Multiple sclerosis and mobility-related assistive technology: Systematic review of literature

Souza, Ana Paula Ramos de; Kelleher, Annmarie; Cooper, Rosemarie; Iezzoni, Lisa I.; Collins, Diane

doi:10.1682/jrrd.2009.07.0096

Cited by 113 publications

(78 citation statements)

References 45 publications

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“…For example, people with multiple sclerosis may experience walking problems due to balance impairments, fatigue, muscle weakness or spasticity. 77 In addition to the devices under consideration here, other assistive technologies that may be considered for people with multiple sclerosis include walking sticks, crutches, wheeled walkers, and manual/motorised wheelchairs. 77 In the studies in which the participants had experienced poliomyelitis, carbon fibre or plastic KAFOs were investigated.…”

Section: Clinical Effectiveness Evidencementioning

confidence: 99%

Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: systematic review, qualitative study, survey and costing analysis

O’Connor

McCaughan

McDaid

et al. 2016

Health Technol Assess

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BackgroundPatients who have knee instability that is associated with neuromuscular disease (NMD) and central nervous system (CNS) conditions can be treated using orthoses, such as knee–ankle–foot orthoses (KAFOs).ObjectivesTo assess existing evidence on the effectiveness of orthoses; patient perspectives; types of orthotic devices prescribed in the UK NHS; and associated costs.MethodsQualitative study of views of orthoses users – a qualitative in-depth interview study was undertaken. Data were analysed for thematic content. A coding scheme was developed and an inductive approach was used to identify themes. Systematic review – 18 databases were searched up to November 2014: MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, Cumulative Index to Nursing and Allied Health, EMBASE, PASCAL, Scopus, Science Citation Index, BIOSIS Previews, Physiotherapy Evidence Database, Recal Legacy, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Health Technology Assessment database, Cochrane Central Register of Controlled Trials, Conference Proceedings Citation Index: Science, Health Management Consortium, ClinicalTrials.gov, International Clinical Trials Registry Platform and National Technical Information Service. Studies of adults using an orthosis for instability of the knee related to NMD or a CNS disorder were included. Data were extracted and quality was assessed by two researchers. Narrative synthesis was undertaken. Survey and costing analysis – a web survey of orthotists, physiotherapists and rehabilitation medicine physicians was undertaken. Telephone interviews with orthotists informed a costing analysis.ResultsQualitative study – a total of 24 people participated. Potential for engagement in daily activities was of vital importance to patients; the extent to which their device enabled this was the yardstick by which it was measured. Patients’ prime desired outcome was a reduction in pain, falls or trips, with improved balance and stability. Effectiveness, reliability, comfort and durability were the most valued features of orthoses. Many expressed frustration with perceived deficiencies in service provision relating to appointment and administrative systems and referral pathways. Systematic review – a total of 21 studies (478 participants) were included of people who had post-polio syndrome, inclusion body myositis, were post stroke or had spinal cord injury. The studies evaluated KAFOs (mainly carbon fibre), stance control KAFO and hip KAFOs. All of the studies were at risk of bias and, in general, were poorly reported. Survey and costing analysis – in total, 238 health-care professionals responded. A range of orthoses is prescribed for knee instability that is related to NMD or CNS conditions, approximately half being custom-made. At least 50% of respondents thought that comfort and confidence in mobility were extremely important treatment outcomes. The cost of individual KAFOs was highly variable, ranging from £73 to £3553.ConclusionsVarious types of orthoses are used in the NHS to manage patients with NMD/CNS conditions and knee instability, both custom-made and prefabricated, of variable cost. Evidence on the effectiveness of the orthoses is limited, especially in relation to the outcomes that are important to orthoses users.LimitationsThe population included was broad, limiting any in-depth consideration of specific conditions. The response rate to the survey was low, and the costing analysis was based on some assumptions that may not reflect the true costs of providing KAFOs.Future workFuture work should include high-quality research on the effectiveness and cost-effectiveness of orthoses; development of a core set of outcome measures; further exploration of the views and experiences of patients; and the best models of service delivery.Study registrationThis study is registered as PROSPERO CRD42014010180. The qualitative study is registered as Current Controlled Trials ISRCTN65240228.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Clinical Effectiveness Evidencementioning

confidence: 99%

Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: systematic review, qualitative study, survey and costing analysis

