Center‐Based Group and Home‐Based Individual Exercise Programs Have Similar Impacts on Gait and Balance in People With Multiple Sclerosis: A Randomized Trial

Abstract

Background Group and home‐based exercises to improve function in people with multiple sclerosis (MS) are common but have little underpinning evidence. Objective To determine the comparative effectiveness of a center‐based group versus home‐based individual 8‐week exercise program to improve gait and balance in people with MS. Design Prospective, randomized controlled trial. Setting Community center‐based and home‐based exercise program. Participants Fifty people with MS were randomized and completed allocated intervention (n = 26 center, n = 24 home), 47 completed post‐assessment and 44 follow‐up assessment. Methods The center‐ and home‐based groups completed an 8‐week progressive functional and balance training exercise program. The center‐based groups of four to six were supervised by a physiotherapist. The home‐based group was provided with telephone support. Main Outcome Measurements The primary outcome was gait speed (10‐meter walk test). Secondary outcomes were gait endurance (6‐minute walk test) and balance (Berg Balance Scale). Outcome assessments were conducted at baseline, immediately postintervention and at 8‐week follow‐up. Results There was no statistically significant difference between groups in gait speed post training, with a mean difference of 0.01 m/s, 95% CI −0.36 to 0.37. There were no group effects, time effects, or interactions for gait speed, endurance, or balance. In both groups, gait speed improved to a level that met minimal clinically important differences. Conclusions Gait speed, endurance, and balance did not statistically improve in either group; however, gait speed changes met minimally important differences.

The Effectiveness of Physiotherapy Interventions for Mobility in Severe Multiple Sclerosis: A Systematic Review and Meta-Analysis

“…16 interventions from 15 studies ( Table 5 ) were included in the vote counting (RAGT [ 41 ], RAGT+VR [ 42 ], CWT [ 31 , 41 ], BWSTT+antigravity treadmill training [ 35 ],BWSTT [ 13 ], BWSTT+dual tasks [ 32 ], blood flow restriction [ 38 , 40 ], total body recumbent stepper training [ 28 ], home exercise [ 19 ], exergaming [ 27 ], balance training [ 27 ], ADSTEP [ 33 ], group physiotherapy [ 26 , 44 ], 1 : 1 physiotherapy [ 26 ], yoga [ 26 ], and kickboxing [ 21 ]).…”

“…Seven interventions from 6 studies were defined as beneficial in improving mobility in severely disabled MS patients (RAGT, CWT, BWSTT+ dual task training, BFR, group physiotherapy, 1 : 1 physiotherapy and Yoga) [ 26 , 31 , 32 , 40 , 41 , 44 ].…”

“…Blood flow restricted walking study demonstrated a significant improvement in the 6MWT, walking speed, 5 time sit to stand, and FSS [ 40 ]. In addition, a study by Williams et al [ 44 ] found that group physiotherapy significantly improved the 10WMT. Hogan et al's study [ 26 ] with three intervention groups showed that individual physiotherapy significantly improved 6MWT, balance, and fatigue and group physiotherapy significantly improved balance and fatigue, while yoga only improved balance significantly after the intervention.…”

“…Five studies [14,22,29,40,43] examined the effect of CWT on the 6mwt for (n = 91 patients), showing no significant effect (SMD 0.162, 95% CI [-0.046-0.369], p = 0:127, I 2 = 0%) (Figure 4(b)). 5) were included in the vote counting (RAGT [41], RAGT+VR [42], CWT [31,41], BWSTT+antigravity treadmill training [35],BWSTT [13], BWSTT+dual tasks [32], blood flow restriction [38,40], total body recumbent stepper training [28], home exercise [19], exergaming [27], balance training [27], ADSTEP [33], group physiotherapy [26,44], 1 : 1 physiotherapy [26], yoga [26], and kickboxing [21]).…”

Is mHealth a Useful Tool for Self-Assessment and Rehabilitation of People with Multiple Sclerosis? A Systematic Review

“…Thirty studies about the use of mHealth for rehabilitation interventions of pwMS were included in this review, representing a total of 1962 patients [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 ]. The majority of these studies ( n = 25; 3%) were RCTs.…”