The Effectiveness of Home-Based Interventions for People with Multiple Sclerosis, Evidence from 2021

#047 – The Effectiveness of Home-Based Interventions for People with Multiple Sclerosis, Evidence from 2021

  • Multiple studies have shown that strength and fitness training can improve gait, endurance, and balance in people with MS. Normally, these training methods are done with supervision in a healthcare facility, which can be costly and harder to maintain.
  • Therefore, home-based (Tele-Rehabilitation) started to get more attraction specifically by the research community to decrease cost and improve healthcare services access.
  • This report summarizes the new evidence published in 2021 on the effectiveness of multiple home-based treatments versus supervised (center-based) training for people with MS.

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1 – Effects on gait and balance of home-based active video game interventions in persons with multiple sclerosis

A systematic review, 2021. (Restricted Access)

Aim

  • The aim of this review is to summarize the current best evidence for the effectiveness of home-based active video games on gait and balance, user compliance, feasibility and safety for persons with multiple sclerosis (pwMS).

Results

  • 9 Studies were included.
  • Significant improvements in balance were found.
  • Mixed results for mobility, physical activity and gait.
  • Home-based active video games are feasible and safe, with good compliance and adherence.

Conclusion

  • Home-based active video games were found safe and effective in improving static and dynamic balance in pwMS.
  • Compliance was good, probably because it is a motivating and enjoyable training.
  • Active video games can be a relevant alternative for physical rehabilitation at home in pwMS.

2 – Supervised exercises versus telerehabilitation. Benefits for persons with multiple sclerosis

A randomized, single-blind trial, 2021. (Restricted Access)

Aim

  • Investigate the effectiveness of structured telerehabilitation on fatigue, health status, quality of life (QoL), and activities of daily living (ADL) and compare the possible effects with structured supervised exercise programs in patients with Multiple Sclerosis.

Methods

  • 30 participants with relapsing-remitting Multiple Sclerosis divided into 2 groups
  • Group 1: Structured supervised exercise for 12 weeks. (15 Participants)
  • Group 2: Telerehabilitation group included a structured home-based exercise program for 12 weeks. (15 Participants)
  • Outcome measures: functional independence measure (FIM), first section of Nottingham Health Profile (NHP-I), fatigue severity scale (FSS), and quality of life scale (QoLS) before and after the intervention.

Results

  • Significant differences were found in all parameters in both groups after the treatment.
  • No significant difference was found between groups regarding FIM-total, FIM-motor, FIM-cognitive, NHP sub-parameters, and QoL.
  • Between-group differences revealed a significant difference in FSS and NHP total in favor of Group 1.

Conclusion

  • A structured home-based exercise program can be an alternative to supervised exercises with no side effects in patients with multiple sclerosis.
  • Home-based rehabilitation exercises that are checked and controlled through telerehabilitation can help patients improve their health-related QoL and ADL.
  • Supervised exercises can be more beneficial regarding fatigue and health profile compared to home-based exercises.

3 – Home-based Pilates for symptoms of anxiety, depression and fatigue among persons with multiple sclerosis

An 8-week randomized controlled trial, 2021. (Open Access)

Why?

  • Symptoms of anxiety, depression and fatigue are common comorbidities among persons with multiple sclerosis (PwMS).
  • A previous pilot study supported Pilates as a feasible exercise modality that may improve these outcomes among PwMS.

Aim

  • To quantify the effects of 8 weeks of home-based Pilates on symptoms of anxiety, depression and fatigue among PwMS.

Methods

  • A total of 80 PwMS (69 female) were randomized to home-based Pilates guided by a DVD (or online) or wait-list control.

Intervention:

  • The Pilates group performed twice-weekly sessions, approximately 48 hours apart, for 8 weeks at home, supported by a DVD developed, implemented and evaluated in a feasibility trial among PwMS. (Click here for detailed Pilates exercise protocol)
    • 4 repetitions during the first 2 weeks, increasing by 2 repetitions at biweekly intervals, resulting in 10 repetitions in the final 2 weeks.

Outcome measures:

  • Fatigue: The 21-item Modified Fatigue Impact Scale (MFIS) assessed physical, cognitive, psychosocial, and total fatigue.
  • Anxiety symptoms: the 20-item trait subscale of the State-Trait Anxiety Inventory (STAI-Y2), and 7-item anxiety subscale of the Hospital Anxiety and Depression Scales (HADS-A).
  • Depressive symptoms: the 16-item Quick Inventory of Depressive Symptomatology (QIDS) and 7-item depression subscale of the HADS (HADS-D).
  • Physical activity was self-reported using a 7-day physical activity recall (7dPAR), and Godin Leisure-Time Exercise Questionnaire (GLTEQ).

Results

  • Group Γ— time interactions were statistically significant for all outcomes.
  • Home-based Pilates significantly improved depressive and anxiety symptoms, physical, cognitive, psychosocial and total fatigue among PwMS.
  • Symptom improvements ranged from moderate to large effects.
  • Female-only results were materially the same.

