Critical Appraisal of Evidence for Improving Gait Speed in People with Multiple Sclerosis

Plummer, Prudence

doi:10.7224/1537-2073.2014-114

Cited by 6 publications

(10 citation statements)

References 55 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The gait speed improvements we observed with this combined intervention also exceed those that have been reported for exercise and gait training interventions in people with MS. 5,14 For example, a pooled analysis of task-specific gait training interventions in people with MS found an overall improvement in self-selected gait speed of 0.06 (95% CI, 0.02-0.10) m/s, 14 whereas the participant in this study had a 0.23-m/s increase in selfselected gait speed during the D-ER + PT phase. A meta-analysis of exercise interventions found only a small, nonsignificant improvement in T25FW time (-0.59 [95% CI, -2.55 to 1.36] seconds), 5 whereas our participant improved T25FW time by 0.90 seconds with the combined intervention.…”

Section: Plummer Et Almentioning

confidence: 58%

Case Report: Combining Dalfampridine with Multicomponent Exercise and Gait Training in a Person with Multiple Sclerosis

Plummer¹,

Bohling²,

Nickles³

et al. 2018

International Journal of MS Care

Self Cite

View full text Add to dashboard Cite

Section: Plummer Et Almentioning

confidence: 58%

Case Report: Combining Dalfampridine with Multicomponent Exercise and Gait Training in a Person with Multiple Sclerosis

Plummer¹,

Bohling²,

Nickles³

et al. 2018

International Journal of MS Care

Self Cite

View full text Add to dashboard Cite

“…77,78 Two fair-quality quasiexperimental studies compared an aerobic exercise with usual care in adolescents with CP over 8 weeks (n=44 total). 88,132 VO2 peak measured in ml/kg/min was increased significantly more with cycle-ergometry in one study, and in both studies VO2 peak measured in ml/min was increased significantly with aerobic exercise (Table 43) (SOE: low). In participants with SCI, three studies reported VO2 peak, with two fair-quality RCTs (n=71) finding a significant increase with aerobic exercise training, 92,140 and a small (n=17), fair-quality cohort study not finding a difference, although the endpoint values were higher in the aerobic exercise group (Table 44) (SOE: low).…”

Section: Aerobic Exercises Versus Usual Carementioning

confidence: 93%

“…Forty-two studies (36 RCTs, 5 quasiexperimental studies, and 1 cohort study) evaluated the effect of physical activity on intermediate outcomes. 53,63,[75][76][77][78]82,88,89,[91][92][93]117,125,[132][133][134][135][136][137]140,147,186,198,204,[206][207][208][209][211][212][213][216][217][218][219][220][221][222]224,227,228,230,231,[234][235][236][237]242,243,246,247,249 Eighteen studies enrolled participants with MS (n=984), 53,63,[76][77]…”

Section: Kq2b: Intermediate Outcomesmentioning

confidence: 99%

“…Across 22 studies of aerobic-type exercise in participants with CP, 13 included children (median age 9 years), 8 included adolescents (median age 16 years), and 1 included adults (median age 27 years). 73,74,[85][86][87][88][99][100][101][102]105,[121][122][123][124][125][126][127][128]131,132,218 Looking at studies of children versus teens, in very global terms, the findings are similar; three of six and four of nine studies reported positive findings on walking tests, while one of three and one of four reported positive findings in gross motor function in children and adolescents (respectively). The measures reported are too varied to be compared with evaluate any potential differences in magnitude of effects.…”

Section: Agementioning

confidence: 99%

See 1 more Smart Citation

Physical Activity and the Health of Wheelchair Users: A Systematic Review in Multiple Sclerosis, Cerebral Palsy, and Spinal Cord Injury

