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Abakay H, Yetkin MF, Doğan H, Güç A, Çalış HT. Acute effect of myofascial stretching exercise on spasticity, balance, ambulation status and mobility of posterior chain muscles in multiple sclerosis. Neurol Res 2024:1-8. [PMID: 38984648 DOI: 10.1080/01616412.2024.2377003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 07/02/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVE To investigate the acute effect of myofascial stretching exercises on spasticity, balance, ambulation status and mobility of posterior chain muscles in multiple sclerosis. METHOD The study was conducted as a randomised controlled experimental study. The study included a total of 80 individuals diagnosed with multiple sclerosis (MS) with a mean age of 43.5 ± 9.62 years (experimental group) and 41.4 ± 10.4 years (control group). All individuals were treated once and evaluated before and after the session. After recording the sociodemographic characteristics, spasticity assessment was performed with the Modified Ashword Scale (MAS), balance assessment with the Berg Balance Scale (BBS), ambulation status with the Timed Up and Go Test (TUG), and posterior chain muscle mobility (PCMM) with finger-to-ground distance measurement. RESULTS The TUG (time to complete the distance) measurements of the experimental group after treatment were lower than those of the control group (p < 0.05). The value of PCMM measurements of the experimental group before the treatment was lower than that of the control group (p < 0.001). The difference in positive increase in PCMM measurements in the experimental group was higher than that in the control group (p < 0.05). After the treatment, the MAS value in the left knee of the experimental group was lower than that of the control group (p < 0.05). DISCUSSION Myofascial stretching exercises applied to individuals with MS made an acute contribution to ambulation status and mobility of posterior chain muscles. There was no difference in the evaluation of spasticity and balance.
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Affiliation(s)
- Hanife Abakay
- Incesu Ayşe and Saffet Arslan Health Services Vocational School, Kayseri University, Kayseri, Turkey
| | - M Fatih Yetkin
- Faculty of Medicine, Internal Medicine, Department of Neurology, Erciyes University, Kayseri, Turkey
| | - Hanife Doğan
- Nezahat Keleşoğlu Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Necmettin Erbakan University, Konya, Turkey
| | - Ayşe Güç
- Kayseri City Hospital, Physical Therapy and Rehabilitation Hospital, Kayseri, Turkey
| | - Havva Talay Çalış
- Kayseri City Hospital, Physical Therapy and Rehabilitation Hospital, Kayseri, Turkey
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Du L, Xi H, Zhang S, Zhou Y, Tao X, Lv Y, Hou X, Yu L. Effects of exercise in people with multiple sclerosis: a systematic review and meta-analysis. Front Public Health 2024; 12:1387658. [PMID: 38660348 PMCID: PMC11039920 DOI: 10.3389/fpubh.2024.1387658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 03/26/2024] [Indexed: 04/26/2024] Open
Abstract
Background A growing body of studies have examined the effect of exercise in people with multiple sclerosis (MS), while findings of available studies were conflicting. This meta-analysis aimed to explore the effects of exercise on balance, walking ability, walking endurance, fatigue, and quality of life in people with MS. Methods We searched PubMed, Web of Science, Scopus, and Cochrane databases, through March 1, 2024. Inclusion criteria were: (1) RCTs; (2) included an intervention and control group; (3) had people with MS as study subjects; (4) had balance, walking ability, walking endurance, fatigue, or quality of life as the outcome measures. Exclusion criteria were: (1) non-English publications; (2) animal model publications; (3) review articles; and (4) conference articles. A meta-analysis was conducted to calculate weighted mean difference (WMD) and 95% confidence interval (CI). Cochrane risk assessment tool and Physiotherapy Evidence Database (PEDro) scale were used to evaluate the methodological quality of the included studies. Results Forty studies with a total of 56 exercise groups (n = 1,300) and 40 control groups (n = 827) were eligible for meta-analysis. Exercise significantly improved BBS (WMD, 3.77; 95% CI, 3.01 to 4.53, P < 0.00001), TUG (WMD, -1.33; 95% CI, -1.57 to -1.08, P < 0.00001), MSWS-12 (WMD, -2.57; 95% CI, -3.99 to -1.15, P = 0.0004), 6MWT (WMD, 25.56; 95% CI, 16.34 to 34.79, P < 0.00001), fatigue (WMD, -4.34; 95% CI, -5.83 to -2.84, P < 0.00001), and MSQOL-54 in people with MS (WMD, 11.80; 95% CI, 5.70 to 17.90, P = 0.0002) in people with MS. Subgroup analyses showed that aerobic exercise, resistance exercise, and multicomponent training were all effective in improving fatigue in people with MS, with resistance exercise being the most effective intervention type. In addition, a younger age was associated with a larger improvement in fatigue. Furthermore, aerobic exercise and multicomponent training were all effective in improving quality of life in people with MS, with aerobic exercise being the most effective intervention type. Conclusion Exercise had beneficial effects in improving balance, walking ability, walking endurance, fatigue, and quality of life in people with MS. Resistance exercise and aerobic exercise are the most effective interventions for improving fatigue and quality of life in people with MS, respectively. The effect of exercise on improving fatigue was associated with the age of the participants, with the younger age of the participants, the greater the improvement in fatigue. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=371056, identifier: CRD42022371056.
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Affiliation(s)
- Liwen Du
- Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport University, Beijing, China
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
| | - Haoyu Xi
- Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport University, Beijing, China
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
| | - Shiyan Zhang
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
| | - Yilun Zhou
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
| | - Xifeng Tao
- School of Physical Education, Xihua University, Chengdu, China
| | - Yuanyuan Lv
- China Institute of Sport and Health Science, Beijing Sport University, Beijing, China
| | - Xiao Hou
- Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport University, Beijing, China
- School of Sport Sciences, Beijing Sport University, Beijing, China
| | - Laikang Yu
- Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport University, Beijing, China
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
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Beratto L, Bressy L, Agostino S, Malandrone F, Brichetto G, Ponzano M. The effect of exercise on mental health and health-related quality of life in individuals with multiple sclerosis: A Systematic review and meta-analysis. Mult Scler Relat Disord 2024; 83:105473. [PMID: 38320418 DOI: 10.1016/j.msard.2024.105473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/16/2024] [Accepted: 01/24/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND A large body of evidence has tested the effect of exercise interventions on mental health and health-related quality of life (HRQoL) in individuals with multiple sclerosis (PwMS). OBJECTIVE To determine the effect of exercise interventions on mental health and HRQoL in PwMS. METHODS We searched four databases up to April 2023, and included randomized controlled trials that: 1) involved PwMS ≥18 years old; 2) delivered an exercise intervention; 3) measured subjective well-being, psychological well-being, social well-being, or HRQoL as outcomes. We reported standardized differences in means (d) with a 95 % confidence interval (CI), for continuous outcomes and an incidence rate ratio (IRR) with a 95 % CI for dichotomous outcomes. RESULTS Forty-nine studies (n = 2,057 participants) were included. Exercise improved overall well-being (d = 0.78; 95 % CI 0.483, 1.077; moderate certainty evidence), subjective well-being (d = 0.666; 95 % CI 0.405, 0.928; moderate certainty evidence), social well-being (d = 1.046; 95 % CI 0.569, 1.523; low certainty evidence), and HRQoL (d = 0.568; 95 % CI 0.396, 0.74; moderate certainty evidence). CONCLUSION Exercise interventions can improve well-being and HRQoL in PwMS. Future studies should focus on PwMS ≥ 65 years or with higher level of impairments.
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Affiliation(s)
- Luca Beratto
- Department of Medical Sciences, University of Turin, Italy; School of Exercise and Sport Science, University of Turin, Italy
| | - Lara Bressy
- School of Exercise and Sport Science, University of Turin, Italy
| | - Samuel Agostino
- Department of Clinical and Biological Sciences, University of Turin, Italy
| | | | | | - Matteo Ponzano
- School of Health and Exercise Sciences, The University of British Columbia, Kelowna, BC, Canada; International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Centre (BSCC), The University of British Columbia, Vancouver, BC, Canada.
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Cuerda-Ballester M, Bustos A, Sancho-Cantus D, Martínez-Rubio D, Privado J, Alarcón-Jiménez J, Villarón-Casales C, de Bernardo N, Navarro Illana E, de la Rubia Ortí JE. Predictive Model of Anxiety and Depression Perception in Multiple Sclerosis Patients: Possible Implications for Clinical Treatment. Bioengineering (Basel) 2024; 11:100. [PMID: 38275580 PMCID: PMC10813122 DOI: 10.3390/bioengineering11010100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
Multiple Sclerosis (MS) is a neurodegenerative disease characterized by motor and non-motor symptoms, including emotional distress, anxiety, and depression. These emotional symptoms currently have a pharmacological treatment with limited effectiveness; therefore, it is necessary to delve into their relationship with other psychological, functional, or prefrontal alterations. Additionally, exploring non-pharmacological therapeutic alternatives that have shown benefits in addressing emotional distress in MS patients is essential. AIM To establish a predictive model for the presence of anxiety and depression in MS patients, based on variables such as psychological well-being, functional activity, and prefrontal symptoms. Additionally, this study aimed to propose non-pharmacological therapeutic alternatives based on this model. MATERIALS AND METHODS A descriptive, observational, and cross-sectional study was conducted with a sample of 64 diagnosed MS patients who underwent functional and cognitive assessments using the following questionnaires and scales: Functional Activities Questionnaire (FAQ), Acceptance and Action Questionnaire (AAQ-II), Experiences Questionnaire (EQ), Self-Compassion Scale Short Form (SCS-SF), Beck Depression Inventory II (BDI-II), State-Trait Anxiety Inventory (STAI), and Prefrontal Symptoms Inventory (PSI). RESULTS The model showed an excellent fit to the data and indicated that psychological well-being was the most significant predictor of the criteria (β = -0.83), followed by functional activity (β = -0.18) and prefrontal symptoms (β = 0.15). The latter two are negatively related to psychological well-being (β = -0.16 and β = -0.75, respectively). CONCLUSIONS Low psychological well-being is the variable that most significantly predicts the presence of anxiety and depression in MS patients, followed by functional activity and prefrontal alterations. Interventions based on mindfulness and acceptance are recommended, along with nutritional interventions such as antioxidant-enriched ketogenic diets and moderate group physical exercise.
