Three weeks of rehabilitation improves walking capacity but not daily physical activity in patients with multiple sclerosis with moderate to severe walking disability

Abstract

Background Patients with multiple sclerosis have low levels of physical activity. This is of concern because low activity levels are related to cardiovascular disease, poor walking ability, and reduced quality of life. The aim of this study was to evaluate the impact of rehabilitation on daily physical activity and walking capacity in patients with multiple sclerosis who have moderate to severe walking disability. Methods This exploratory, observational study of 24 patients with multiple sclerosis examined daily physical activity, walking capacity and fatigue before and after 3 weeks of inpatient rehabilitation. Inpatient rehabilitation included physiotherapy (30–60 min, 5 times/week), strength and endurance training (30–45 min, 3–5 times/week), occupational therapy (30 min, 2–3 times/week), and neuropsychological training (30 min, 2 times/week). There were no specific interventions to target daily levels of physical activity. Results Daily physical activity did not change after rehabilitation (physical activity: effect size = –0.23, 95% confidence interval (95% CI) 0.02‒0.62). There were significant improvements in walking capacity (Two-Minute Walk Test: effect size = 0.74, 95% CI 0.31‒1.16, +17 m, 20.2%) and mobility (Timed Up and Go Test: effect size = 0.65, 95% CI 0.22‒1.07, ‒2.1 s, 14.9%). Motor and cognitive fatigue (Fatigue Scale for Motor: effect size = 0.56, 95% CI 0.14‒0.99 and Cognitive Functions: effect size = 0.44, 95% CI 0.01‒0.86) improved significantly after rehabilitation. Conclusion Three weeks of rehabilitation improved walking capacity, but not daily physical activity, in patients with multiple sclerosis with moderate to severe walking disability. To increase physical activity, it may be necessary to add specific behavioural interventions to the rehabilitation programme. The intervention plan should include strategies to overcome personal and environmental barriers.

Effects of multidisciplinary inpatient rehabilitation on everyday life physical activity and gait in patients with multiple sclerosis

“…The improvements measured in TUG test of 15.4% and 12.0% in the mildly and severely disabled pwMS, respectively, are statistically significant but lower than the established threshold of 23% for genuine changes [ 40 ]. Our results confirm previous findings demonstrating statistically significant improvements in all clinical walking outcome measurements (i.e., 10mWT, 2MWT and TUG) after a physical rehabilitation program [ 13 , 14 , 22 , 26 ]. Taken together, these results demonstrate that pwMS with mild and severe disabilities benefit from the MIR by significantly and clinically improving their perceived and actual functional mobility.…”

“…In the present MS cohort, mildly and severely disabled pwMS reported significant improvements in their walking ability as assessed by the MSWS-12 questionnaire (-6.6 and -9.4 points, respectively), which is in the range of clinically meaningful changes between -6 and -11 points [ 5 , 6 ]. The improvement in fatigue (FSMC) by -4 and -3 for mildly and severely disabled pwMS, respectively, is consistent with previous studies [ 26 , 33 ], but below the reported minimum for a clinical meaningful change (-9 points) [ 53 ]. In addition, pwMS also reported significant improvements in their self-rated health (EQ-VAS) of about + 10 and + 9 points for mildly and severely disabled pwMS (see appendix 3 in supplementary material).…”

“…Although supervised assessments performed in the clinic provide important information about improvement in functional capacity, they do not provide objective information about the impact of therapy in daily life (i.e., actual performance of the pwMS). The ecological validity of supervised clinical tests has been questioned, and discrepancies between mobility parameters measured in supervised and unsupervised settings have been demonstrated [ 14 , 26 , 57 ]. For example, the T25FW or 2MWT correlate only weakly with walking in free-living as reported in cross-sectional studies [ 17 ].…”