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MS research update - Can personalised physical rehabilitation improve walking in people with MS? - 24 March 2015

Summary

Previous research has shown that physiotherapy or exercise based rehabilitation for people with MS, can improve walking ability. What is not clear from previous research is if improvements can be made in a short period of time or in people more affected by MS who have more walking problems.

This study looked at the people who had taken part in a an intense three week rehabilitation programme specifically designed for people with MS. Treatment in the programme is goal directed and personalised to the participant's specific needs and what they want to achieve. They receive 36 one-on-one treatment sessions that includes physical therapy, aerobic exercise and aquatic therapy, as well as input from other health professionals including nurses and occupational therapists.

312 participants in the three week programme were subdivided into one of three classification groups based on their level of walking disability as measured by the EDSS: mild, moderate and severe.

After taking part in the intense rehabilitation programme as there was a significant improvement in walking performance for each of the groups. Regardless of their level of walking disability at the start of the programme participants were able to walk further and faster after completing the programme.

The biggest improvements in walking were for those participants who were in the moderate and severe groups, the mild group improved but not as much as the other groups.

The authors conclude that walking improvement can be achieved in people with higher levels of walking disability and the results also show that improvements can be safely and realistically achieved in the space of three weeks.

Background

Walking difficulties are common in MS. Problems with walking can make it more difficult to socialise or continue working and can cause other aches and pains through the strain the person puts on their body as they try to walk in a normal and steady manner.

Previous research studies into physiotherapy or exercise based rehabilitation for people with MS, have shown that exercise can improve walking. However many studies have looked at programmes that last over many weeks or months and others have looked at people with MS as one large similar group. What is not clear from previous research is if improvements can be made in a short period of time or in people more affected by MS who have more walking problems. This study assessed if a three week intense rehabilitation programme could improve walking and if improvements were dependent on how severe the walking problem was.

How this study was carried out

For this study the researchers used the medical records of people with MS who attend the Sheba MS Centre in Israel.

For the past ten years the centre has offered an intense three week rehabilitation programme specifically designed for people with MS. Participants in the programme stay as an inpatient at the centre and receive 36 one-on-one treatment sessions spread over three weeks. Treatment in the programme is goal directed and personalised to the participant's specific needs and what they want to achieve. The physical components of the programme include:

  • physical therapy - to increase muscle strength, improve balance and walking and decrease spasticity.
  • aerobic exercise training on a bicycle - to improve fitness.
  • aquatic therapy - to aid movement.

In addition to the physical components of the programme, each patient meets several times with a nurse, psychologist, social worker and occupational therapist.

The researchers identified all of the people with MS who had been treated in the rehabilitation programme. Out of 3,250 people registered at the centre, 381 had participated in the three week programme and complete records that could be analysed were available for 312 participants.

Participants were subdivided into one of three classification groups based on their level of walking disability as measured by the EDSS. Mild was a score of less than 4.5 (87 participants), moderate was an EDSS score of between 4.5 and 5.5 (104 participants) and severe was an EDSS score of 6.0 to 6.5 (121 participants).

Before and after the programme the participants took part in several assessments. These included tests of walking ability, speed and distance.

The researchers analysed the data collected during each participant's period in the programme to examine the effect of the rehabilitation.

What was found

After taking part in the intense rehabilitation programme as there was a significant improvement in walking performance for each of the groups. Regardless of their level of walking disability at the start of the programme participants were able to walk further and faster after completing the programme.

The biggest improvements in walking were for those participants who were in the moderate and severe groups, the mild group improved but not as much as the other groups.

What does it mean?

The authors conclude that the study shows that a three week goal-directed intense personalised rehabilitation programme is effective at improving walking abilities in people with MS. Walking improvement can be achieved in people with higher levels of walking disability and the results also show that improvements can be safely and realistically achieved in the space of three weeks.

They suggest further studies would be needed to compare those who took part in the programme to a control group who did not and also to investigate if the programme has a long term effect on walking ability or has any other positive effects on day to day life.

Kalron A, Nitzani D, Magalashvili D , et al.
A personalized, intense physical rehabilitation program improves walking in people with multiple sclerosis presenting with different levels of disability: a retrospective cohort..
BMC Neurol. 2015 Dec;15(1):281. doi: 10.1186/s12883-015-0281-9. Epub 2015 Mar 4. [PubMed - in process]
abstract
Read the full text of this paper

More about walking difficulties and rehabilitation

Many people with MS have some difficulties with walking but walking problems vary considerably from one person with MS to another. Common difficulties include: unsteadiness on walking or turning, tripping, stumbling, weakness of the leg when weight is on it and difficulty placing the foot on the ground. Other MS symptoms can also make walking more difficult, such as vision problems, balance problems and pain. Having trouble walking can mean people with MS are more vulnerable to tripping and falling. It can also use up more energy and people may alter how they walk to try and compensate for the difficulty they are having. This alteration in walking can result in bad posture which can lead to pain and strains.