Selph¹,

Skelly²,

Wasson³

et al. 2021

View full text Add to dashboard Cite

Objectives. Although the health benefits of physical activity are well described for the general population, less is known about the benefits and harms of physical activity in people dependent upon, partially dependent upon, or at risk for needing a wheelchair. This systematic review summarizes the evidence for physical activity in people with multiple sclerosis, cerebral palsy, and spinal cord injury regardless of current use or nonuse of a wheelchair. Data sources. We searched MEDLINE®, CINAHL®, PsycINFO®, Cochrane CENTRAL, Embase®, and Rehabilitation and Sports Medicine Source from 2008 through November 2020, reference lists, and clinical trial registries. Review methods. Predefined criteria were used to select randomized controlled trials, quasiexperimental nonrandomized trials, and cohort studies that addressed the benefits and harms of observed physical activity (at least 10 sessions on 10 different days of movement using more energy than rest) in participants with multiple sclerosis, cerebral palsy, and spinal cord injury. Individual study quality (risk of bias) and the strength of bodies of evidence for key outcomes were assessed using prespecified methods. Dual review procedures were used. Effects were analyzed by etiology of impairment and physical activity modality, such as treadmill, aquatic exercises, and yoga, using qualitative, and when appropriate, quantitative synthesis using random effects meta-analyses. Results. We included 146 randomized controlled trials, 15 quasiexperimental nonrandomized trials, and 7 cohort studies (168 studies in 197 publications). More studies enrolled participants with multiple sclerosis (44%) than other conditions, followed by cerebral palsy (38%) and spinal cord injury (18%). Most studies were rated fair quality (moderate risk of bias). The majority of the evidence was rated low strength. • In participants with multiple sclerosis, walking ability may be improved with treadmill training and multimodal exercise regimens that include strength training; function may be improved with treadmill training, balance exercises, and motion gaming; balance is likely improved with postural control exercises (which may also reduce risk of falls) and may be improved with aquatic exercises, robot-assisted gait training, treadmill training, motion gaming, and multimodal exercises; activities of daily living may be improved with aquatic therapy; sleep may be improved with aerobic exercises; aerobic fitness may be improved with multimodal exercises; and female sexual function may be improved with aquatic exercise. • In participants with cerebral palsy, balance may be improved with hippotherapy and motion gaming, and function may be improved with cycling, treadmill training, and hippotherapy. • In participants with spinal cord injury, evidence suggested that activities of daily living may be improved with robot-assisted gait training. • When randomized controlled trials were pooled across types of exercise, physical activity interventions were found to improve walking in multiple sclerosis and likely improve balance and depression in multiple sclerosis. Physical activity may improve function and aerobic fitness in people with cerebral palsy or spinal cord injury. When studies of populations with multiple sclerosis and cerebral palsy were combined, evidence indicated dance may improve function. • Evidence on long-term health outcomes was not found for any analysis groups. For intermediate outcomes such as blood pressure, lipid profile, and blood glucose, there was insufficient evidence from which to draw conclusions. There was inadequate reporting of adverse events in many trials. Conclusions. Physical activity was associated with improvements in walking ability, general function, balance (including fall risk), depression, sleep, activities of daily living, female sexual function, and aerobic capacity, depending on population enrolled and type of exercise utilized. No studies reported long-term cardiovascular or metabolic disease health outcomes. Future trials could alter these findings; further research is needed to examine health outcomes, and to understand the magnitude and clinical importance of benefits seen in intermediate outcomes.

show abstract

“…The existing evidence supports the efficacy of D-ER for improving mobility (based on walking speed), but the beneficial effects only occur in a subset of persons with MS (i.e., responders). Responder status was not related to demographic characteristics, disease duration, level of disability, baseline walking speed, type of MS, or use of DMDs [32]. This indicates that the differences in responsiveness may be related to the underlying mechanism of action of D-ER [23].…”

Section: Pharmacologic Therapiesmentioning

confidence: 99%

Therapies for mobility disability in persons with multiple sclerosis

Baird

Sandroff

Motl

2018

Expert Review of Neurotherapeutics

View full text Add to dashboard Cite

Mobility disability is one of the most widespread and impactful consequences of multiple sclerosis (MS). Disease modifying drugs (DMDs) may delay the progression of disability over time; however, there is minimal evidence supporting the efficacy of DMDs for reversing mobility disability or restoring ambulatory function in persons with MS. Areas covered: This review outlines symptomatic pharmacologic and non-pharmacologic therapeutic approaches that target mobility disability with the goal of restoring and improving walking function. First, the efficacy of dalfampridine, currently the only Food and Drug Administration approved symptomatic pharmacologic agent that improves walking in persons with MS is described. Next, a review of the efficacy of non-pharmacologic therapies for improving walking, including exercise training, physical therapy, and gait training is given. Last, guidance on future research on mobility in MS is provided by emphasizing the importance of combinatory treatment approaches that include multiple intervention modalities, as the best treatment plan likely involves a comprehensive, multidisciplinary approach. Expert commentary: There has been an increased effort to develop symptom-specific treatments in MS that directly target mobility disability; however, more research is needed to determine the efficacy of these rehabilitative strategies alone and together for improving walking in persons with MS.

show abstract

Critical Appraisal of Evidence for Improving Gait Speed in People with Multiple Sclerosis

Cited by 6 publications

References 55 publications

Case Report: Combining Dalfampridine with Multicomponent Exercise and Gait Training in a Person with Multiple Sclerosis

Case Report: Combining Dalfampridine with Multicomponent Exercise and Gait Training in a Person with Multiple Sclerosis

Physical Activity and the Health of Wheelchair Users: A Systematic Review in Multiple Sclerosis, Cerebral Palsy, and Spinal Cord Injury

Therapies for mobility disability in persons with multiple sclerosis

Contact Info

Product

Resources

About