Rhythmic-cued motor imagery improves walking, fatigue and QoL in people with MS, with music-cued motor imagery being more effective.

All interventions significantly improved walking. MVMI was superior in improving walking, fatigue and QoL. Results suggest that MI and SMS were mechanisms of action.

BackgroundMotor imagery (MI) is increasingly used in neurorehabilitation to facilitate motor performance. Our previous study results demonstrated significantly improved walking after rhythmic-cued MI in people with multiple sclerosis (pwMS). The present feasibility study was aimed to obtain preliminary information of changes in walking, fatigue, quality of life (QoL) and MI ability following cued and non-cued MI in pwMS. The study further investigated the feasibility of a larger study and examined the reliability of a two-dimensional gait analysis system.MethodsAt the MS-Clinic, Department of Neurology, Medical University of Innsbruck, Austria, 15 adult pwMS (1.5–4.5 on the Expanded Disability Status Scale, 13 females) were randomised to one of three groups: 24 sessions of 17 min of MI with music and verbal cueing (MVMI), with music alone (MMI), or non-cued (MI). Descriptive statistics were reported for all outcomes. Primary outcomes were walking speed (Timed 25-Foot Walk) and walking distance (6-Minute Walk Test). Secondary outcomes were recruitment rate, retention, adherence, acceptability, adverse events, MI ability (Kinaesthetic and Visual Imagery Questionnaire, Time-Dependent MI test), fatigue (Modified Fatigue Impact Scale) and QoL (Multiple Sclerosis Impact Scale-29). The reliability of a gait analysis system used to assess gait synchronisation with music beat was tested.ResultsParticipants showed adequate MI abilities. Post-intervention, improvements in walking speed, walking distance, fatigue, QoL and MI ability were observed in all groups. Success of the feasibility criteria was demonstrated by recruitment and retention rates of 8.6% (95% confidence interval, CI 5.2, 13.8%) and 100% (95% CI 76.4, 100%), which exceeded the target rates of 5.7% and 80%. Additionally, the 83% (95% CI 0.42, 0.99) adherence rate surpassed the 67% target rate. Intra-rater reliability analysis of the gait measurement instruments demonstrated excellent Intra-Class Correlation coefficients for step length of 0.978 (95% CI 0.973, 0.982) and step time of 0.880 (95% CI 0.855, 0.902).ConclusionResults from our study suggest that cued and non-cued MI are valuable interventions in pwMS who were able to imagine movements. A larger study appears feasible, however, substantial improvements to the methods are required such as stratified randomisation using a computer-generated sequence and blinding of the assessors.Trial registrationISRCTN ISRCTN92351899. Registered 10 December 2015.Electronic supplementary materialThe online version of this article (10.1186/s40945-018-0045-0) contains supplementary material, which is available to authorized users.

BackgroundNovel physiotherapy approaches such as motor imagery and rhythmic auditory stimulation have been shown to improve walking in people with multiple sclerosis (MS). Rhythmic cued motor imagery was used in this study, whose objectives were to evaluate the feasibility of a larger randomised controlled trial (RCT) in people with MS and to obtain information on walking.MethodsThirty adult people with MS who scored 1.5–4.5 on the Expanded Disability Status Scale were recruited at the MS Clinic Innsbruck, Austria. Participants were randomly allocated to one of three groups, all receiving usual care: 17 min of motor imagery, six times per week, for 4 weeks, with music (A) or metronome cues (B) and (C) controls. Primary outcomes were recruitment rates, retention, compliance, adverse events and fatigue (Modified Fatigue Impact Scale). Secondary outcomes were walking speed (Timed 25-Foot Walk) and walking distance (6-Minute Walk Test).ResultsWe achieved our recruitment target by recruiting 12 participants per month, a mean eligibility rate of 40.1 % (95 % confidence interval (CI) 35.8, 44.6 %) out of 2500 MS Centre patients, mean consent rate of 15.9 % (95 % CI 11.3, 21.7 %) plus 54.5 % (95 % CI 47.4, 61.4 %) of eligible patients who expressed their interest to participate. Retention of 100 %, no adverse events, good compliance, high acceptability of the interventions and no worsening of fatigue confirmed feasibility. The mean improvement in walking speed in both groups A and B was −0.9 s (95 % CI −1.3, −0.5), and mean worsening in group C was 0.4 s (95 % CI −0.3, 1.1). The mean improvement in walking distance in group A was 68.1 m (95 % CI 51.4, 84.7) and in group B 92.9 m (95 % CI 55.2, 130.5), and mean worsening in group C was −9.4 m (95 % CI −35.6, 16.9).ConclusionsResults from our study showed that a full-scale RCT is feasible to investigate the effects of rhythmic cued motor imagery on walking in people with MS, with no changes to the interventions and assessments. Based on the walking improvements, a total sample size of 138 participants was calculated. Stratified blocked randomisation, allocation concealment and blinding will be used in the main study.Trial registrationISRCTN: ISRCTN67054113

2 IntroductionCompassion is not a new concept. It has been described and debated as a religious and secular value and virtue, as an emotion, a psychological process, a political phenomenon, a core value in health professional practice and as a topic of empirical research for some time. The word 'compassion' comes from the Latin 'co-suffering' or 'to suffer together with ' (Austin et al. 2013). We ensure that compassion is central to the care we provide and respond with humanity and kindness to each person's pain, distress, anxiety or need. We search for the things we can do, however small, to give comfort and relieve suffering. We find time for patients, their families and carers, as well as those we work alongside. We do not wait to be asked, because we care. (DH 2015:5) The impetus for the call was in response to the Francis reports (Francis 2010(Francis , 2013) which detailed numerous care failures that resulted in the avoidable distress, neglect and deaths of patients. These reports indicate that the values of the NHS Constitution are not always enacted.In the call for bids, HEKSS highlighted the fact that the Secretary of State had issued a mandate to Health Education England (HEE) to deliver 'high quality, effective, compassionate care: Developing the right people with the right skills and the right values' (DH 2013).A research team from two universities, one medical school, four NHS organisations and service users collaborated together to design, implement and evaluate the project. The project built on previous research, practice and educational expertise in the areas of professionalism and ethics in healthcare practice. The project had funding for one year and it aimed to develop a sustainable programme of 'compassion awareness training' that engaged with diverse healthcare staff within the partner organisations across the region, building on existing compassion initiatives. The nature and purpose of the research element of the project was to generate an evidence base for the implementation and evaluation of the compassion training programme. Literature ReviewCompassion is recognised as a core value within the NHS Constitution, in professional codes, 3 several policy documents relating to high quality service delivery, and in the Prime Minister's Commission Report on the Future of Nursing and Midwifery (NMC 2015, DH 2015, DH 2013, DH 2012, DH 2010. A significant number of empirical and philosophical studies on compassion have been published in the nursing, care and ethics literature. These papers were identified through online professional databases and included if they demonstrated rigour as well as relevance to the development and maintenance of compassion for people accessing healthcare services and for a variety of health professionals, students and support staff. Research from many countries and using different methodologies were included in the review. For example, Torjuul et al (2007) conducted a qualitative study of nurses and physicians regarding compassion and responsibility in surgical ca...