Web-based physiotherapy for people affected by multiple sclerosis: a single blind, randomized controlled feasibility study

Abstract

Objective: To examine the feasibility of a trial to evaluate web-based physiotherapy compared to a standard home exercise programme in people with Multiple Sclerosis (MS). Design: Multi-centre, randomised controlled, feasibility study Setting; Three Multiple Sclerosis outpatient centres Participants: Ninety people with Multiple Sclerosis (Expanded Disability Disease Scale 4-6.5), Interventions: Participants were randomised, to a 6 month individualised, home exercise programme delivered via web-based physiotherapy (n=45) (intervention) or a sheet of exercises (n=45) (active comparator). Main outcome measures: Outcome measures (0, 3, 6 and 9 months) included adherence, 2min walk test, 25ft walk, Berg Balance Scale, physical activity and healthcare resource use. Interviews were undertaken with 24 participants and 3 physiotherapists. Results: Almost 25% of people approached agreed to take part. No intervention-related adverse events were recorded. Adherence was 40-63% and 53-71% in the web-based physiotherapy and comparator groups. There was no difference in the 2min walk test between groups at baseline (Intervention-80.4(33.91)m, Comparator-70.6(31.20)m) and no change over time (at 6 months Intervention-81.6(32.75)m, Comparator 74.8(36.16)m). There were no significant changes over time in other outcome measures except the EQ-5D at 6 months which improved in the active comparator group. For a difference of 8(17.4)m in the 2min walk test between groups 76 participants/group would be required (80% power, p>0.05) for a future randomised controlled trial. 3 Conclusion: no changes were found in the majority of outcome measures over time. This study was acceptable and feasible by participants and physiotherapists. An adequately powered study needs 160 participants.

Adherence to Physiotherapy-Guided Web-Based Exercise for Persons with Moderate-to-Severe Multiple Sclerosis

“…This participation rate in twice-weekly exercise is comparable to the six-month, multi-center trial (n = 90) with webbasedphysio, except the previously reported multi-center trial included only ambulatory people. 12 Comparing our adherence results with other web-based exercise research in multiple sclerosis is challenging, since methods for defining and measuring adherence are not consistent in the literature. 20 Studies reporting internet-delivered physical activity interventions for people with MS commonly describe physical activity levels measured by self-report questionnaire or…”

“…The website contains exercises (videos, text and audio description), which are individually prescribed by a physiotherapist at an initial assessment. 12,13 The physiotherapist is able to review the electronic exercise diaries and remotely alter the exercises in response to comments from participants. The inventory of exercises and the educational materials were previously developed with input from people living with MS in the UK with mild to moderate disability.…”

Implementing Supported Self-Management in Community-Based Stroke Care: A Secondary Analysis of Nurses’ Perspectives

“…It is plausible that since this time, the developments in the political landscape surrounding, and the culture of support for, self-management more broadly, have increased. This, coupled with the evolution of digital health in stroke (and in other neurological conditions) such as smart phone applications, telerehabilitation, and telemonitoring [40][41][42][43] for supporting rehabilitation and long-term behavior change, may have impacted on and shifted perceptions about SSM and its implementation somewhat. A secondary analysis approach potentially limited the extent to which broader issues of implementation could have been probed for further exploration in the original focus groups/interviews meaning that some questions may remain unanswered.…”

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“…1,2 Web Based Rehabilitation approaches are an infra-structure that helps all individuals at all ages, including healthy individuals, to guide caregivers and in order to guide multiple sclerosis, rheumatoid arthritis, spinal cord injury, stroke, diabetes mellitus, elderly people, pediatric rehabilitation. 1,[3][4][5] It is estimated that 10% of the global population, about 90% of them live with Type 2 diabetes. Poorly controlled diabetes; There are high risk of complications, including early mortality and cardiovascular disease, nephropathy and retinopathy.…”

“…However, for selfmanagement, a Web-based support can relieve some of these barriers (especially in high-income countries with high web access levels). [1][2][3] In people with spinal cord injury (SCI), physical activity and exercise can help maintain muscle strength and flexibility, reduce healing and pain. With the home based, Web rehabilitation approach, it has been determined that exercise programs are effective in improving physical activity in people with SCI.…”