search August 26, 2021). We searched MEDLINE via Ovid, Embase, and PubMed and bibliographies of included studies, and we conducted a manual search.MethodologyTwo independent reviewers evaluated the quality of the studies using appropriate Risk of Bias (RoB) tools, and the level of evidence for each domain was graded. Study characteristics and effectiveness data for TC were extracted and synthesized. Meta‐analyses were conducted for the three dimensions (physical/mental/social health), using a random‐effects model.SynthesisA total of 112 publications were reviewed, and 22 full‐text articles were assessed regarding the eligibility criteria, of which 18 trials involving 568 patients were included. TC is safe and positively affects physical (e.g., fitness, motor control, movement velocity, dexterity, strength), mental (e.g., depressiveness, somatisation, psychoticism, emotion regulation, body perception, self‐esteem, fatigue), and social (e.g., social functioning, trust, communication, sense of responsibility) health for individuals with neurological, orthopedic, psychiatric, and pediatric ailments. The meta‐analysis showed a statistically significant improvement in the physical dimension favoring the climbing group. Improvements that were not statistically significant were found for the mental/social dimensions in the climbing group. The heterogeneity of data was moderate/high (social/mental dimension), and for the physical dimension, data were homogenous.ConclusionsThe studies investigating TC outline its positive effects in various patient groups. TC is a safe and effective treatment for improving physical/mental/social well‐being. This review is based on the best available evidence; however, significant gaps remain in providing sufficiently strong evidence.

Objective To investigate the effect of sport climbing on a biomechanical marker of axial posture in patients with Parkinson's disease, as well as its association with age, body mass index and health-related quality-of-life outcome measures. Design Pre-planned secondary analysis of our randomized controlled, semi-blind trial (unblinded patients, blinded assessors) comparing sport climbing to unsupervised exercise. Setting Single-centre study conducted at the Department of Neurology of the Medical University of Vienna, Austria. Participants Forty-eight Parkinson's disease patients (aged 64 ± 8 years, Hoehn & Yahr stage 2–3) were included. Intervention Sport climbers ( n = 24) followed a 12-week, 90 min/week supervised top-rope sport climbing course in an indoor climbing gym. The unsupervised training group ( n = 24) independently followed the ‘European Physiotherapy Guidelines for Parkinson's Disease’ and World Health Organization recommendations for an active lifestyle for 12 weeks. Main measures Posture was assessed with the horizontal distance of the seventh cervical vertebra to the wall at baseline and after the intervention. Results Participating in the sport climbing group significantly predicted the biomechanical marker of axial posture ( P = 0.044). The improvement in the biomechanical marker did not affect the quality of life, depression, fatigue, physical activity or fear of falling. Participants in the sport climbing group showed a significantly decreased horizontal distance of the seventh cervical vertebra to the wall after the intervention (−1.7 cm (95%CI [−2.6, −0.8]). In the unsupervised training group, no difference was found (−0.5 cm; 95%CI −1.3, 0.2]). Conclusions We conclude that sport climbing improves a biomechanical marker of axial posture in Parkinson's disease.