Conclusion

  • Home-based Pilates significantly improved anxiety, depressive and fatigue symptoms, including moderate-to-large, clinically meaningful improvements in depressive and fatigue symptoms among PwMS, who were predominantly female.
  • Findings support the potential of home-based Pilates as an alternative low-impact exercise modality to improve mental health among PwMS for whom mobility limitations may hamper traditional exercise participation.
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4 – Center-Based Group and Home-Based Individual Exercise ProgramsHave Similar Impacts on Gait and Balance in People With Multiple Sclerosis

A Randomized Trial, 2021. (Restricted Access)

Aim

  • To determine the comparative effectiveness of a center-based group versus a home-based individual 8-week exercise program to improve gait and balance in people with MS.

Interventions

Exercise program:

  • The exercise program for both groups included two 60-minute sessions per week, held at least 2 days apart for 8 weeks.
  • Exercises were aimed at improving gait speed, endurance, and balance.
  • They were individualized, specific, progressed in load, and performed at a moderate to high intensity.

Center-Based Group Intervention

  • 24 Participants, 4 to 6 participants per class.
  • Led by a physiotherapist
  • Group participants were provided with an illustrated exercise booklet at the completion of the intervention based on their class program and were encouraged to continue this level of exercise during the 8-week follow-up period.

Home-Based Individual Exercise Intervention

  • 26 Participants
  • Home exercise participants were provided with one center-based physiotherapist-led session at the commencement of the intervention period for training, and telephone support by a physiotherapist to discuss their program every 2 weeks.
  • Participants were instructed to complete two, 60-minute home exercise sessions per week, held at least 2 days apart.
Exercise description  Progression  
Warm up In standing and or sitting Lifting legs up and down at the hips or straightening and bending knees reaching overhead or out to side both arms / single arms   Rotating body/upper trunk, around stable base  Upper limbs could be used for balance if required in standing – light touch Lift legs higher / alternate quicker  Lean further / quicker Rotate further / quicker  Reduction in upper limb support   
1. Functional strengthening – standing up and sitting down From chair – stand up then sit down. Feet aligned Upper limbs could be used for balance / assistance if required  Increase repetitions  Vary speed Alter foot alignment – preferential loading Alter chairs – heights / softness Reduction in upper limb support  
2. Increasing single leg balance β€“ in standing  Alternate leg lifts on the spot / stepping out to sides / placing foot onto block / stepping up and down off block.  Upper limbs could be used for balance if required – light touch Progress through various exercises aim for stepping up and down off block Speed of leg movement β€“ increase repetitions Height – alignment of block Combination of directions to step Reduction in upper limb support 
3. Dynamic standing balance β€“ standing with feet in most challenging base of support, moving arms, trunk, head in various directions to encourage movement and weight shift.  No upper limb support allowed  Decrease base of support Increase distance reached Increase speed of movement Reduce visual input.  Co-ordination between participants in ball activities β€“ direction – timing 
4Functional strengthening – standing weight-bearing with increasing loads, squatting, lunging, heel raises. Upper limbs could be used for balance if required – light touch Increase repetitions Increase speed Increase depth / hold of position Use block for heel raises to drop below neutral to push back up.  Reduction in upper limb support  
5. Walking β€“ walking with usual aid continuously as able for duration of station  Increase speed Increase step length – arm swing Vary direction of walk Reduce base of support Add in head movements Reduction in upper limb support is possible 
6. Stretching β€“ in seated or standing position Stretching of calf, hamstring, quadriceps  Duration of hold Depth of stretch  Do actively  
7. Functional strengthening β€“ in sitting Sitting in standard chair with 50% thigh support Reaching forward to target at 40-60% past arms length. Reach to sides and forward Reach with both hands Speed of reach Duration of reach Reduce thigh support on chair Increase chair height 
8. Body control β€“ in sitting Sitting with 50% thigh support on standard chair. Moving body to sit up tall in center, to sides.  Add in head movement to follow body movement Speed Duration of hold Combination of truncal movements – tall, lean right and turn right.  
Cool down – seated position  Relaxed deep breathing with reaching overhead as breath in. Stretches in sitting quadriceps, hamstrings, upper limb  Duration of hold Depth of stretch  

Outcome measures:

Primary: Gait speed, measured using the 10-meter walk test.

Secondary: Walking endurance (6-minute walk test), standing balance (Berg Balance Scale).

Results:

  • Adherence: During the 8-week intervention, participants in the home group reported completing a lower proportion of exercise sessions than those in the group exercise program.
  • No group effect, time effect, or group X time interactions for the primary outcome measure of gait speed, or for the secondary outcome measures of gait endurance or balance.
  • Both groups showed nonsignificant improvements in gait speed (0.11 m/s), but both reached MICD (0.03-0.1 m/s).
  • Improvement in gait endurance for the center-based group reached a reported MICD.

Conclusion

  • Gait speed, endurance, and balance did not statistically improve with either center-based group exercise or home-based exercise in people with MS; however, In both groups, gait speed improved to a level that met minimal clinically important differences.

Are Home-Based Interventions effective for People with Multiple Sclerosis (MS)?

The results of the 4 articles included in this report show that:

  • Home-based active video games are effective for static and dynamic balance.
  • A structured home-based exercise program can help improve QoL and ADLs.
  • Home-based Pilates significantly improved anxiety, depressive and fatigue symptoms.
  • When compared to center-based group interventions, there was no significant difference between the 2 groups, also both achieved similar improvements in gait speed.

Thank you for reading.

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