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Affiliation(s)
| | - Antonio Bustos
- Physical Therapy Clinic, Antonio Bustos, 46007 Valencia, Spain;
| | - David Sancho-Cantus
- Department of Nursing, Catholic University San Vicente Mártir, 46001 Valencia, Spain; (N.d.B.); (J.E.d.l.R.O.)
| | - David Martínez-Rubio
- Department of Nursing and Physiotherapy, University of Lleida, 25006 Lleida, Spain
- Department of Psychology, European University of Valencia, 46010 Valencia, Spain
| | - Jesús Privado
- Department of Methodology of Behavioral Sciences, Universidad Complutense de Madrid, Campus de Somosaguas, Pozuelo de Alarcón, 28223 Madrid, Spain;
| | - Jorge Alarcón-Jiménez
- Department of Physiotherapy, Universidad Católica de Valencia, 46900 Valencia, Spain;
| | - Carlos Villarón-Casales
- Biomechanics & Physiotherapy in Sports (BIOCAPS), Faculty of Health Sciences, European University of Valencia, 46001 Valencia, Spain;
| | - Nieves de Bernardo
- Department of Nursing, Catholic University San Vicente Mártir, 46001 Valencia, Spain; (N.d.B.); (J.E.d.l.R.O.)
| | - Esther Navarro Illana
- Department of Nursing, Catholic University San Vicente Mártir, 46001 Valencia, Spain; (N.d.B.); (J.E.d.l.R.O.)
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Prusynski RA, Rundell SD, Pradhan S, Mroz TM. Some But Not Too Much: Multiparticipant Therapy and Positive Patient Outcomes in Skilled Nursing Facilities. J Geriatr Phys Ther 2023; 46:185-195. [PMID: 36103147 PMCID: PMC10008750 DOI: 10.1519/jpt.0000000000000363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND PURPOSE Physical and occupational therapy practices in skilled nursing facilities (SNFs) were greatly impacted by the 2019 Medicare Patient-Driven Payment Model (PDPM). Under the PDPM, the practice of multiparticipant therapy-treating more than one patient per therapy provider per session-increased in SNFs, but it is unknown how substituting multiparticipant therapy for individualized therapy may impact patient outcomes. This cross-sectional study establishes baseline relationships between multiparticipant therapy and patient outcomes using pre-PDPM data. METHODS We used Minimum Data Set assessments from all short-term Medicare fee-for-service SNF stays in 2018. Using generalized mixed-effects logistic regression adjusted for therapy volume and patient factors, we examined associations between the proportion of minutes of physical and occupational therapy that were received as multiparticipant sessions during the SNF stay and 2 outcomes: community discharge and functional improvement. Multiparticipant therapy minutes as a proportion of total therapy time were categorized as none, low (below the median of 5%), medium (median to <25%), and high (≥25%) to reflect the 25% multiparticipant therapy limit required by the PDPM. RESULTS AND DISCUSSION We included 901 544 patients with complete data for functional improvement and 912 996 for the discharge outcome. Compared with patients receiving no multiparticipant therapy, adjusted models found small positive associations between low and medium multiparticipant therapy levels and outcomes. Patients receiving low levels of multiparticipant therapy had 14% higher odds of improving in function (95% CI 1.09-1.19) and 10% higher odds of community discharge (95% CI 1.05-1.15). Patients receiving medium levels of multiparticipant therapy had 18% higher odds of functional improvement (95% CI 1.13-1.24) and 44% higher odds of community discharge (95% CI 1.34-1.55). However, associations disappeared with high levels of multiparticipant therapy. CONCLUSIONS Prior to the PDPM, providing up to 25% multiparticipant therapy was an efficient strategy for SNFs that may have also benefitted patients. As positive associations disappeared with high levels (≥25%) of multiparticipant therapy, it may be best to continue delivering the majority of therapy in SNFs as individualized treatment.
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Affiliation(s)
- Rachel A Prusynski
- Department of Rehabilitation Medicine, University of Washington, Seattle
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Lysogorskaia E, Ivanov T, Mendalieva A, Ulmasbaeva E, Youshko M, Brylev L. Yoga vs Physical Therapy in Multiple Sclerosis: Results of Randomized Controlled Trial and the Training Protocol. Ann Neurosci 2023; 30:242-250. [PMID: 38020405 PMCID: PMC10662275 DOI: 10.1177/09727531231161994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/20/2022] [Indexed: 12/01/2023] Open
Abstract
Background Yoga originated in the territory of modern India more than 3,000 years ago uses techniques for working with the musculoskeletal system, cardiorespiratory system, and attention. Currently, the effectiveness and safety of yoga in patients with various neurological disorders, including multiple sclerosis (MS), is of interest to many scientists and clinicians. Purpose The main aim of this study is to examine the effect of yoga on symptoms and quality of life in patients with MS vs physical therapy (exercise therapy) and no exercise. Methods The patients were randomly assigned to three groups (yoga, physical therapy (PT), or waiting list). After 12 weeks of regular exercises (or the absence of them), the effect of yoga and PT on the functional status and quality of life of patients were evaluated. The data were collected during the patients' two visits to the study center - before the start of the study and at the end of the 12-week period. The in-person examination included a doctor's assessment of the Expanded Disability Status Scale (EDSS), the SF-36 quality of life questionnaire, the fatigue scale, the Berg balance scale, and the 6-min walking test. Results A total of 36 patients finished the clinical study: thirty women and six men. There was no statistically significant difference between the groups in terms of improvement in MS symptoms as measured by the balance, walking test, and fatigue scales. However, in the analysis of eight criteria of SF-36 quality-of-life questionnaire by the covariation analysis, statistically significant differences were found in favor of the yoga group in terms of physical functioning (PF) (p = .003), life activity (VT) (p < .001), mental health (MH) (p = 013), and social functioning (SF) (p = .028). Conclusion Thus, regular yoga classes under the guidance of qualified staff are a promising method of non-drug rehabilitation of patients with MS with motor disorders.
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Affiliation(s)
| | | | | | | | | | - Lev Brylev
- Bujanov Moscow City Clinical Hospital, Moscow, Russia
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Romein J, Bishop J. An Australian exploratory study of individual physical functioning and wellbeing of rural clients with chronic diseases whose structured exercise groups were cancelled due to social distancing requirements of the COVID-19 pandemic. Aust J Prim Health 2023; 29:501-509. [PMID: 37011665 DOI: 10.1071/py22229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 03/13/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND The primary aim of this study was to describe if there was a change in physical functioning of rural clients with chronic diseases who were unable to attend their structured exercise groups during the COVID-19 pandemic. The secondary aim was to describe their physical activity during lockdown and their wellbeing upon return to their structured exercise groups. METHOD Physical functioning measures collected in January to March 2020 (prior to suspension of structured exercise groups due to the lockdown) were repeated in July 2020 (when face-to-face activity resumed) and compared. A survey collected information about the client's level of physical activity during lockdown and wellbeing measures at the end of the lockdown. RESULTS Forty-seven clients consented to provide physical functioning tests and 52 completed the survey. Only the modified 2-min step-up test displayed a statistically (but not clinically) significant change (n =29, 51.7vs 54.1 rep, P =0.01). Physical activity undertaken during lockdown was less in 48% (n =24), the same in 44% (n =22) and increased in 8% (n =4) of clients. Despite the lockdown, clients had high global satisfaction, high subjective wellbeing and normal resilience. CONCLUSIONS Clinically significant changes in physical functioning when clients were unable to attend structured exercise groups for three months during the COVID-19 pandemic were not observed in this exploratory study. Further research is required to confirm the impact of isolation on physical functioning in those participating in group exercise to improve their chronic disease management.
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Affiliation(s)
- Jake Romein
- East Grampians Health Service, 5 Girdlestone Street, Ararat, Vic. 3377, Australia
| | - Jaclyn Bishop
- East Grampians Health Service, 5 Girdlestone Street, Ararat, Vic. 3377, Australia
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Barakou I, Sakalidis KE, Abonie US, Finch T, Hackett KL, Hettinga FJ. Effectiveness of physical activity interventions on reducing perceived fatigue among adults with chronic conditions: a systematic review and meta-analysis of randomised controlled trials. Sci Rep 2023; 13:14582. [PMID: 37666869 PMCID: PMC10477297 DOI: 10.1038/s41598-023-41075-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/21/2023] [Indexed: 09/06/2023] Open
Abstract
Fatigue is barrier of physical activity participation in adults with chronic conditions. However, physical activity alleviates fatigue symptoms. This systematic review and meta-analysis aimed to (1) synthesise evidence from randomised controlled trials (RCTs) exploring the effects of physical activity interventions on fatigue reduction and (2) evaluate their effectiveness. Medline/CINAHL/EMBASE/Web of Science and Scopus were searched up to June 24th, 2023. Two reviewers independently conducted study screening and selection (RCTs), extracted data and assessed risk of bias (RoB2). Outcome was the standardised mean difference (SMD) with 95% confidence intervals in fatigue between experimental and control groups. 38 articles met the inclusion criteria. Overall, physical activity interventions moderately reduced fatigue (SMD = 0.54, p < 0.0001). Interventions lasting 2-6 weeks demonstrated a larger effect on fatigue reduction (SMD = 0.86, p < 0.00001). Interventions with 18-24 sessions showed a large effect on fatigue reduction (SMD = 0.97, p < 0.00001). Aerobic cycling and combination training interventions had a large to moderate effect (SMD = 0.66, p = 0.0005; SMD = 0.60, p = 0.0010, respectively). No long-term effects were found during follow-up. Physical activity interventions moderately reduced fatigue among adults with chronic conditions. Duration, total sessions, and mode of physical activity were identified as key factors in intervention effectiveness. Further research is needed to explore the impact of physical activity interventions on fatigue.
