Group‐based, individualized, comprehensive core stability and balance intervention provides immediate and long‐term improvements in walking in individuals with multiple sclerosis: A randomized controlled trial

Abstract

ObjectivesWalking impairments are common in individuals with multiple sclerosis. Trunk control is a prerequisite for walking; however, knowledge regarding whether core stability and balance training influence walking is limited. This study aimed to investigate the immediate and long‐term effects of a group‐based, individualized, comprehensive core stability and balance intervention (GroupCoreDIST) compared with those of standard care on walking.MethodsThis assessor‐blinded, prospective randomized controlled trial included 80 participants (Expanded Disability Status Scale scores 1–6.5) randomly allocated to GroupCoreDIST, conducted in groups of three for 60 min three times per week for 6 weeks (18 sessions) or standard care (n = 40/40). One participant attended no posttests, leaving 79 subjects for intention‐to‐treat analysis. The assessments were performed at baseline and at Weeks 7, 18, and 30. Outcomes included the 2‐min walk test (2MWT), 10‐m walk test‐preferred/fast/slow speed (10MWT), Multiple Sclerosis Walking Scale‐12 (MSWS‐12), Patient Global Impression of Change‐walking (PGIC‐walking), Rivermead Visual Gait Assessment (RVGA), and ActiGraphsWgt3X‐BT activity monitors (ActiGraph). The statistical analyses included repeated‐measures mixed models performed in IBM SPSS Version 24.ResultsThere were no significant between‐group differences in the outcome measurements at baseline. The mean differences between groups were significant at all follow‐up time points in favour of GroupCoreDIST for the 2MWT, 16.7 m at 7 weeks (95% CI [8.15, 25.25], 15.08 m at 18 weeks (95% CI [6.39, 23.77]) and 16.38 m at 30 weeks (95% CI [7.65, 25.12]; and the PGIC‐walking, 0.89 points at 7 weeks (95% CI [1.34, 0.45]), 0.97 points at 18 weeks (95% CI [1.42, 0.52]), and 0.93 points at 30 weeks (95% CI [1.39, 0.48]; all p ≤ .001). The 10MWT‐fast speed and the MSWS‐12 showed significant between‐group differences at 7 and 18 weeks and the RVGA at 7 weeks. No between‐group differences were found regarding activity level (ActiGraph) or the 10MWT‐preferred or slow speed.ConclusionCompared with standard care, GroupCoreDIST significantly improved walking immediately after the intervention for up to 24 weeks of follow‐up.

Therapeutic Effects of the Pilates Method in Patients with Multiple Sclerosis: A Systematic Review

“…Another 93 potential articles were removed after the title and abstract review. Forty-five full texts were reviewed, and twenty articles [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] were used in the analysis based on inclusion and exclusion criteria. Figure 1 shows the PRISMA selection process flow chart [24].…”

“…Significant improvement compared with physician care [30] or with 1-h massage [38] • No significant differences between Pilates and rebound therapy [45] or aquatic therapy [47] Gait • Significant improvement [28,31,32,34,[36][37][38]40,43,44] • Significant improvement compared with standard physiotherapy care [31] or with home relaxation exercises [32] • No significant improvement [42] • Significant improvement in standardized exercises group compared to Pilates group [43] Physical-functional conditions • No significant improvement in post-intervention Pilates group, but there was in aerobic exercise group [42] (no difference between groups)…”

Personalised inpatient multidisciplinary rehabilitation elicits clinically relevant improvements in physical function in patients with multiple sclerosis – The Danish MS Hospitals Rehabilitation Study

“…Moreover, whilst reduction in walking capacity occurs over time (years) in pwMS and preferentially in vulnerable subgroups, 35,36 it rarely becomes detectable within a time span of three to six months. 37 Future longitudinal (ranging from months to years) studies should help establish the trajectory of walking capacity across MS patient subgroups.…”

Wearable technologies to measure clinical outcomes in multiple sclerosis: A scoping review

“…devices, especially when they are less invasive in day-to-day situations and provide real-time feedback. 8,9 Currently, there are two randomised controlled trials (RCTs) 10,11 that have utilised wearable technology in people with multiple sclerosis (PwMS); however, there are several more RCTs currently ongoing that utilise wearable technology, for example, the MD3001 (SPI2) trial. 12 The advantages and disadvantages of wearable technology are summarised in Table 1 above.…”

“…Studies have shown that patients, caregivers and health care professionals find value in using such devices, especially when they are less invasive in day-to-day situations and provide real-time feedback. 8 , 9 Currently, there are two randomised controlled trials (RCTs) 10 , 11 that have utilised wearable technology in people with multiple sclerosis (PwMS); however, there are several more RCTs currently on-going that utilise wearable technology, for example, the MD3001 (SPI2) trial. 12 …”