Group-Based Individualized Comprehensive Core Stability Intervention Improves Balance in Persons With Multiple Sclerosis: A Randomized Controlled Trial

Abstract

Background Balance and trunk control are often impaired in individuals with multiple sclerosis (MS). Interventions addressing these issues are needed. Objective The objective of this study was to compare the immediate and long-term effects of a 6-week individualized, group-based, comprehensive core stability intervention (GroupCoreDIST) with standard care on balance and trunk control in individuals with MS. Design This study was a prospective, assessor-masked, randomized controlled trial. Setting The GroupCoreDIST intervention was conducted by 6 physical therapists in 6 municipalities in Norway. Standard care included the usual care for individuals with MS in the same municipalities. Assessments at all time points took place at a Norwegian hospital. Participants Eighty people with Expanded Disability Status scores of 1 to 6.5 participated in this trial. Intervention Randomized, concealed allocation was used to assign the participants to the GroupCoreDIST intervention (n = 40) or to standard care (n = 40). The GroupCoreDIST intervention was conducted with groups of 3 participants (1 group had 4 participants), for 60 minutes 3 times per week. Measurements Assessments were undertaken at baseline and at weeks 7, 18, and 30. Outcomes were measured with the Trunk Impairment Scale–Norwegian Version, Mini Balance Evaluation Systems Test, and Patient Global Impression of Change–Balance. Repeated-measures mixed models were used for statistical analysis. Results One individual missed all postintervention tests, leaving 79 participants in the intention-to-treat analysis. GroupCoreDIST produced significant between-group effects on the mean difference in the following scores at 7, 18, and 30 weeks: for Trunk Impairment Scale–Norwegian Version, 2.63 points (95% confidence interval [CI] = 1.89–3.38), 1.57 points (95% CI = 0.81–2.33), and 0.95 point (95% CI = 0.19–1.71), respectively; for Mini Balance Evaluation Systems Test, 1.91 points (95% CI = 1.07–2.76), 1.28 points (95% CI = 0.42–2.15), and 0.91 points (95% CI = 0.04–1.77), respectively; and for Patient Global Impression of Change–Balance, 1.21 points (95% CI = 1.66–0.77), 1.02 points (95% CI = 1.48–0.57), and 0.91 points (95% CI = 1.36–0.46), respectively. Limitations Groups were not matched for volume of physical therapy. Conclusions Six weeks of GroupCoreDIST improved balance and trunk control in the short and long terms compared with standard care in individuals who were ambulant and had MS. The intervention is an effective contribution to physical therapy for this population.

Group-based, individualized exercises can provide perceived bodily changes and strengthen aspects of self in individuals with MS: a qualitative interview study

“…The participants' perceptions of improved symptoms, movement control and easier access to daily activities are not surprising and in line with significant effects on balance in the RCT, in which this interview study is nested (Arntzen et al, 2019). It is also in agreement with previous reviews of effects in balance and walking (Byrnes, Wu, and Whillier, 2018;Gunn et al, 2015;Hogan and Coote, 2009;Paltamaa, Sjogren, Peurala, and Heinonen, 2012;Rietberg, Brooks, Uitdehaag, and Kwakkel, 2005;Snook and Motl, 2009) and qualitative studies of group-based training in individuals with MS (Carling, Nilsagård, and Forsberg, 2018;Clarke and Coote, 2015).…”

“…Balance dysfunctions are associated with an increased risk of falling (Comber, Sosnoff, Galvin, and Coote, 2018) and less participation in daily activities (Cameron and Lord, 2010;Cattaneo et al, 2017), and can influence aspects of self (Normann, Sørgaard, Salvesen, and Moe, 2013). Individual exercise therapy is associated with improvements in walking (Dalgas, Stenager, and Ingemann-Hansen, 2008;Hogan and Coote, 2009;Snook and Motl, 2009) and balance (Gunn et al, 2015;Paltamaa, Sjogren, Peurala, and Heinonen, 2012;Rietberg, Brooks, Uitdehaag, and Kwakkel, 2005); and the same association has been reported for group-based interventions for individuals with MS (Arntzen et al, 2019;Forsberg, von Koch, and Nilsagård, 2016;Tarakci et al, 2013).…”

“…Although the prevailing principle of individualization (European Multiple Sclerosis Platform, 2012) has been questioned in group settings (Kalron et al, 2019;Plow, Mathiowetz, and Lowe, 2009), an individualized intervention conducted in small groups was recently introduced and found feasible and effective on trunk control, balance and walking in individuals with MS (Arntzen et al, 2019;Dybesland and Normann, 2018;Normann, Salvesen, and Arntzen, 2016) From a professional perspective individualization within small groups is dependent on an initial individual assessment (Lahelle, Øberg, and Normann, 2018b), ongoing movement analyzes and adaptations through hands-on interactions (Lahelle, Øberg, and Normann, 2018a). Knowledge gained from the participant´s perspective regarding small groups is however limited.…”

<strong></strong>Multi-function Swing Suspension Training in Multiple Sclerosis: Assessing the Influence on Upper and Lower Extremities Function and Quality of Life with Respect to Expanded Disability Status Scale

“…In another study, Miyake et al (2013) [37] demonstrated that core training is likely to elevate trunk stabilization to improve UEF, also they emphasized that trunk stability ensures shoulder movement, and shoulder stability supports the elbow, wrist, and fingers movement. Previous studies have reported that MS patients would present impaired trunk control that is directly influencing disability in ULEF, and it has been showing that exercise programs that comprehensively focus on the aspects of the core stability could influence ULEF [38][39][40][41]. Chung et al (2008) [42] demonstrated that in clinical practice, trunk postural control is purported to be an important contributor to voluntary ULF in MS patients, including motor control and upper limb dexterity.…”

Embodiment, tailoring, and trust are important for co‐construction of meaning in physiotherapy after stroke: A qualitative study

“…I-CoreDIST 1 is a recent, individualized intervention aimed at recovery. For people with multiple sclerosis, it has proved effective (Arntzen, Straume, et al, 2019) and meaningful in group settings (Arntzen, Oberg, et al, 2019). It is also feasible in individual post-stroke rehabilitation (Normann et al, 2019).…”