Efficacy of an Internet-Based Program to Promote Physical Activity and Exercise after Inpatient Rehabilitation in Persons with Multiple Sclerosis: A Randomized, Single-Blind, Controlled Study

Abstract

Background: Multimodal rehabilitation improves fatigue and mobility in persons with multiple sclerosis (PwMS). Effects are transient and may be conserved by internet-based physical activity promotion programs. Objective: Evaluate the effects of internet-based physical activity and exercise promotion on fatigue, quality of life, and gait in PwMS after inpatient rehabilitation. Methods: PwMS (Expanded Disability Status Scale (EDSS) ≤ 6.0, fatigue: Würzburg Fatigue Inventory for Multiple Sclerosis (WEIMuS) ≥ 32) were randomized into an intervention group (IG) or a control group (CG). After rehabilitation, IG received 3 months of internet-based physical activity promotion, while CG received no intervention. Primary outcome: self-reported fatigue (WEIMuS). Secondary outcomes: quality of life (Multiple Sclerosis Impact Scale 29, MSIS-29), gait (2min/10m walking test, Tinetti score). Measurements: beginning (T0) and end (T1) of inpatient rehabilitation, 3 (T2) and 6 (T3) months afterwards. Results: 64 of 84 PwMS were analyzed (IG: 34, CG: 30). After rehabilitation, fatigue decreased in both groups. At T2 and T3, fatigue increased again in CG but was improved in IG (p < 0.001). MSIS-29 improved in both groups at T1 but remained improved at T2 and T3 only in IG. Gait improvements were more pronounced in IG at T2. Conclusions: The study provides Class II evidence that the effects of rehabilitation on fatigue, quality of life, and gait can be maintained for 3–6 months with an internet-based physical activity and exercise promotion program.

Physical activity behavior in people with multiple sclerosis during the COVID-19 pandemic in Israel: Results of an online survey

“…We believe that these efforts have succeeded during the COVID-19 pandemic in motivating a large segment of PwMS to maintain their PA habits, despite the lockdown conditions. An additional explanation might involve the rapid development and use of digital applications promoting PA, including applications specifically addressed to PwMS ( Dennett et al, 2018 , Remy et al, 2020 , Flachenecke et al, 2020 ). Recently Remi et al (2020) investigated the compliance of PwMS in using telecommunication technologies for rehabilitation.…”

“…Recently Remi et al (2020) investigated the compliance of PwMS in using telecommunication technologies for rehabilitation. The authors found that 62% of the cohort was interested in receiving physical exercise program, and 69% were interested in information and personalized advice about PA and MS ( Flachenecke et al, 2020 ). Although, access to these technologies was not feasible for all PwMS, there was a possibility that a relatively large portion of patients benefited from these novel technologies during the lockdown.…”

Is mHealth a Useful Tool for Self-Assessment and Rehabilitation of People with Multiple Sclerosis? A Systematic Review

“…Thirty studies about the use of mHealth for rehabilitation interventions of pwMS were included in this review, representing a total of 1962 patients [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 ]. The majority of these studies ( n = 25; 3%) were RCTs.…”

Are mHealth a Useful Tool for Self-Assessment and Rehabilitation of People With Multiple Sclerosis? A Review

“…The heterogeneity between the studies, and the patients, makes it more difficult to compare studies and especially to generalize the results. A second important limitation is that most of the included studies on the rehabilitation aspects (except [32,35,38,40,45]) have relatively small sample sizes and the results are likely to be underpowered [72]. Furthermore, the percentage of participants that were included in the final analysis is 90% and information about the adherence to the intervention was missing (usually a threshold of 80% is applied to determine if the participants do a sufficient amount of exercises [73]).…”

“…Amongst the included RCTs, 20 were included in the meta-analysis assessing the efficacy of mHeath for rehabilitation [24,[26][27][28][29][30][31][33][34][35][36][37]39,40,44,45,[47][48][49]51,65], representing 1,393 pwMS. When considering all the studies and ICF domains together, the heterogeneity between the studies was moderate (tau 2 = 0.30, 95%CI [0.26; 0.62]), therefore we decided to use random-effect model.…”