A personalized, intense physical rehabilitation program improves walking in people with multiple sclerosis presenting with different levels of disability: a retrospective cohort

Alon Kalron, Dalia Nitzani, David Magalashvili, Mark Dolev, Shay Menascu, Yael Stern, Uri Rosenblum, Diana Pasitselsky, Lior Frid, Gabi Zeilig, Caroline Barmatz, Uri Givon, Anat Achiron, Alon Kalron, Dalia Nitzani, David Magalashvili, Mark Dolev, Shay Menascu, Yael Stern, Uri Rosenblum, Diana Pasitselsky, Lior Frid, Gabi Zeilig, Caroline Barmatz, Uri Givon, Anat Achiron

Abstract

Background: People with multiple sclerosis (PwMS) endure walking limitations. To address this restriction, various physical rehabilitation programs have been implemented with no consensus regarding their efficacy. Our objective was to report on the efficacy of an integrated tailored physical rehabilitation program on walking in people with multiple sclerosis categorized according to their level of neurological disability.

Methods: Retrospective data were examined and analyzed. Specifically, data obtained from all patients who participated in the Multiple Sclerosis Center's 3 week rehabilitation program were extracted for in depth exploration. The personalized rehabilitation program included three major components modified according to the patient's specific impairments and functional needs: (a) goal directed physical therapy (b) moderately intense aerobic exercise training on a bicycle ergometer and (c) aquatic therapy chiefly oriented to body structures appropriate to movement. Gait outcome measurements included the 10 meter, 20 meter, Timed up and go and 2 minute walking tests measured pre and post the rehabilitation program. Three hundred and twelve people with relapsing-remitting multiple sclerosis were included in the final analysis. Patients were categorized into mild (n = 87), moderate (n = 104) and severely (n = 121) disabled groups.

Results: All clinical walking outcome measurements demonstrated statistically significant improvements, however, only an increase in the 2 minute walking test was above the minimal clinical difference value. The moderate and severe groups considerably improved compared to the mild gait disability group. Mean change scores (%) of the pre-post intervention period of the 2 minute walking test were 19.0 (S.E. = 3.4) in the moderate group, 16.2 (S.E. = 5.4) in the severe group and 10.9 (S.E. = 2.3) in the mild gait disability group.

Conclusions: We presented comprehensive evidence verifying the effects of an intense goal-directed physical rehabilitation program on ambulation in people with multiple sclerosis presenting with different neurological impairment levels.

Figures

Figure 1
Figure 1
Pre-post rehabilitation program mean difference in the 2mWT. MCD, Minimal Clinical Difference, based on (Baret et al, 2014).
Figure 2
Figure 2
Pre-post rehabilitation program mean difference in the timed up and go test. MCD, Minimal Clinical Difference based on (Learmonth et al, 2012).