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Affiliation(s)
- Ioulia Barakou
- Department of Nursing, Midwifery & Health, Northumbria University, Newcastle upon Tyne, NE7 7XA, UK
| | - Kandianos Emmanouil Sakalidis
- Department of Sport Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumberland Building, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK
| | - Ulric Sena Abonie
- Department of Sport Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumberland Building, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK
| | - Tracy Finch
- Department of Nursing, Midwifery & Health, Northumbria University, Newcastle upon Tyne, NE7 7XA, UK
| | - Katie L Hackett
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
- CRESTA Fatigue Clinic, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Florentina Johanna Hettinga
- Department of Sport Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumberland Building, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK.
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Adamson B, Wyatt N, Key L, Boone C, Motl RW. Results of the MOVE MS Program: A Feasibility Study on Group Exercise for Individuals with Multiple Sclerosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6567. [PMID: 37623153 PMCID: PMC10454660 DOI: 10.3390/ijerph20166567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/31/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023]
Abstract
Exercise improves a wide range of symptoms experienced by those living with multiple sclerosis (MS) and may foster community and a positive sense of disability identity. However, exercise rates remain low. Sustained exercise participation has the greatest likelihood of improving symptoms and requires a theory-based approach accounting for the barriers faced by people with MS that impede exercise participation long-term. MOVE MS is a once weekly group exercise program based on Social Cognitive Theory supporting long-term exercise participation through peer instruction, behavior change education, multiple exercise modalities, and seated instruction. This feasibility study evaluated MOVE MS with a 7-month trial. The primary scientific outcome was exercise participation and the secondary outcomes were MS symptoms/impact, self-efficacy, depression, anxiety, disability identity, and quality of life, among others. We further conducted semi-structured formative interviews post-intervention. Thirty-three participants began the program. The onset of COVID-19 necessitated a shift toward online delivery. Seventeen participants completed the program. There were non-significant improvements in exercise participation (Godin Leisure-Time Exercise Questionnaire, baseline mean = 14.2 (SD = 11.8), post-intervention mean = 16.6 (SD = 11.2), F-value = 0.53 (Partial Eta2 = 0.08), and several secondary outcomes (including the MS Impact Scale, MS Walking Scale, and the Leeds MS Quality of Life Scale). Sixteen participants were interviewed, and analysis yielded five themes on program components and feedback. MOVE MS-delivered in-person or online-may be a feasible option for long-term exercise programming for people with MS.
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Affiliation(s)
- Brynn Adamson
- Department of Health Sciences, University of Colorado Colorado Springs, 1420 Austin Bluffs Pkwy, Colorado Springs, CO 80907, USA
| | - Nic Wyatt
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 506 S. Wright St., Urbana, IL 61801, USA
| | - Latashia Key
- Department of Recreation, Sport, and Tourism, University of Illinois at Urbana-Champaign, 506 S. Wright St., Urbana, IL 61801, USA
| | - Carrena Boone
- Department of Health Sciences, University of Colorado Colorado Springs, 1420 Austin Bluffs Pkwy, Colorado Springs, CO 80907, USA
| | - Robert W. Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, 1200 West Harrison St., Chicago, IL 60607, USA
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Mobility and balance rehabilitation in multiple sclerosis: A systematic review and dose-response meta-analysis. Mult Scler Relat Disord 2023; 69:104424. [PMID: 36473240 DOI: 10.1016/j.msard.2022.104424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/16/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the benefits of neurological rehabilitation and the dose-response relationship for the treatment of mobility and balance in multiple sclerosis. METHODS We included studies investigating the effects of neurological rehabilitation on mobility and balance with the following eligibility criteria for inclusion: Population, People with Multiple Sclerosis (PwMS); Intervention, method of rehabilitation interventions; Comparison, experimental (specific balance intervention) vs control (no intervention/no specific balance intervention); Outcome, balance clinical scales; Study Design, randomised controlled trials. We conducted a random effects dose-response meta-analysis to assess linear trend estimations and a one stage linear mixed effects meta-regression for estimating dose-response curves. RESULTS We retrieved 196 studies from a list of 5020 for full text review and 71 studies (n subjects=3306) were included. One study was a cross-over and 70 studies were randomized controlled trials and the mean sample size per study was 46.5 ± 28.6 (mean±SD) with a mean age of 48.3 ± 7.8years, disease duration of 11.6 ± 6.1years, and EDSS of 4.4 ± 1.4points. Twenty-nine studies (40.8%) had the balance outcome as the primary outcome, while 42 studies (59.1%) had balance as secondary outcome or did not specify primary and secondary outcomes. Thirty-three trials (46.5%) had no active intervention as comparator and 38 trials (53.5%) had an active control group. Individual level data from 20 studies (n subjects=1016) were analyzed showing a medium pooled effect size for balance interventions (SMD=0.41; 95% CIs 0.22 to 0.59). Moreover, we analyzed 14 studies (n subjects=696) having balance as primary outcome and BBS as primary endpoint yielding a mean difference of 3.58 points (95% CIs 1.79 to 5.38, p<0.0001). Finally, we performed meta regression of the 20 studies showing an association between better outcome, log of intensity defined as minutes per session (β=1.26; SEβ=0.51; p = 0.02) and task-oriented intervention (β=0.38; SEβ=0.17; p = 0.05). CONCLUSION Our analyses provide level 1 evidence on the effect of balance intervention to improve mobility. Furthermore, according to principles of neurological rehabilitation, high intensity and task-specific interventions are associated with better treatment outcomes.
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Muñoz-Paredes I, Herrero AJ, Román-Nieto N, Peña-Gomez AM, Seco-Calvo J. Influence of Transcranial Direct Current Stimulation and Exercise on Fatigue and Quality of Life in Multiple Sclerosis. Healthcare (Basel) 2022; 11:healthcare11010084. [PMID: 36611546 PMCID: PMC9818739 DOI: 10.3390/healthcare11010084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system that leads to a great deterioration in the quality of life. OBJECTIVE We aimed to assess the effectiveness of two individual programs, one based on transcranial direct current stimulation (tDCS) and another based on the effect of physical exercise on fatigue and quality of life in patients with MS. METHODS A total of 12 patients with relapsing-remitting and progressive secondary MS participated. Fatigue and quality of life were assessed before and after intervention. The exercise program and tDCS were carried out over a 4-week period, with a washout period of 5 months. RESULTS The results show significant improvements in the different quality of life subscales after the application of tDCS, activities of daily living (r = 0.625; p = 0.037) (g = 0.465), psychological well-being (r = 0.856; p = 0.004) (g = 0.727) and coping (r = 0.904; p = 0.18) (g = 0.376), and in those after the application of exercise, activities of daily living (r = 0.853; p = 0.003) (g = 0.570) and psychological well-being (r = 0.693; p = 0.041) (g = 0.417). After the application of both therapies, more than 50% of the subjects did not have a positive fatigue score on the MFIS scale. CONCLUSION The major findings suggest that the application of both therapies produces a beneficial effect with significant improvements in the quality of life of this sample.
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Affiliation(s)
- Inés Muñoz-Paredes
- Faculty of Health Sciences, University of León, 24071 León, Spain
- Correspondence: (I.M.-P.); (J.S.-C.)
| | - Azael J. Herrero
- Department of Health Sciences, European University Miguel de Cervantes, 47012 Valladolid, Spain
- Research Center on Physical Disability, ASPAYM Castilla y León, 47008 Valladolid, Spain
| | | | - Alba M. Peña-Gomez
- Multiple Sclerosis Association of Palencia, 34004 Palencia, Spain
- Physiotherapy Department, Hospital of Cabueñes, University of Oviedo, 33394 Gijón, Spain
| | - Jesús Seco-Calvo
- Faculty of Physiotherapy and Nursing, University of Leon, 24071 León, Spain
- Physiology Department, University of the Basque Country, 48940 Leioa, Spain
- Correspondence: (I.M.-P.); (J.S.-C.)
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12
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Ceren AN, Salcı Y, Fil Balkan A, Çalık Kütükçü E, Armutlu K, Erdem Özdamar S. The effects of spinal stabilization exercises in patients with myasthenia gravis: a randomized crossover study. Disabil Rehabil 2022; 44:8442-8449. [PMID: 34978954 DOI: 10.1080/09638288.2021.2022221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE The effects of spinal stabilization exercises (SSE) on fatigue, muscle strength, respiratory functions, functional capacity, and quality of life (QoL) in myasthenia gravis (MG) patients were investigated. MATERIALS AND METHODS This study which was designed a single-blinded, randomized crossover trial were included mild to moderate 10 MG patients, aged between 18 and 65. SSE and home program were applied to the patients for six weeks, four weeks between each exercise program. Fatigue assessed with Fatigue Severity Scale (FSS) and Visual Analog Fatigue Scale (VAFS). Muscle strengths were assessed with dynamometric measures. Respiratory Function Test, 6 Minute Walk Test (6MWT), Quantitative Myasthenia Gravis Score (QMGS), Myasthenia Gravis Quality of Life Scale-15 (MGQOL-15) were used. RESULTS All parameters were improved in SSE group, but not neck muscles strength, QMGS, and respiratory functions in home program group. FSS, VAFS, muscle strength, 6MWT, MGQOL-15 values were found significantly different in SSE group (p = .005 in all parameters). CONCLUSIONS SSE are safe and effective on fatigue, muscle strength, respiratory functions, functional capacity, and QoL for MG patients, so it may be suggested to include SSE in rehabilitation programs of MG patients.Implications For RehabilitationSpinal stabilization exercises are safe and effective for Myasthenia Gravis patients.Home exercise program which included breathing exercises and callisthenic exercises tailored to the patients' needs is safe and effective for Myasthenia Gravis patients.Rehabilitation programs of Myasthenia Gravis patients should include spinal stabilization exercises.