If you are experiencing walking difficulties, you can speak to your MS nurse or GP who may refer you to physiotherapy services. The best way forward depends on what is causing the difficulties. Treatment may involve physiotherapy or drug treatments to alleviate specific underlying symptoms such as spasticity or pain.

If you are concerned about falls, you might like to read Falls: managing the ups and downs of MS, which gives tips and suggestions for reducing the risks of falling. This can be read online, downloaded as a pdf or ordered as a printed version.

Rehabilitation

Rehabilitation involves helping an individual achieve their personal goals. Rehabilitation professionals, including nurses, rehabilitation consultants, physiotherapists and occupational therapists can help someone work out ways of dealing with some of the common problems MS can cause and support them to draw up practical goals for living the way they want to. This might mean finding solutions to difficulties at home or work, such as walking difficulties, memory problems, fatigue or pain. However as rehabilitation services, often shorted to 'rehab', involve several different types of health professional, there are many more things that rehab can help with.

You can read more about rehabilitation in MS in the May 2014 issue of our newsletter Open Door which had a special feature on the subject, talking to professionals working in the area explaining how the can help and also people with MS describing their experiences of rehab. You can read an online version of the full issue or read the rehab section online to learn more.

MS rehab services do vary depending on where you live. If you have an MS nurse, they are often the best people to ask what's available locally. If you have an MS therapy centre near you they might also be able to help you find a physiotherapist or other rehab professionals. You might need a referral from your GP to access some of these services.

You can use our online map to find MS health professionals and services near you.

Research by topic areas...

Assessment tools

Heine M, van den Akker LE, Verschuren O, et al.
Reliability and responsiveness of cardiopulmonary exercise testing in fatigued persons with multiple sclerosis and low to mild disability.
PLoS One. 2015;10(3):e0122260.
abstract
Read the full text of this paper

Lizrova Preiningerova J, Novotna K, Rusz J, et al.
Spatial and temporal characteristics of gait as outcome measures in multiple sclerosis (EDSS 0 to 6.5).
J Neuroeng Rehabil. 2015 Dec;12(1):1.
abstract
Read the full text of this paper

Sosnoff JJ, Klaren RE, Pilutti LA, et al.
Reliability of gait in multiple sclerosis over 6 months.
Gait Posture. 2015 Feb 25. [Epub ahead of print]
abstract

Causes of MS

Ragnedda G, Leoni S, Parpinel M, et al.
Reduced duration of breastfeeding is associated with a higher risk of multiple sclerosis in both Italian and Norwegian adult males: the EnvIMS study.
J Neurol. 2015 Mar 21. [Epub ahead of print]
abstract

CCSVI

Arata M, Sternberg Z.
Neuroendocrine responses to transvascular autonomic modulation: a modified balloon angioplasty in multiple sclerosis patients.
Horm Metab Res. 2015 Mar 19. [Epub ahead of print]
abstract

Co-existing conditions

Kemenyova P, Siarnik P, Sutovsky S, et al.
Impairment of endothelial function in patients with multiple sclerosis.
Neuro Endocrinol Lett. 2015 Feb 19;36(1). [Epub ahead of print]
abstract

Plantone D, Renna R, Sbardella E, et al.
Concurrence of multiple sclerosis and brain tumors.
Front Neurol. 2015;6:40.
abstract
Read the full text of this paper

Disease modifying treatments

Kappos L, O'Connor P, Radue EW, et al.
Long-term effects of fingolimod in multiple sclerosis: the randomized FREEDOMS extension trial.
Neurology. 2015 Mar 20. [Epub ahead of print]
abstract
Read the full text of this paper

Cobo-Calvo Á, Bau L, Matas E, et al.
Effectiveness of natalizumab in patients with highly active relapsing remitting multiple sclerosis.
Eur Neurol. 2015 Mar 13;73(3-4):220-229. [Epub ahead of print]
abstract

Cohen BA, Coyle PK, Leist T, et al.
Therapy optimization in multiple sclerosis: a cohort study of therapy adherence and risk of relapse.
Mult Scler Relat Disord. 2015 Jan;4(1):75-82.
abstract

Signori A, Schiavetti I, Gallo F, et al.
Subgroups of multiple sclerosis patients with larger treatment benefits: a meta-analysis of randomized trials.
Eur J Neurol. 2015 Mar 19. [Epub ahead of print]
abstract

Falls

Nilsagård Y, Westerdahl E, Wittrin A, et al.
Walking distance as a predictor of falls in people with multiple sclerosis.
Physiother Res Int. 2015 Mar 17. [Epub ahead of print]
abstract
Read the full text of this paper