O’Connor

McCaughan

McDaid

et al. 2016

Health Technol Assess

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“…The effort of self-propelling contributes to fatigue and is thought to render self-propulsion non-functional [8]. Powered wheelchairs are often considered for PwMS to address fatigue and to facilitate rest [9].…”

Section: Introductionmentioning

confidence: 99%

Problematic clinical features of powered wheelchair users with severely disabling multiple sclerosis

Souza

Frank

2014

Disability and Rehabilitation

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Purpose: The aim of this study is to describe the clinical features of powered wheelchair users with severely disabling multiple sclerosis (MS) and explore the problematic clinical features influencing prescription. Method: Retrospective review of electronic and case note records of recipients of electric-powered indoor/outdoor powered wheelchairs (EPIOCs) attending a specialist wheelchair service between June 2007 and September 2008. Records were reviewed by a consultant in rehabilitation medicine, data systematically extracted and entered into a computer database. Further data were entered from clinical records. Data were extracted under three themes; demographic, diagnostic, clinical and wheelchair factors. Results: Records of 28 men mean age 57 (range 37-78, SD 12) years and 63 women mean age 57 (range 35-81, SD 11) years with MS were reviewed a mean of 64 (range 0-131) months after receiving their wheelchair. Twenty two comorbidities, 11 features of MS and 8 features of disability were thought to influence wheelchair prescription. Fifteen users were provided with specialised seating and 46 with tilt-in-space seats. Conclusions: Our findings suggest that people with severe MS requiring an EPIOC benefit from a holistic assessment to identify problematic clinical features that influence the prescription of the EPIOC and further medical and therapeutic interventions. ä Implications for RehabilitationPeople with multiple sclerosis (MS), referred for an EPIOC, require a full clinical assessment to identify problematic clinical features that are potentially treatable and/or can be accommodated through specialised seating and tilt. The beneficial effects of TIS should be considered for all EPIOC users with MS and particularly for those with comorbidity Poorly controlled spasticity, when identified in people with MS, should be managed through positioning in the chair, pressure-relieving cushion and referral for medical management.

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“…Fatigue is the most significant symptom for 50 to 60 percent of individuals with MS [10], and tremor is present in 75 percent and "incapacitating" for 10 percent [11]. Fatigue is one major reason that people with MS begin using power wheelchairs [12]. However, fatigue, when severe, can also limit the use of the control interface during flares, after a period of activity, or in a person with a more advanced condition.…”

Section: Introductionmentioning

confidence: 99%

Preliminary evaluation of variable compliance joystick for people with multiple sclerosis

et al. 2014

Self Cite

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Abstract-Upper-limb fatigue is a common problem that may restrict people with multiple sclerosis (MS) from using their electric powered wheelchair effectively and for a long period of time. The objective of this research is to evaluate whether participants with MS can drive better with a variable compliance joystick (VCJ) and customizable algorithms than with a conventional wheelchair joystick. Eleven participants were randomly assigned to one of two groups. The groups used the VCJ in either compliant or noncompliant isometric mode and a standard algorithm, personally fitted algorithm, or personally fitted algorithm with fatigue adaptation running in the background in order to complete virtual wheelchair driving tasks. Participants with MS showed better driving performance metrics while using the customized algorithms than while using the standard algorithm with the VCJ. Fatigue adaptation algorithms are especially beneficial in improving overall task performance while using the VCJ in isometric mode. The VCJ, along with the personally fitted algorithms and fatigue adaptation algorithms, has the potential to be an effective input interface for wheelchairs.

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Multiple sclerosis and mobility-related assistive technology: Systematic review of literature

Cited by 113 publications

References 45 publications

Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: systematic review, qualitative study, survey and costing analysis

Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: systematic review, qualitative study, survey and costing analysis

Problematic clinical features of powered wheelchair users with severely disabling multiple sclerosis

Preliminary evaluation of variable compliance joystick for people with multiple sclerosis

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