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Affiliation(s)
- Ali Naim Ceren
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Adnan Saygun Caddesi, Ankara, Turkey
| | - Yeliz Salcı
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Adnan Saygun Caddesi, Ankara, Turkey
| | - Ayla Fil Balkan
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Adnan Saygun Caddesi, Ankara, Turkey
| | - Ebru Çalık Kütükçü
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Adnan Saygun Caddesi, Ankara, Turkey
| | - Kadriye Armutlu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Adnan Saygun Caddesi, Ankara, Turkey
| | - Sevim Erdem Özdamar
- Faculty of Medicine, Department of Neurology, Hacettepe University, Adnan Saygun Caddesi, Ankara, Turkey
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Gaemelke T, Frandsen JJ, Hvid LG, Dalgas U. Participant characteristics of existing exercise studies in persons with multiple sclerosis - A systematic review identifying literature gaps. Mult Scler Relat Disord 2022; 68:104198. [PMID: 36257149 DOI: 10.1016/j.msard.2022.104198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Exercise is a cornerstone in rehabilitation of persons with multiple sclerosis (pwMS), which is known to elicit beneficial effects on various symptoms and to have a potential disease-modifying effect. However, it remains to be elucidated if the existing MS exercise literature covers the full age and disability span of pwMS. OBJECTIVE To systematically review MS exercise studies and provide a detailed mapping of the demographic and clinical characteristics of the included pwMS. METHODS A systematic review of MS exercise studies were performed using MEDLINE and EMBASE. From the resulting MS exercise studies, mean sample characteristics were extracted. RESULTS 4576 records were identified, from which 202 studies were included. Of these, 166 studies (82.2%) enrolled pwMS aged 35-54 years, 10.9% enrolled pwMS <35 years, and 6.9% enrolled pwMS ≥55 years (only 1.5% enrolled pwMS ≥60 years). A total of 118 studies (58.4%) reported Expanded Disability Status Scale (EDSS), with 88.1% of included pwMS having an EDSS between 2.0 and 6.5, while only one study enrolled pwMS with an EDSS ≥7.0. Finally, 80% of the studies included pwMS having a disease duration of 5-14.5 years. CONCLUSION Exercise studies in pwMS included primarily middle-aged (35-54 years) pwMS having an EDSS of 2.0-6.5 and a disease duration of 5-14.5 years. Few exercise studies were identified in young and older pwMS, in pwMS with mild disability and severe disability, and in pwMS having shorter or longer disease durations. These findings highlight the need for further investigation of exercise in these specific subgroups of pwMS as benefits of exercise might not generalize across subpopulations.
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Affiliation(s)
- Tobias Gaemelke
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, Aarhus C 8000, Denmark.
| | - Jens Jakob Frandsen
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, Aarhus C 8000, Denmark
| | - Lars G Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, Aarhus C 8000, Denmark
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, Aarhus C 8000, Denmark
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Bouquiaux O, Beaudart C, Thibaut A, Detal T, Marsala L, Dorban G, Kaux J. Beneficial effects of a supervised and individualized training circuit on physical capacities and quality of life of patients suffering from multiple sclerosis. Sci Sports 2022. [DOI: 10.1016/j.scispo.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Straudi S, De Marco G, Martinuzzi C, Baroni A, Lamberti N, Brondi L, Da Roit M, Pizzongolo LDM, Basaglia N, Manfredini F. Combining a supervised and home-based task-oriented circuit training improves walking endurance in patients with multiple sclerosis. The MS_TOCT randomized-controlled trial. Mult Scler Relat Disord 2022; 60:103721. [DOI: 10.1016/j.msard.2022.103721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 02/19/2022] [Accepted: 03/03/2022] [Indexed: 10/18/2022]
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Einstein O, Katz A, Ben-Hur T. Physical exercise therapy for autoimmune neuroinflammation: Application of knowledge from animal models to patient care. Clin Exp Rheumatol 2022; 21:103033. [PMID: 34995760 DOI: 10.1016/j.autrev.2022.103033] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/02/2022] [Indexed: 12/12/2022]
Abstract
Physical exercise (PE) impacts various autoimmune diseases. Accordingly, clinical trials demonstrated the safety of PE in multiple sclerosis (MS) patients and indicated beneficial outcomes. There is also an increasing body of research on the beneficial effects of exercise on experimental autoimmune encephalomyelitis (EAE), the animal model of MS, and various mechanisms underlying these effects were suggested. However, despite the documented favorable impact of PE on our health, we still lack a thorough understanding of its effects on autoimmune neuroinflammation and specific guidelines of PE therapy for MS patients are lacking. To that end, current findings on the impact of PE on autoimmune neuroinflammation, both in human MS and animal models are reviewed. The concept of personalized PE therapy for autoimmune neuroinflammation is discussed, and future research for providing biological rationale for clinical trials to pave the road for precise PE therapy in MS patients is described.
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Affiliation(s)
- Ofira Einstein
- Department of Physical Therapy, Faculty of Health Sciences, Ariel University, Ariel, Israel.
| | - Abram Katz
- Åstrand Laboratory, The Swedish School of Sport and Health Sciences, GIH, Stockholm, Sweden
| | - Tamir Ben-Hur
- Department of Neurology, The Agnes Ginges Center for Human Neurogenetics, Hadassah - Hebrew University Medical Center, Jerusalem, Israel
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Sattelmayer KM, Chevalley O, Kool J, Wiskerke E, Denkinger LN, Giacomino K, Opsommer E, Hilfiker R. Development of an exercise programme for balance abilities in people with multiple sclerosis: a development of concept study using Rasch analysis. Arch Physiother 2021; 11:29. [PMID: 34906261 PMCID: PMC8672542 DOI: 10.1186/s40945-021-00120-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 10/26/2021] [Indexed: 12/22/2022] Open
Abstract
Background People with multiple sclerosis (PwMS) frequently have impaired balance from an early stage of the disease. Balance difficulties can be divided into categories; although, to date, these lack scientific foundation. Impaired balance in PwMS can be addressed using specific and challenging exercises. Such exercises should provide an optimal challenge point; however, the difficulty of balance exercises is often unknown, making it difficult to target the exercises to an individual’s abilities. The aims of this study were: to develop an exercise programme for PwMS relating the exercises to the balance problem categories; to establish the order of difficulty of exercises in each category and; to evaluate the content and structural validity of the exercise programme. Methods A “construct map” approach was used to design and develop an exercise programme for PwMS. Potentially relevant balance exercises were identified, then a framework was set up, comprising four dimensions (subsequently reduced to three dimensions) of balance exercises. The relevance, comprehensibility, and comprehensiveness of the exercise programme were rated by 13 physiotherapists, who also linked 19 key exercises to balance categories. A total of 65 PwMS performed the 19 balance exercises, rated their difficulty and commented on the relevance and comprehensibility of each exercise. A Rasch model was used to evaluate the relative difficulty of the exercises. To assess fit of the data to the Rasch model a rating scale model was used, which is a unidimensional latent trait model for polytomous item responses. Results Evaluation by the physiotherapists and PwMS indicated that the content validity of the exercise programme was adequate. Rasch analysis showed that the latent trait “balance exercises in PwMS” comprised three subdimensions (“stable BOS”, “sway” and “step and walk”). The 19 balance exercises showed adequate fit to the respective dimensions. The difficulties of the balance exercises were adequate to cover the ability spectrum of the PwMS. Conclusion A balance exercise programme for PwMS comprising three dimensions of balance exercises was developed. Difficulty estimates have been established for each of the exercises, which can be used for targeted balance training. Content and structural validity of the programme was adequate. Supplementary Information The online version contains supplementary material available at 10.1186/s40945-021-00120-3.
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Affiliation(s)
| | - Odile Chevalley
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
| | - Jan Kool
- Rehazentrum Valens - Kliniken Valens, Taminaplatz 1, 7317, Valens, Switzerland
| | - Evelyne Wiskerke
- Rehazentrum Valens - Kliniken Valens, Taminaplatz 1, 7317, Valens, Switzerland.,Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Tervuursevest 101, 3001, Leuven, Heverlee, Belgium
| | | | - Katia Giacomino
- School of Health Sciences, HES-SO Valais-Wallis, Leukerbad, Switzerland
| | - Emmanuelle Opsommer
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
| | - Roger Hilfiker
- School of Health Sciences, HES-SO Valais-Wallis, Leukerbad, Switzerland
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Selph SS, Skelly AC, Wasson N, Dettori JR, Brodt ED, Ensrud E, Elliot D, Dissinger KM, McDonagh M. Physical Activity and the Health of Wheelchair Users: A Systematic Review in Multiple Sclerosis, Cerebral Palsy, and Spinal Cord Injury. Arch Phys Med Rehabil 2021; 102:2464-2481.e33. [PMID: 34653376 DOI: 10.1016/j.apmr.2021.10.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/10/2021] [Accepted: 10/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To understand the benefits and harms of physical activity in people who may require a wheelchair with a focus on people with multiple sclerosis (MS), cerebral palsy (CP), and spinal cord injury (SCI). DATA SOURCES Searches were conducted in MEDLINE, Cumulative Index to Nursing and Allied Health, PsycINFO, Cochrane CENTRAL, and Embase (January 2008 through November 2020). STUDY SELECTION Randomized controlled trials, nonrandomized trials, and cohort studies of observed physical activity (at least 10 sessions on 10 days) in participants with MS, CP, and SCI. DATA EXTRACTION We conducted dual data abstraction, quality assessment, and strength of evidence. Measures of physical functioning are reported individually where sufficient data exist and grouped as "function" where data are scant. DATA SYNTHESIS No studies provided evidence for prevention of cardiovascular conditions, development of diabetes, or obesity. Among 168 included studies, 44% enrolled participants with MS (38% CP, 18% SCI). Studies in MS found walking ability may be improved with treadmill training and multimodal exercises; function may be improved with treadmill, balance exercises, and motion gaming; balance is likely improved with balance exercises and may be improved with aquatic exercises, robot-assisted gait training (RAGT), motion gaming, and multimodal exercises; activities of daily living (ADL), female sexual function, and spasticity may be improved with aquatic therapy; sleep may be improved with aerobic exercises and aerobic fitness with multimodal exercises. In CP, balance may be improved with hippotherapy and motion gaming; function may be improved with cycling, treadmill, and hippotherapy. In SCI, ADL may be improved with RAGT. CONCLUSIONS Depending on population and type of exercise, physical activity was associated with improvements in walking, function, balance, depression, sleep, ADL, spasticity, female sexual function, and aerobic capacity. Few harms of physical activity were reported in studies. Future studies are needed to address evidence gaps and to confirm findings.
