Biofeedback Based Home Balance Training can Improve Balance but Not Gait in People with Multiple Sclerosis

Abstract

Background. Impaired balance is common in people with multiple sclerosis (MS) and can be present even in those with a mild disability level. With increasing disability, gait, and balance impairment progress, and lead to increased risk of falls. In some recent studies, interactive commercial video games were used for improving balance, but their limitation is their lack of individual training parameter settings needed for rehabilitation purposes. The aim of this study was to evaluate the feasibility and effect of balance exercise in the home setting using the rehabilitation Homebalance® system. Methods. A single-centre, controlled, single blind study with allocation to intervention group or to control group was utilised. Participants were assessed at baseline, after four weeks of home-based balance training, and follow-up after four weeks. The primary outcomes were the Berg Balance Test (BBT). The secondary outcome measures included the Mini-BESTest, Timed Up, and Go Test (part of Mini-BESTest), and spatio-temporal gait parameter evaluation using the GAITRite instrument. The patient reported outcomes (PRO) included the 12-Item MS Walking Scale, Activities-specific Balance Confidence Scale, and the Falls Efficacy Scale. Results. A total of 39 people with Multiple Sclerosis (10 men) were enrolled into the study. The mean age of participants was 40.69 ± 10.2 years, with a mean disease duration 14.76 ± 9.1 years and mean disability level 3.8 ± 1.9 EDSS (EDSS range 1.5–7). Statistically significant improvements within the home exercise group were present for the BBT and the Mini-BESTest. This improvement was more significant in the subgroup with moderate and higher disability (EDSS 4.5–7). All other gait parameters and PRO did not show any improvement. Follow-up assessment after four weeks showed that the reached improvement persisted for a short time period after finishing the regular training regimen. Conclusion. In comparison with no intervention, a short-term programme of home-based balance training using Homebalance® improved balance but not gait performance in a group of people with MS. It seems that home-based balance training tailored according to individual needs by a physiotherapist may be a future approach to consider for telerehabilitation of people with MS.

Effect of home-based virtual reality training and telerehabilitation on balance in individuals with Parkinson disease, multiple sclerosis, and stroke: a systematic review and meta-analysis

“…After all, increasing the sample size gives greater power to detect differences. The second largest included study has only 39 included participants, which emphasizes this hypothesis [38].…”

“…2 and 3. Four studies used random sequence generation through computer-generated number tables [32,[34][35][36][37]; one study used wait-list randomization [38]; and one study took an algorithm using MAT-LAB [35]. Krpic et al did not describe the randomization method [31].…”

“…Only Lloréns et al was scored "low risk" because of the use of two therapists with one therapist blinded to allocation, gave the treatment, and assessed the participants [34]. Detection bias was unclear in two studies, and the other studies used evaluators blinded to allocation [31,38]. Incomplete outcome data was low in four studies [32,34,36,38], and the other three studies did not write about the missing data or loss-to-follow-up.…”

“…Detection bias was unclear in two studies, and the other studies used evaluators blinded to allocation [31,38]. Incomplete outcome data was low in four studies [32,34,36,38], and the other three studies did not write about the missing data or loss-to-follow-up. The other bias was the influence of financial support, and this was high in Krpic et al [31].…”

“…Gandolfi et al found a significant difference between-group comparison at post-assessment, in favor of the EG [37]. Follow-up assessment significantly improved over time on the BBS in either EG or CG, in the studies of Gandolfi et al, Novotna et al, and Yang et al [35,37,38]. Between-group comparison showed no significant differences at follow-up in the studies of Gandolfi et al, Llórens et al, and Yang et al [34,35,37].…”