Hormones and MS

Bove R, Healy BC, Secor E, et al.
Patients report worse MS symptoms after menopause: findings from an online cohort.
Mult Scler Relat Disord. 2015 Jan;4(1):18-24.
abstract

Other

Calsius J, Courtois I, Feys P, et al.
"How to conquer a mountain with multiple sclerosis". How a climbing expedition to Machu Picchu affects the way people with multiple sclerosis experience their body and identity: a phenomenological analysis.
Disabil Rehabil. 2015 Mar 19:1-7. [Epub ahead of print]
abstract

Ontaneda D, Fox RJ, Chataway J.
Clinical trials in progressive multiple sclerosis: lessons learned and future perspectives.
Lancet Neurol. 2015 Feb;14(2):208-223.
abstract

Feinstein A, Freeman J, Lo AC.
Treatment of progressive multiple sclerosis: what works, what does not, and what is needed.
Lancet Neurol. 2015 Feb;14(2):194-207.
abstract

Other treatments

Pihl-Jensen G, Tsakiri A, Frederiksen JL.
Statin treatment in multiple sclerosis: a systematic review and meta-analysis.
CNS Drugs. 2015 Mar 21. [Epub ahead of print]
abstract

Sedel F, Papeix C, Bellanger A, et al.
High doses of biotin in chronic progressive multiple sclerosis: A pilot study.
Mult Scler Relat Disord. 2015 Mar;4(2):159-69.
abstract
Read the full text of this paper

Paediatric MS

Lulu S, Julian L, Shapiro E, et al.
Treatment adherence and transitioning youth in pediatric multiple sclerosis.
Mult Scler Relat Disord. 2014 Nov 1;3(6):689-695.
abstract

Pathophysiology

Bernitsas E, Bao F, Seraji-Bozorgzad N, et al.
Spinal cord atrophy in multiple sclerosis and relationship with disability across clinical phenotypes.
Mult Scler Relat Disord. 2015 Jan;4(1):47-51.
abstract

Physical activity

Kjølhede T, Vissing K, Langeskov-Christensen D, et al.
Relationship between muscle strength parameters and functional capacity in persons with mild to moderate degree multiple sclerosis.
Mult Scler Relat Disord. 2015 Mar;4(2):151-8.
abstract

Mulero P, Almansa R, Neri MJ, et al.
Improvement of fatigue in multiple sclerosis by physical exercise is associated to modulation of systemic interferon response.
J Neuroimmunol. 2015 Mar 15;280:8-11.
abstract

Pregnancy and childbirth

Türkyılmaz E, Yıldırım M, Avşar AF.
Multiple sclerosis; a disease of reproductive-aged women and the dilemma involving contraceptive methods.
J Turk Ger Gynecol Assoc. 2015;16(1):49-53.
abstract
Read the full text of this paper

Amato MP, Portaccio E.
Fertility, pregnancy and childbirth in patients with multiple sclerosis: impact of disease-modifying drugs.
CNS Drugs. 2015 Mar 14. [Epub ahead of print]
abstract

Provision of care

Lonergan R, Kinsella K, Fitzpatrick P, et al.
Unmet needs of multiple sclerosis patients in the community.
Mult Scler Relat Disord. 2015 Mar;4(2):144-50.
abstract

Basak T, Unver V, Demirkaya S.
Activities of daily living and self-care agency in patients with multiple sclerosis for the first 10 years.
Rehabil Nurs. 2015 Jan-Feb;40(1):60-5.
abstract
Read the full text of this paper

Psychological aspects

Schirda B, Nicholas JA, Prakash RS.
Examining trait mindfulness, emotion dysregulation, and quality of life in multiple sclerosis.
Health Psychol. 2015 Mar 16. [Epub ahead of print]
abstract

Relapses

Bevan C, Gelfand JM.
Therapeutic management of severe relapses in multiple sclerosis.
Curr Treat Options Neurol. 2015 Apr;17(4):345.
abstract

Puthenparampil M, Poggiali D, Causin F, et al.
Cortical relapses in multiple sclerosis.
Mult Scler. 2015 Mar 19. [Epub ahead of print]
abstract

Rakusa M, Cano SJ, Porter B, et al.
A predictive model for corticosteroid response in individual patients with MS relapses.
PLoS One. 2015;10(3):e0120829.
abstract
Read the full text of this paper

Symptoms and symptom management

Damasceno A, Damasceno BP, Cendes F.
Subclinical MRI disease activity influences cognitive performance in MS patients.
Mult Scler Relat Disord. 2015 Mar;4(2):137-43.
abstract

Vitamin D

Røsjø E, Myhr KM, Løken-Amsrud KI, et al.
Vitamin D status and effect of interferon-β1a treatment on MRI activity and serum inflammation markers in relapsing-remitting multiple sclerosis.
J Neuroimmunol. 2015 Mar 15;280:21-8.
abstract

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