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Affiliation(s)
- Shelley S Selph
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon.
| | | | - Ngoc Wasson
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon
| | | | | | - Erik Ensrud
- Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Diane Elliot
- Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Kristin M Dissinger
- Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Marian McDonagh
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon
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19
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The effect of exercise on balance in patients with stroke, Parkinson, and multiple sclerosis: a systematic review and meta-analysis of clinical trials. Neurol Sci 2021; 43:167-185. [PMID: 34709478 DOI: 10.1007/s10072-021-05689-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 10/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Stroke, Parkinson, and multiple sclerosis are a range of diseases affecting the nervous system and show balance impairments due to damage of the balance control system. Many early articles have been published on the effect of exercise on balance in patients suffering from neuromuscular diseases. However, a comprehensive study showing a clear result of these three diseases was not found. Hence, the purpose of the present meta-analysis and systematic review is to determine the effect of exercise on balance in people with stroke, Parkinson, and multiple sclerosis. METHODS According to the PRISMA 2009 multi-step instructions, keywords related to the purpose of the research were browsed in the MeSH browser databases; IranDoc, MagIran, IranMedex, SID, ScienceDirect, Web of Science (WoS), ProQuest, Medline (PubMed), Scopus, and Google Scholar were searched to extract articles published in Persian and English language. The search process for retrieving the articles in the sources mentioned from January 01, 2000, to December 30, 2020, was done. The heterogeneity index of the studies was determined using the I2 test. Given the heterogeneity, the random-effects model was used to combine the articles and the results. RESULTS Initially, 7067 articles were found, but after removing duplicate and irrelevant articles, 96 clinical trials with a sample size of the intervention group of 1760 people were included in the study. As a result of the articles' composition, the mean balance score index after exercise in the intervention group showed a significant increase of 0.67 ± 0.12 of the unit (P˂0.01). The highest rate of increase in the balance score after the intervention was reported in patients with myelomeningocele with 1.66 ± 0.3 unit (P˂0.01). CONCLUSION Considering the positive effect of using exercise on increasing the balance in patients with stroke, Parkinson, and multiple sclerosis, it is recommended that health care providers implement a regular exercise program to improve the condition of these patients.
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20
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Impact of Lockdown during COVID-19 Pandemic on Central Activation, Muscle Activity, Contractile Function, and Spasticity in People with Multiple Sclerosis. BIOMED RESEARCH INTERNATIONAL 2021; 2021:2624860. [PMID: 34692828 PMCID: PMC8531768 DOI: 10.1155/2021/2624860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/23/2021] [Accepted: 10/04/2021] [Indexed: 11/24/2022]
Abstract
Background People with multiple sclerosis (MS) suffer from symptoms related to neural control, such as reduced central activation, lower muscle activity, and accentuated spasticity. A forced 9-week home confinement related to COVID-19 in Spain may have worsened these symptoms. However, no study has demonstrated the impact of home confinement on neuromuscular mechanisms in the MS population. This study was aimed at analyzing the effects of a 9-week home confinement on central activation, muscle activity, contractile function, and spasticity in MS patients. Methods Eighteen participants were enrolled in the study. Left and right knee extensor maximum voluntary isometric contraction (MVIC), maximal neural drive via peak surface electromyography (EMG) of the vastus lateralis, central activation ratio (CAR), and muscle contractile function via electrical stimulation of the knee extensor muscles, as well as spasticity using the pendulum test, were measured immediately before and after home confinement. Results Seventeen participants completed the study. CAR significantly decreased after lockdown (ES = 1.271, p < 0.001). Regarding spasticity, there was a trend to decrease in the number of oscillations (ES = 0.511, p = 0.059) and a significant decrease in the duration of oscillations (ES = 0.568, p = 0.038). Furthermore, in the left leg, there was a significant decrease in the first swing excursion (ES = 0.612, p = 0.027) and in the relaxation index (ES = 0.992, p = 0.001). Muscle contractile properties, MVIC, and EMG variables were not modified after confinement. Conclusions The results suggest that a home confinement period of 9 weeks may lead to an increase in lower limb spasticity and a greater deficit in voluntary activation of the knee extensors.
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21
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Harrison AM, Safari R, Mercer T, Picariello F, van der Linden ML, White C, Moss-Morris R, Norton S. Which exercise and behavioural interventions show most promise for treating fatigue in multiple sclerosis? A network meta-analysis. Mult Scler 2021; 27:1657-1678. [PMID: 33876986 PMCID: PMC8474304 DOI: 10.1177/1352458521996002] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/19/2021] [Accepted: 01/29/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Fatigue is a common, debilitating symptom of multiple sclerosis (MS) without a current standardised treatment. OBJECTIVE The aim of this systematic review with network meta-analyses was to estimate the relative effectiveness of both fatigue-targeted and non-targeted exercise, behavioural and combined (behavioural and exercise) interventions. METHODS Nine electronic databases up to August 2018 were searched, and 113 trials (n = 6909) were included: 34 were fatigue-targeted and 79 non-fatigue-targeted trials. Intervention characteristics were extracted using the Template for Intervention Description and Replication guidelines. Certainty of evidence was assessed using GRADE. RESULTS Pairwise meta-analyses showed that exercise interventions demonstrated moderate to large effects across subtypes regardless of treatment target, with the largest effect for balance exercise (SMD = 0.84). Cognitive behavioural therapies (CBTs) showed moderate to large effects (SMD = 0.60), with fatigue-targeted treatments showing larger effects than those targeting distress. Network meta-analysis showed that balance exercise performed significantly better compared to other exercise and behavioural intervention subtypes, except CBT. CBT was estimated to be superior to energy conservation and other behavioural interventions. Combined exercise also had a moderate to large effect. CONCLUSION Treatment recommendations for balance and combined exercise are tentative as the certainty of the evidence was moderate. The certainty of the evidence for CBT was high.
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Affiliation(s)
- Anthony M Harrison
- Department of Clinical and Health Psychology,
Leeds Teaching Hospitals National Health Service Trust, Leeds, UK
| | - Reza Safari
- Health and Social Care Research Centre, College
of Health, Psychology and Social Care, University of Derby, Derby, UK
| | - Tom Mercer
- Centre for Health, Activity and Rehabilitation
Research, Queen Margaret University, Edinburgh, UK
| | - Federica Picariello
- Health Psychology Section, Institute of
Psychiatry, Psychology and Neuroscience, King’s College London, London,
UK
| | | | - Claire White
- School of Population Health & Environmental
Sciences, Faculty of Life Sciences & Medicine, King’s College London,
London, UK
| | - Rona Moss-Morris
- Health Psychology Section, Institute of
Psychiatry, Psychology and Neuroscience, King’s College London, London,
UK
| | - Sam Norton
- Health Psychology Section, Institute of
Psychiatry, Psychology and Neuroscience, King’s College London, London,
UK
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22
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Torres-Costoso A, Martínez-Vizcaíno V, Reina-Gutiérrez S, Álvarez-Bueno C, Guzmán-Pavón MJ, Pozuelo-Carrascosa DP, Fernández-Rodríguez R, Sanchez-López M, Cavero-Redondo I. Effect of Exercise on Fatigue in Multiple Sclerosis: A Network Meta-analysis Comparing Different Types of Exercise. Arch Phys Med Rehabil 2021; 103:970-987.e18. [PMID: 34509464 DOI: 10.1016/j.apmr.2021.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/28/2021] [Accepted: 08/11/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE A network meta-analysis (NMA) of current evidence was conducted to determine if physical exercise has a positive influence on multiple sclerosis (MS) fatigue and type of exercise with the largest effect on fatigue also according to disease severity. DATA SOURCES MEDLINE, Embase, SPORTDiscus, Physiotherapy Evidence Database, Cochrane Library, and Web of Science. The search strategy combined relevant terms related to (1) MS; (2) clinical trials; (3) exercise; and (4) fatigue from inception to February 2021. STUDY SELECTION Randomized controlled trials concerning the effectiveness of different types of exercise on total and physical fatigue in people with MS were included. DATA EXTRACTION The data were extracted into predesigned data extraction tables. Risk of bias was evaluated with the Cochrane Risk of Bias tool (RoB 2.0), and the Grading of Recommendations, Assessment, Development, and Evaluation tool was used to evaluate the quality of the evidence. DATA SYNTHESIS A total of 58 studies were examined. Data were pooled using a random-effects model. A ranking of 7 and 8 different exercise interventions for physical and total fatigue scores, respectively, was achieved. The highest effects for pairwise comparisons were for combined exercise and resistance training vs control (ranging between -0.74 and -1.24). In the NMA, combined exercise (-1.51; 95% confidence interval [CI], -2.01 to -1.01) and resistance training (-1.15; 95% CI, -1.81 to -0.49) compared with the control group achieved the highest effects for physical and total fatigue, respectively. CONCLUSIONS Exercise should be considered an effective fatigue management strategy. Among the different exercise modalities, combined exercise is the most effective exercise modality for improving both physical and total fatigue. Resistance training is also an effective exercise for total fatigue among people diagnosed with MS.
