Does aerobic training alleviate fatigue and improve societal participation in patients with multiple sclerosis? A randomized controlled trial

Heine, Martin; Verschuren, Olaf; Hoogervorst, Erwin L.J.; Munster, Erik van; Hacking, Hub G.A.; Visser‐Meily, Anne; Twisk, Jos W. R.; Beckerman, Heleen; Groot, Vincent de; Kwakkel, Gert

doi:10.1177/1352458517696596

Cited by 60 publications

(77 citation statements)

References 27 publications

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“…This supports the thought that the relation between fatigue and PB is not straightforward and as a reason, targeting primarily on PB, even when personalized, will not lead to reduced levels of fatigue for every patient. Still, it is important to maintain a healthy lifestyle including appropriate levels of PA in order to improve other symptoms than fatigue, such as disability, quality of life and incidence of comorbidity [35, 36]. Insight in the PB profile with multiple PB measures therefore has potential as a starting point during counseling sessions to further interrogate the underlying causes of a patients affected PB.…”

Section: Discussionmentioning

confidence: 99%

Three distinct physical behavior types in fatigued patients with multiple sclerosis

Braakhuis

Berger

Stok

et al. 2019

J NeuroEngineering Rehabil

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Background Multiple sclerosis often leads to fatigue and changes in physical behavior (PB). Changes in PB are often assumed as a consequence of fatigue, but effects of interventions that aim to reduce fatigue by improving PB are not sufficient. Since the heterogeneous nature of MS related symptoms, levels of PB of fatigued patients at the start of interventions might vary substantially. Better understanding of the variability by identification of PB subtypes in fatigued patients may help to develop more effective personalized rehabilitation programs in the future. This study aimed to identify PB subtypes in fatigued patients with multiple sclerosis based on multidimensional PB outcome measures. Methods Baseline accelerometer (Actigraph) data, demographics and clinical characteristics of the TREFAMS-ACE participants ( n = 212) were used for secondary analysis. All patients were ambulatory and diagnosed with severe fatigue based on a score of ≥35 on the fatigue subscale of the Checklist Individual Strength (CIS20r). Fifteen PB measures were used derived from 7 day measurements with an accelerometer. Principal component analysis was performed to define key outcome measures for PB and two-step cluster analysis was used to identify PB types. Results Analysis revealed five key outcome measures: percentage sedentary behavior, total time in prolonged moderate-to-vigorous physical activity, number of sedentary bouts, and two types of change scores between day parts (morning, afternoon and evening). Based on these outcomes three valid PB clusters were derived. Conclusions Patients with severe MS-related fatigue show three distinct and homogeneous PB subtypes. These PB subtypes, based on a unique set of PB outcome measures, may offer an opportunity to design more individually-tailored interventions in rehabilitation. Trial registration Clinical trial registration no ISRCTN 82353628 , ISRCTN 69520623 and ISRCTN 58583714 . Electronic supplementary material The online version of this article (10.1186/s12984-019-0573-1) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Three distinct physical behavior types in fatigued patients with multiple sclerosis

Braakhuis

Berger

Stok

et al. 2019

J NeuroEngineering Rehabil

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“…Modifications: If the placebo/sham intervention was modified during the course of the study, describe the changes (what, why, when, and how) . Examples: ‘In some cases, the face-to-face were replaced with phone sessions if needed [ 55 ]’. ‘…the protocol was amended to require a time-out before the beginning of surgery [sham neurosurgery] on each side of the brain, with the coordinates confirmed by the surgeon and documented in writing by a study coordinator or other surgical team member before penetration of the brain [ 56 ]’.…”

Section: Resultsmentioning

confidence: 99%

TIDieR-Placebo: A guide and checklist for reporting placebo and sham controls

et al. 2020

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Background Placebo or sham controls are the standard against which the benefits and harms of many active interventions are measured. Whilst the components and the method of their delivery have been shown to affect study outcomes, placebo and sham controls are rarely reported and often not matched to those of the active comparator. This can influence how beneficial or harmful the active intervention appears to be. Without adequate descriptions of placebo or sham controls, it is difficult to interpret results about the benefits and harms of active interventions within placebo-controlled trials. To overcome this problem, we developed a checklist and guide for reporting placebo or sham interventions. Methods and findings We developed an initial list of items for the checklist by surveying experts in placebo research (n = 14). Because of the diverse contexts in which placebo or sham treatments are used in clinical research, we consulted experts in trials of drugs, surgery, physiotherapy, acupuncture, and psychological interventions. We then used a multistage online Delphi process with 53 participants to determine which items were deemed to be essential. We next convened a group of experts and stakeholders (n = 16). Our main output was a modification of the existing Template for Intervention Description and Replication (TIDieR) checklist; this allows the key features of both active interventions and placebo or sham controls to be concisely summarised by researchers. The main differences between TIDieR-Placebo and the original TIDieR are the explicit requirement to describe the setting (i.e., features of the physical environment that go beyond geographic location), the need to report whether blinding was successful (when this was measured), and the need to present the description of placebo components alongside those of the active comparator.

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“…Consideramos que la proporción de pacientes neurológicos y con amputaciones evaluados es insuficiente. Recomendamos que las enfermedades neurológicas no neurovasculares reciban al menos una evaluación por el especialista en rehabilitación [23][24][25][26][27][28] . En el caso de los pacientes amputados, sería deseable evaluar a todos para educarlos durante la etapa de hospitalización 16 .…”

Section: Resultsunclassified

Características de la población y las atenciones de rehabilitación que recibe en un hospital general

2017

Rev. méd. Chile

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Background Patients discharged from general hospitals with a potentially disabling condition can benefit in their recovery with the aid of physical medicine and rehabilitation services. Aim To determine the proportion of patients discharged from a general hospital with a potentially disabling condition, who were derived to physiatry for rehabilitation. Material and Methods Review of the discharge database of a general hospital, identifying all discharges with a potentially disabling condition, and those who were effectively derived for rehabilitation. Results Only 7% of patients with a potentially disabling condition were effectively evaluated by Physiatry. Among these patients, 20% had neurological diseases and 19% had an amputation. Those attended by physiatry had a higher proportion of multidisciplinary care by the rehabilitation team. Conclusions A low proportion of patients discharged with a potentially disabling conditions are referred for an adequate rehabilitation therapy.

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Does aerobic training alleviate fatigue and improve societal participation in patients with multiple sclerosis? A randomized controlled trial

Cited by 60 publications

References 27 publications

Three distinct physical behavior types in fatigued patients with multiple sclerosis

Three distinct physical behavior types in fatigued patients with multiple sclerosis

TIDieR-Placebo: A guide and checklist for reporting placebo and sham controls

Características de la población y las atenciones de rehabilitación que recibe en un hospital general

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