References

    1. Noseworthy JH, Lucchinetti C, Rodriguez M, Weinshenker BG. Multiple sclerosis. N Eng J Med. 2000;343:938–52. doi: 10.1056/NEJM200009283431307.
    1. Pearson OR, Busse ME, Van Deursen RWM, Wiles CM. Quantification of walking mobility in neurological disorders. QJM. 2004;97:463–75. doi: 10.1093/qjmed/hch084.
    1. Hobart JC, Lamping DL, Fitzpatrick R, Riazi A, Thompson A. The multiple sclerosis impact scale (MSIS-29) a new patient-based outcome measure. Brain. 2001;124:962–73. doi: 10.1093/brain/124.5.962.
    1. Kalron A, Achiron A, Dvir Z. Muscular and gait abnormalities in persons with early onset multiple sclerosis. JNPT. 2011;35:164–9.
    1. Larocca NG. Impact of walking impairment in multiple sclerosis: perspectives of patients and care partners. Patient. 2011;4:189–201. doi: 10.2165/11591150-000000000-00000.
    1. Polman CH, O’Connor PW, Havrdova E, Hutchinson M, Kappos L, Miller DH, et al. AFFIRM Investigators: A randomised, placebo-controlled trial of natalizumab for relapsing multiple sclerosis. N Engl J Med. 2006;354:899–910. doi: 10.1056/NEJMoa044397.
    1. Dettmers C, Sulzmann M, Ruchay-Plossi A, Gutler R, Vieten M. Endurance exercise improves walking distance in MS patients with fatigue. Acta Neurol Scand. 2009;120:251–7. doi: 10.1111/j.1600-0404.2008.01152.x.
    1. Garrett M, Hogan N, Larkin A, Saunders J, Jakeman P, Coote S. Exercise in the community for people with minimal gait impairment due to MS: an assessor-blind randomized controlled trial. Mult Scler. 2013;19:782–9. doi: 10.1177/1352458512461966.
    1. Hayes HA, Gappmaier E, LaStayo PC. Effects of high intensity resistance training on strength, mobility, balance, and fatigue in individuals with multiple sclerosis: a randomized control study. J Neurol Phys Ther. 2011;35:2–10. doi: 10.1097/NPT.0b013e31820b5a9d.
    1. Rampello A, Franceschini M, Piepoli M, Antenucci R, Lenti G, Olivieri D, et al. Effect of aerobic training on walking capacity and maximal exercise tolerance in patients with multiple sclerosis: a randomized control study. Phys Ther. 2007;87:545–59. doi: 10.2522/ptj.20060085.
    1. DeBolt LS, McCubbin JA. The effects of home-based resistance exercise on balance, power, and mobility in adults with multiple sclerosis. Arch Phys Med Rehabil. 2004;85:290–7. doi: 10.1016/j.apmr.2003.06.003.
    1. Romberg A, Virtanen A, Ruutiainen J, Aunola S, Karppi SL, Vaara M, et al. Effects of a 6-month exercise program on patients with multiple sclerosis: a randomized study. Neurology. 2004;63:2034–8. doi: 10.1212/01.WNL.0000145761.38400.65.
    1. Motl RW, Smith DC, Elliott J, Weikert M, Dlugonski D, Sosnoff JJ. Combined training improves walking mobility in persons with significant disability from multiple sclerosis: a pilot study. J Neurol Phys Ther. 2012;36:32–7. doi: 10.1097/NPT.0b013e3182477c92.
    1. Cakt BD, Nacir B, Genc H, Saracoglu M, Karagoz A, Erdem HR, et al. Cycling progressive resistance training for people with multiple sclerosis: a randomized controlled study. Am J Phys Med Rehabil. 2010;89:446–57. doi: 10.1097/PHM.0b013e3181d3e71f.
    1. Dalgas U, Stenager E, Jakobsen J, Petersen T, Hansen HJ, Knudsen C, et al. Resistance training improves muscle strength and functional capacity in multiple sclerosis. Neurology. 2009;73:1478–84. doi: 10.1212/WNL.0b013e3181bf98b4.
    1. Freeman JA, Gear M, Pauli A, Cowan P, Finnigan C, Hunter H, et al. The effect of core stability training on balance and mobility in ambulant individuals with multiple sclerosis: a multi-centre series of single case studies. Mult Scler. 2010;16:1377–84. doi: 10.1177/1352458510378126.
    1. Salem Y, Scott AH, Karpatkin H, Concert G, Haller L, Kaminsky E, et al. Community-based group aquatic programme for individuals with multiple sclerosis: a pilot study. Disabil Rehabil. 2011;33:720–8. doi: 10.3109/09638288.2010.507855.
    1. Collett J, Dawes H, Meaney A, Sackley C, Barker K, Wade D, et al. Exercise for multiple sclerosis: a single-blind randomized trial comparing three exercise intensities. Mult Scler. 2011;17:594–603. doi: 10.1177/1352458510391836.
    1. Sabapathy NM, Minahan CL, Turner GT, Broadley SA. Comparing endurance and resistance exercise training in people with multiple sclerosis: a randomized pilot study. Clin Rehabil. 2011;25:14–24. doi: 10.1177/0269215510375908.
    1. Motl RW, Pilutti L. The benefits of exercise training in multiple sclerosis. Nat Rev Neurol. 2012;8:487–97. doi: 10.1038/nrneurol.2012.136.
    1. Dalgas U, Stenager A. Exercise and disease progression in multiple sclerosis: can exercise slow down the progression of multiple sclerosis? Ther Adv Neurol Disord. 2012;5:81–95. doi: 10.1177/1756285611430719.
    1. Confavreux C, Vukusic S. Accumulation of irreversible disability in multiple sclerosis: from epidemiology to treatment. Clin Neurol Neurosurg. 2006;108:327–32. doi: 10.1016/j.clineuro.2005.11.018.
    1. Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an Expanded Disability Status Scale (EDSS) Neurology. 1983;33:1444–52. doi: 10.1212/WNL.33.11.1444.
    1. Baret I, Freeman J, Smedal T, Dalgas U, Romberg A, Kalron A, et al. Responsiveness and clinically meaningful improvement, according to disability level, of walking measures after rehabilitation in multiple sclerosis: a European multi-center study. Neurorehabil Neural Repair. 2014;28:621–31. doi: 10.1177/1545968314521010.
    1. Nilsagard Y, Lundholm C, Gunnarsson LG, Denison E. Clinical relevance using timed walk tests and ‘timed up and go’ testing in persons with multiple sclerosis. Physiother Res Int. 2007;12:105–14. doi: 10.1002/pri.358.
    1. Hobart J, Blight AR, Goodman A, Lynn F, Putzki N. Timed 25-foot walk: direct evidence that improving 20% or greater is clinically meaningful in MS. Neurology. 2013;80:1509–17. doi: 10.1212/WNL.0b013e31828cf7f3.
    1. Learmonth YC, Paul L, McFadyen AK, Mattison P, Miller L. Reliability and clinical significance of mobility and balance assessments in multiple sclerosis. Int J Rehabil Res. 2012;35:69–74. doi: 10.1097/MRR.0b013e328350b65f.
    1. Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to “McDonald Criteria. Ann Neurol. 2011;69:292–302. doi: 10.1002/ana.22366.
    1. Kieseier BC, Pozilli C. Assessing walking disability in multiple sclerosis. Mult Scler. 2012;18:914–24. doi: 10.1177/1352458512444498.
    1. Filipi ML, Kucera DL, Filipi EO, Ridpath AC, Leuschen MP. Improvement in strength following resistance training in MS patients despite varied disability levels. NeuroRehabilitation. 2011;28:373–82.
    1. Sandroff BM, Klaren RE, Pilutti LA, Dlugonski D, Benedict RH, Motl RW. Randomized controlled trial of physical activity, cognition, and walking in multiple sclerosis. J Neurol. 2014;261:363–72. doi: 10.1007/s00415-013-7204-8.
    1. Latimer-Cheung AE, Pilutti L, Hicks AL, Martin Ginis KA, Fenuta AM, MacKibbon KA, et al. Effects of exercise training on fitness, mobility, fatigue, and health-related quality of life among adults with multiple sclerosis: a systematic review to inform guideline development. Arch Phys Med Rehabil. 2013;94:1800–28. doi: 10.1016/j.apmr.2013.04.020.
    1. Snook EM, Motl RW. Effect of exercise training on walking mobility in multiple sclerosis: a meta-analysis. Neurorehabil Neural Repair. 2009;23:108–16. doi: 10.1177/1545968308320641.

Source: PubMed

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