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Affiliation(s)
- Ana Torres-Costoso
- Universidad de Castilla-La Mancha, Facultad de Fisioterapia y Enfermería, Toledo, Spain
| | - Vicente Martínez-Vizcaíno
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain; Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile.
| | - Sara Reina-Gutiérrez
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
| | - Celia Álvarez-Bueno
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain; Universidad de Castilla-La Mancha, Facultad de Enfermería de Cuenca, Cuenca, Spain; Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
| | | | - Diana P Pozuelo-Carrascosa
- Universidad de Castilla-La Mancha, Facultad de Fisioterapia y Enfermería, Toledo, Spain; Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain; Universidad de Castilla-La Mancha. Grupo de Investigación Multidisciplinar en Cuidados (IMCU), Campus de Fábrica de Armas, Toledo, Spain
| | | | - Mairena Sanchez-López
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain; Universidad de Castilla-La Mancha, School of Education, Ciudad Real, Spain
| | - Iván Cavero-Redondo
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain; Universidad de Castilla-La Mancha, Facultad de Enfermería de Cuenca, Cuenca, Spain; Rehabilitation in Health Research Center (CIRES), Universidad de las Americas, Santiago, Chile
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Ślusarz R, Olkiewicz J, Bonek R, Filipska K, Biercewicz M, Wiśniewski A. The Impact of Motor Disability and the Level of Fatigue on Adherence to Therapeutic Recommendations in Patients with Multiple Sclerosis Treated with Immunomodulation. Int J Med Sci 2021; 18:3609-3614. [PMID: 34522188 PMCID: PMC8436112 DOI: 10.7150/ijms.61964] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/19/2021] [Indexed: 01/01/2023] Open
Abstract
Aim: The aim of the study was to clarify whether the motor disability and the fatigue-related syndrome affect the level of compliance with therapeutic recommendations. Methods: Prospective studies were conducted among 165 patients treated under the drug program - Treatment of Multiple Sclerosis (MS) at the Department of Neurology and Clinical Neuroimmunology of the Regional Specialist Hospital in Grudziadz (Poland). The research was carried out by the method of diagnostic survey, questionnaire technique with the use of standardized research tools. The Adherence in Chronic Diseases Scale (ACDS) was used to assess the level of compliance with therapeutic recommendations. The Expanded Disability Status Scale (EDSS) was used to assess the degree of disability, and the Modified Fatigue Impact Scale (MFIS) was used to assess the degree of disability. The Chi-square test, Shapiro-Wilk test and Kruskal-Wallis were used. Results: The statistical analysis showed that there is a relationship (p=0.0055) between the patient's motor disability assessed in the EDSS scale and the level of compliance with therapeutic recommendations assessed in the ACDS scale. The higher the patient's disability level (EDSS 4.5-6.5), the lower the treatment adherence rate. The conducted research shows that the average score in the MFIS scale for individual levels of compliance with therapeutic recommendations expressed in the ACDS scale is, respectively: for the low level - 38.3 MFIS points, for the medium level - 34.4 MFIS points and for the high level- 33.2 MFIS points. The obtained results were not statistically significant (p=0.6098). Conclusion: It was found that the level of adherence to therapeutic recommendations in patients with relapsing-remitting multiple sclerosis treated with immunomodulation in the study group remained high. There is a relationship between the patient's disability and the level of adherence to therapeutic recommendations.
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Affiliation(s)
- Robert Ślusarz
- Neurological and Neurosurgical Nursing Department, Faculty of Health Science, Collegium Medicum, Nicolaus Copernicus University, Torun, Poland
- Polish Association of Neuroscience Nursing, Poland
| | - Joanna Olkiewicz
- Department of Neurology and Clinical Neuroimmunology, Regional Specialist Hospital, Grudziadz, Poland
- Polish Association of Neuroscience Nursing, Poland
| | - Robert Bonek
- Department of Neurology and Clinical Neuroimmunology, Regional Specialist Hospital, Grudziadz, Poland
| | - Karolina Filipska
- Neurological and Neurosurgical Nursing Department, Faculty of Health Science, Collegium Medicum, Nicolaus Copernicus University, Torun, Poland
- Polish Association of Neuroscience Nursing, Poland
| | - Monika Biercewicz
- Clinic of Geriatrics, Faculty of Health Science, Collegium Medicum, Nicolaus Copernicus University, Torun, Poland
| | - Adam Wiśniewski
- Department of Neurology, Faculty of Medicine, Collegium Medicum, Nicolaus Copernicus University, Torun, Poland
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D'Silva LJ, Chalise P, Obaidat S, Rippee M, Devos H. Oculomotor Deficits and Symptom Severity Are Associated With Poorer Dynamic Mobility in Chronic Mild Traumatic Brain Injury. Front Neurol 2021; 12:642457. [PMID: 34381408 PMCID: PMC8350131 DOI: 10.3389/fneur.2021.642457] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 06/25/2021] [Indexed: 12/02/2022] Open
Abstract
Oculomotor deficits, vestibular impairments, and persistent symptoms are common after a mild traumatic brain injury (mTBI); however, the relationship between visual-vestibular deficits, symptom severity, and dynamic mobility tasks is unclear. Twenty-three individuals (mean age 55.7 ± 9.3 years) with persistent symptoms after mTBI, who were between 3 months to 2 years post-injury were compared with 23 age and sex-matched controls. Oculomotor deficits [depth perception, near-point convergence, baseline visual acuity (BLVA), perception time], vestibular deficits (dynamic visual acuity in the pitch and yaw planes), dynamic mobility measured by the Functional Gait Assessment (FGA), and symptoms measured by the Post-Concussion Symptom Scale (PCSS) and Dizziness Handicap Inventory (DHI) were compared between groups. Participants with mTBI had poorer performance on the FGA (p < 0.001), higher symptom severity on the PCSS (p < 0.001), and higher DHI scores (p < 0.001) compared to controls. Significant differences were seen on specific items of the FGA between individuals with mTBI and controls during walking with horizontal head turns (p = 0.002), walking with vertical head tilts (p < 0.001), walking with eyes closed (p = 0.003), and stair climbing (p = 0.001). FGA performance was correlated with weeks since concussion (r = −0.67, p < 0.001), depth perception (r = −0.5348, p < 0.001), near point convergence (r = −0.4717, p = 0.001), baseline visual acuity (r = −0.4435, p = 0.002); as well as with symptoms on the PCSS (r = −0.668, p < 0.001), and DHI (r = −0.811, p < 0.001). Dynamic balance deficits persist in chronic mTBI and may be addressed using multifaceted rehabilitation strategies to address oculomotor dysfunction, post-concussion symptoms, and perception of handicap due to dizziness.
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Affiliation(s)
- Linda J D'Silva
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, MO, United States
| | - Prabhakar Chalise
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, MO, United States
| | - Sakher Obaidat
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, MO, United States
| | - Michael Rippee
- Department of Neurology, University of Kansas Health System, Kansas City, MO, United States
| | - Hannes Devos
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, MO, United States
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Nourbakhsh B, Waubant E, Evers AWM, Solomon AJ. Ethical considerations in the treatment of multiple sclerosis fatigue. Mult Scler Relat Disord 2021; 54:103129. [PMID: 34247106 DOI: 10.1016/j.msard.2021.103129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 06/26/2021] [Accepted: 06/29/2021] [Indexed: 12/19/2022]
Abstract
Fatigue is the most common symptom and a leading cause of disability multiple sclerosis (MS). Despite the lack of evidence, several medications are frequently prescribed by physicians to ameliorate fatigue in patients with MS. However, a recent study demonstrated that improvement in fatigue severity with these medications appears to be due to placebo effect and is also is associated with more frequent adverse events than the placebo. These findings raise ethical concerns surrounding the initiation and discontinuation of these treatments for fatigue in MS. Starting these medications for the treatment of MS fatigue for their placebo effect may not be justified. However, stopping the medications in patients who report symptomatic benefits and have no side effects may also not be ethical. In MS care non-pharmacological approaches for fatigue treatment, such as exercise and cognitive behavioral therapy, should now be prioritized. Novel study designs may be necessary to address placebo response in future clinical trials evaluating interventions for fatigue in MS.
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Affiliation(s)
- Bardia Nourbakhsh
- Department of Neurolgy, Johns Hopkins University, Baltimore, MD, United States.
| | - Emmanuelle Waubant
- Department of Neurology, University of California San Francisco, San Francisco, California, United States
| | - Andrea W M Evers
- Department of Health, Medical and Neuropsychology, Institute of Psychology, Leiden University, Leiden, the Netherlands
| | - Andrew J Solomon
- Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, Burlington Vermont, United States
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26
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Sokhangu MK, Rahnama N, Etemadifar M, Rafeii M, Saberi A. Effect of Neuromuscular Exercises on Strength, Proprioceptive Receptors, and Balance in Females with Multiple Sclerosis. Int J Prev Med 2021; 12:5. [PMID: 34084302 PMCID: PMC8106275 DOI: 10.4103/ijpvm.ijpvm_525_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 03/26/2019] [Indexed: 11/24/2022] Open
Abstract
Background: Multiple sclerosis (MS) is the third most common cause of adult neurologic disabilities. The aim of this study was to determine the effect of 8 weeks of neuromuscular exercises on strength, proprioceptive receptors, and balance of women with MS. Methods: In this randomized controlled trial study, 20 female volunteers with relapsing-remitting MS were randomly assigned into the experimental group (n = 10) and control group (n = 10). Maximum muscular strength of knee extensor and flexor muscles, knee joint proprioceptive error (Biodex), and balance (Berg Balance Scale) was measured at baseline and after 8 weeks of neuromuscular exercise. The data were analyzed using paired t-test and independent t-test. Results: The results showed a significant improvement (P < 0.05) in the quadriceps strength, hamstring strength, proprioceptive receptor error, and the balance in the experimental group, but not in the control group. A significant difference was evident between the experimental and control groups in terms of strength, balance, and proprioceptive receptor error (P < 0.05). Conclusions: Neuromuscular exercise training is effective in improving balance, strength, and reducing the proprioceptive error in people with MS, and it could be recommended as modalities for these patients.
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Affiliation(s)
- Maryam K Sokhangu
- Department of Sport Injury and Corrective Exercises, Faculty of Sport Science, University of Isfahan, Isfahan, Iran
| | - Nader Rahnama
- Department of Sport Injury and Corrective Exercises, Faculty of Sport Science, University of Isfahan, Isfahan, Iran
| | - Masoud Etemadifar
- Department of Neurology, Medical School, Isfahan Research Committee of Multiple Sclerosis, Isfahan, Iran
| | - Mehdi Rafeii
- Faculty of Sport Science, University of Isfahan, Isfahan, Iran
| | - Ali Saberi
- Department of Sport Management, Faculty of Management, Farabi Campus, University of Tehran, Iran
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Kline PW, Christiansen CL, Hager ER, Alvarez E, Mañago MM. Movement compensations during a step ascent task are associated with stair climbing performance in people with multiple sclerosis. Gait Posture 2021; 87:27-32. [PMID: 33878510 PMCID: PMC8441993 DOI: 10.1016/j.gaitpost.2021.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 04/08/2021] [Accepted: 04/14/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The biomechanical mechanisms underlying stair climbing limitations are poorly understood in people with multiple sclerosis (MS). RESEARCH QUESTIONS Are trunk and pelvis motion and lower extremity joint moments during step ascent different between MS and control groups? Are step ascent biomechanics and stair climbing performance associated in people with MS? METHODS 20 people with MS (49 ± 12 years, EDSS range: 1.5-5.5) and ten control participants (48 ± 12 years) underwent three-dimensional motion analysis while ascending a 15.2-cm step and also completed a timed Functional Stair Test. Main effects of group (MS vs Control) and limb (Stronger/Dominant vs Weaker/Non-dominant) and interactions were assessed using two-way analyses of variance. Associations between movement patterns during the step ascent and Functional Stair Test performance were performed using Pearson's correlations and backward stepwise linear regression. RESULTS Significant group main effects were observed in greater sagittal pelvis excursion (p < 0.001), greater sagittal (p = 0.013) and frontal (p = 0.001) trunk excursion, and lower trail limb peak ankle plantar flexion moment (p < 0.001) of the MS group. Significant limb main effects were observed with greater sagittal trunk excursion (p = 0.037) and peak trail limb ankle plantar flexion moment (p = 0.037) in the stronger/dominant limb. A significant interaction was observed in peak knee extensor moment (p = .002). Stair climbing performance in the MS group correlated with sagittal (r = .607, p=<0.001) and frontal pelvis excursions (r = 0.385, p = 0.014), sagittal trunk excursion (r = .411, p = 0.008), and ankle plantar flexion moments (r=-0.415, p = 0.008). Sagittal and frontal pelvis excursion and bilateral handrail use explained a significant amount of variability in stair climbing performance (Adj R2 = 0.775). SIGNIFICANCE In conclusion, despite the presence of proximal and distal lower extremity movement pattern compensations during a step ascent task, larger pelvis angular excursions are associated with impaired stair climbing performance in people with MS and may serve as targets for future rehabilitation interventions.
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Affiliation(s)
- Paul W Kline
- Department of Physical Therapy, High Point University, High Point, NC, USA,Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA,Geriatric Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, CO, USA
| | - Cory L Christiansen
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA,Geriatric Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, CO, USA
| | - Emily R Hager
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA,Geriatric Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, CO, USA
| | - Enrique Alvarez
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mark M Mañago
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA,Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Homayuni A, Abedini S, Hosseini Z, Etemadifar M, Ghanbarnejad A. Explaining the facilitators of quality of life in patients with multiple sclerosis: a qualitative study. BMC Neurol 2021; 21:193. [PMID: 33975555 PMCID: PMC8111999 DOI: 10.1186/s12883-021-02213-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/26/2021] [Indexed: 12/05/2022] Open
Abstract
Background In patients with multiple sclerosis (MS), the disease’s complications and manifestations affect a person’s ability to function normally and leads to further disruptions in their education, family life, job opportunities, and daily life activities, thereby reduce their quality of life. Different factors as facilitators or inhibitors affect the quality of life in patients with MS. This study aimed to explain the facilitators of quality of life in patients with MS. Methods This research applied qualitative methodology, utilizing semi-structured interviews with individuals with MS and their family members/caregivers. Purposeful sampling was done among people who referred to Isfahan MS Association. Participants were selected with a maximum variation in terms of gender, age, education, occupation and marital status. Interviews were continued to reach data saturation. The gathered data were concurrently analyzed by the content analysis technique. MAXQDA software version 10 was used for data management. Results Saturation was reached after eighteen interviews. A total of three main categories and 8 sub-categories were extracted from the data. The identified facilitators were: personal facilitators (leisure time and coping strategies), interpersonal facilitators (exercise therapy, social support and social organizations) and needs and suggestions for improvement (family therapy, adopting urban architecture and facilities, and supportive systems). Conclusions Based on these findings, in order to improve the quality of life in patients with MS, we should pay attention to factors such as leisure time, spirituality and positive thinking, exercise, social support and social organizations. Health professionals, the government, community and families could help to improve patients’ quality of life through adapting urban architecture, holding family therapy sessions and providing supportive systems. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02213-9.
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Affiliation(s)
- Atefeh Homayuni
- Health School, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Sedigheh Abedini
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
| | - Zahra Hosseini
- Tobacco and Health Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Masoud Etemadifar
- Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amin Ghanbarnejad
- Department of Public Health, School of Health, Tobacco and Health Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Dauwan M, Begemann MJH, Slot MIE, Lee EHM, Scheltens P, Sommer IEC. Physical exercise improves quality of life, depressive symptoms, and cognition across chronic brain disorders: a transdiagnostic systematic review and meta-analysis of randomized controlled trials. J Neurol 2021; 268:1222-1246. [PMID: 31414194 PMCID: PMC7990819 DOI: 10.1007/s00415-019-09493-9] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/29/2019] [Accepted: 07/30/2019] [Indexed: 01/20/2023]
Abstract
We performed a meta-analysis to synthesize evidence on the efficacy and safety of physical exercise as an add-on therapeutic intervention for quality of life (QoL), depressive symptoms and cognition across six chronic brain disorders: Alzheimer's disease, Huntington's disease, multiple sclerosis, Parkinson's disease, schizophrenia and unipolar depression. 122 studies ( = k) (n = 7231) were included. Exercise was superior to treatment as usual in improving QoL (k = 64, n = 4334, ES = 0.40, p < 0.0001), depressive symptoms (k = 60, n = 2909, ES = 0.78, p < 0.0001), the cognitive domains attention and working memory (k = 21, n = 1313, ES = 0.24, p < 0.009), executive functioning (k = 14, n = 977, ES = 0.15, p = 0.013), memory (k = 12, n = 994, ES = 0.12, p = 0.038) and psychomotor speed (k = 16, n = 896, ES = 0.23, p = 0.003). Meta-regression showed a dose-response effect for exercise time (min/week) on depressive symptoms (β = 0.007, p = 0.012). 69% of the studies that reported on safety, found no complications. Exercise is an efficacious and safe add-on therapeutic intervention showing a medium-sized effect on QoL and a large effect on mood in patients with chronic brain disorders, with a positive dose-response correlation. Exercise also improved several cognitive domains with small but significant effects.
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Affiliation(s)
- Meenakshi Dauwan
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Postbus 85500, 3508 GA Utrecht, The Netherlands
- Department of Clinical Neurophysiology and MEG Center, Amsterdam UMC, VU University Medical Center Amsterdam, Neuroscience Campus, Postbus 7057, 1007 MB Amsterdam, The Netherlands
- Department of Biomedical Sciences of Cells and Systems Section, University of Groningen, University Medical Center Groningen, Neuroimaging Center 3111, Deusinglaan 2, 9713 AW Groningen, The Netherlands
| | - Marieke J. H. Begemann
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Postbus 85500, 3508 GA Utrecht, The Netherlands
| | - Margot I. E. Slot
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Postbus 85500, 3508 GA Utrecht, The Netherlands
| | - Edwin H. M. Lee
- Department of Psychiatry, 2/F, New Clinical Building, University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Philip Scheltens
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Postbus 7057, 1007 MB Amsterdam, The Netherlands
| | - Iris E. C. Sommer
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Postbus 85500, 3508 GA Utrecht, The Netherlands
- Department of Biomedical Sciences of Cells and Systems Section, University of Groningen, University Medical Center Groningen, Neuroimaging Center 3111, Deusinglaan 2, 9713 AW Groningen, The Netherlands
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
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Introduction of the Watzmann Severity Scale: A sensorimotor approach to estimate the course of inpatient rehabilitation in multiple sclerosis. Mult Scler Relat Disord 2020; 48:102674. [PMID: 33340928 DOI: 10.1016/j.msard.2020.102674] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/16/2020] [Accepted: 12/03/2020] [Indexed: 01/22/2023]
Abstract
Multiple sclerosis is an autoimmune disease with a plethora of potentially arising impairments and a coarse standard clinical estimation of severity, the expanded disability status scale (EDSS). In this study, we introduced the Watzmann Severity Scale (WSS), a sensorimotor function based statistical model of the EDSS of 113 patients. Using the WSS, we examined the rehabilitation course of 87 patients. The WSS revealed to be a reliable estimate of the EDSS with an R²adjusted of 0.81, although lower EDSS grades were systematically overestimated. Further, patients slightly improved during their inpatient stay of in average 17d by 0.21 on the WSS, with changes in gait performance being the driving factor (|β|-weight of 0.84). We were not able to reliably predict changes in the WSS and found no association with the duration of hospitalization. We conclude and advise that rehabilitation should start earlier, if lower EDSS grades were not overestimated, to emphasize gait less in rehabilitation, and to change from a perspective of impairment and disability to performance in order to maximize patient rehabilitation.
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New Strategies for Rehabilitation and Pharmacological Treatment of Fatigue Syndrome in Multiple Sclerosis. J Clin Med 2020; 9:jcm9113592. [PMID: 33171768 PMCID: PMC7695014 DOI: 10.3390/jcm9113592] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/03/2020] [Accepted: 11/05/2020] [Indexed: 12/11/2022] Open
Abstract
Multiple sclerosis (MS) is the most common autoimmune disease of the central nervous system (CNS), with an inflammatory demyelinating basis and a progressive course. The course of the disease is very diverse and unpredictable. Patients face many problems on a daily basis, such as problems with vision; sensory, balance, and gait disturbances; pain; muscle weakness; spasticity; tremor; urinary and fecal disorders; depression; and rapidly growing fatigue, which significantly influences quality of life among MS patients. Excessive fatigue occurs in most MS patients in all stages of this disease and is named MS-related fatigue. The crucial issue is the lack of effective treatment; therefore, this review focuses not only on the most common treatment methods, but also on additional novel therapies such as whole-body cryotherapy (WBC), functional electrical stimulation (FES), and non-invasive brain stimulation (NIBS). We also highlight the advantages and disadvantages of the most popular clinical scales used to measure fatigue. The entire understanding of the origins of MS-related fatigue may lead to the development of more effective strategies that can improve quality of life among MS patients. A literature search was performed using MEDLINE, EMBASE, and PEDro databases.
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Klautau AV, da Silva Pinto D, Santana BB, Freitas Queiroz MA, Rangel da Silva ANM, Vieira Cayres-Vallinoto IM, Ishak R, Rosário Vallinoto AC. Pilates exercise improves the clinical and immunological profiles of patients with human T-cell lymphotropic virus 1 associated myelopathy: A pilot study. J Bodyw Mov Ther 2020; 24:1-8. [PMID: 32825975 DOI: 10.1016/j.jbmt.2020.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 11/13/2019] [Accepted: 02/17/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is an infectious chronic-inflammatory disease, which can lead to lower limb motions. METHODS The study evaluated the effects of serial Pilates exercises on the clinical and immunological profiles of patients with HAM/TSP. Eight patients with ages ranging from 39 to 70 years old (2 males and 6 females), 2 wheelchair users and 6 with compromised gait, were evaluated. The patients were submitted to 20 Pilates sessions for 10 weeks. Data were collected at 3 time points (beginning of the study, after Pilates sessions and after 10 weeks without Pilates) and consisted of evaluations of the pain level, spasticity, motor strength, balance, mobility, functional capacity, quality of life and quantification of IFN-γ, IL-10 and IL-9 cytokines levels. RESULTS After the Pilates sessions, significant improvements in pain level, static and dynamic balance, trunk control, mobility and quality of life were observed, with simultaneous and significant reductions in the serum levels of the cytokines IFN-γ and IL-10. However, after 10 weeks without Pilates, there were significant changes in terms of increasing pain and regression of mobility, with no changes in strength, spasticity, functional capacity in any of the periods of the study. CONCLUSIONS The results suggest that Pilates may be a promising auxiliary physical therapy for patients with HAM/TSP.
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Affiliation(s)
- Altair Vallinoto Klautau
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará, Guamá, 66.075-110, Pará state, Brazil
| | - Denise da Silva Pinto
- Institute of Health Sciences, Federal University of Pará, Umarizal, 66.050-060, Pará state, Brazil; Division of Tropical Medicine, Federal University of Pará, Umarizal, 66.050-060, Belém, Pará state, Brazil
| | - Bárbara Brasil Santana
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará, Guamá, 66.075-110, Pará state, Brazil
| | - Maria Alice Freitas Queiroz
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará, Guamá, 66.075-110, Pará state, Brazil
| | | | | | - Ricardo Ishak
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará, Guamá, 66.075-110, Pará state, Brazil
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Lehmann I, Thaler I, Luder G, Damm U, Wälti C, Steinheimer S, Verra ML, Müri RM, Nyffeler T, Vanbellingen T, Kamm CP. Standardized, comprehensive, hospital-based circuit training in people with multiple sclerosis: results on feasibility, adherence and satisfaction of the training intervention. Eur J Phys Rehabil Med 2020; 56:279-285. [DOI: 10.23736/s1973-9087.20.06191-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ergul M, Nodehi Moghadam A, Soh R. The effectiveness of interventions targeting spasticity on functional clinical outcomes in patients with multiple sclerosis: a systematic review of clinical trials. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2020.1775888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Merziye Ergul
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Afsun Nodehi Moghadam
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Rachel Soh
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Pérez de Heredia-Torres M, Huertas-Hoyas E, Sánchez-Camarero C, Máximo-Bocanegra N, Alegre-Ayala J, Sánchez-Herrera-Baeza P, Martínez-Piédrola RM, García-Bravo C, Mayoral-Martín A, Serrada-Tejeda S. Occupational performance in multiple sclerosis and its relationship with quality of life and fatigue. Eur J Phys Rehabil Med 2020; 56:148-154. [DOI: 10.23736/s1973-9087.20.05914-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Williams KL, Low Choy NL, Brauer SG. Center-Based Group and Home-Based Individual Exercise Programs Have Similar Impacts on Gait and Balance in People With Multiple Sclerosis: A Randomized Trial. PM R 2020; 13:9-18. [PMID: 32249509 DOI: 10.1002/pmrj.12377] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/25/2020] [Accepted: 03/04/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Group and home-based exercises to improve function in people with multiple sclerosis (MS) are common but have little underpinning evidence. OBJECTIVE To determine the comparative effectiveness of a center-based group versus home-based individual 8-week exercise program to improve gait and balance in people with MS. DESIGN Prospective, randomized controlled trial. SETTING Community center-based and home-based exercise program. PARTICIPANTS Fifty people with MS were randomized and completed allocated intervention (n = 26 center, n = 24 home), 47 completed post-assessment and 44 follow-up assessment. METHODS The center- and home-based groups completed an 8-week progressive functional and balance training exercise program. The center-based groups of four to six were supervised by a physiotherapist. The home-based group was provided with telephone support. MAIN OUTCOME MEASUREMENTS The primary outcome was gait speed (10-meter walk test). Secondary outcomes were gait endurance (6-minute walk test) and balance (Berg Balance Scale). Outcome assessments were conducted at baseline, immediately postintervention and at 8-week follow-up. RESULTS There was no statistically significant difference between groups in gait speed post training, with a mean difference of 0.01 m/s, 95% CI -0.36 to 0.37. There were no group effects, time effects, or interactions for gait speed, endurance, or balance. In both groups, gait speed improved to a level that met minimal clinically important differences. CONCLUSIONS Gait speed, endurance, and balance did not statistically improve in either group; however, gait speed changes met minimally important differences.
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Affiliation(s)
- Katrina Louise Williams
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Nancy Louise Low Choy
- School of Physiotherapy, Australian Catholic University (McAuley Campus), Brisbane, Australia
| | - Sandra Gail Brauer
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Lahelle AF, Øberg GK, Normann B. Group dynamics in a group-based, individualized physiotherapy intervention for people with multiple sclerosis: A qualitative study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 25:e1829. [PMID: 31883187 DOI: 10.1002/pri.1829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/22/2019] [Accepted: 12/13/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Group-based physiotherapy is a common and beneficial intervention for people with multiple sclerosis (MS). Most group interventions are not individually adapted to each participant's needs. Evidence on how individualization and group elements can be combined in a clinical setting is lacking. The objective of this study is to expand the knowledge base in neurological physiotherapy by investigating the nature of group dynamics in a group-based, individualized intervention for people with MS. METHODS This qualitative study included 13 nonparticipatory video observations (14 hr 38 min) of GroupCoreDIST exercise sessions complemented by 13 interviews (12 hr 37 min) with physiotherapists (PTs). The purposively sampled participants included 40 patients with MS (expanded disability scale of 1.0-6.5) and six PTs with expertise in neurological physiotherapy. Data were analysed using systematic text condensation in an enactive theoretical framework. RESULTS Two main categories emerged from the material. (a) Individual systems affect group dynamics: Individual perceptions of success through adapted and embodied approaches positively affected the dynamics of the group. (b) Disease and exercise peer support: Social support was a substantial product of dynamic group processes and was enhanced through the PTs' strategic focus on experience sharing. CONCLUSION The results revealed that group dynamics benefit from individualization and the PTs' focus on experience sharing. These findings are contrary to the prevailing view that individualization and group-based interventions are mutually exclusive and thus should be considered in group-based interventions for people with MS.
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Affiliation(s)
- Andreas Falck Lahelle
- Department of Health and Care Sciences, University of Tromsø, The Artic University of Norway, Tromsø, Norway
| | - Gunn Kristin Øberg
- Department of Health and Care Sciences, University of Tromsø, The Artic University of Norway, Tromsø, Norway
| | - Britt Normann
- The Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.,Department of Physiotherapy, Nordland Hospital Trust, Bodø, Norway
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Comparison of the effects of two different exergaming systems on balance, functionality, fatigue, and quality of life in people with multiple sclerosis: A randomized controlled trial. Mult Scler Relat Disord 2019; 39:101902. [PMID: 31924591 DOI: 10.1016/j.msard.2019.101902] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/20/2019] [Accepted: 12/19/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Balance disorders, fatigue, and walking impairments are the most common symptoms of multiple sclerosis (MS), which lead to a decrease in quality of life. To cope with these disability-increasing symptoms, it is important to select and regularly apply appropriate rehabilitation approaches. In recent years, virtual reality approaches have been suggested as a potentially useful tool in rehabilitation. Exergaming systems are used in the treatment of symptoms associated with MS, but there are few randomized controlled studies investigating the efficacy of these systems. OBJECTIVE To investigate and compare the effects of exercise training with two different exergaming systems on balance, functionality, fatigue, and quality of life in people with multiple sclerosis (PwMS). METHODS Forty-seven volunteer PwMS were included in the study and randomized to the group I (Nintendo Wii Fit), group II (Balance Trainer), and group III (control group). The participants in the study groups underwent an exercise program under the supervision of a physiotherapist on 2 days a week for 8 weeks. Outcome measures were the Berg Balance Scale (BBS), Timed Up and Go test (TUG), Six-Minute Walk Test (6MWT), Fatigue Severity Scale (FSS), and Multiple Sclerosis International Quality of Life Questionnaire (MusiQol), which were performed before and after the treatment. RESULTS Forty-two participants completed the study protocol. All parameters evaluated in group I and II showed statistically significant improvement after treatment. Changes in all outcome measures were found to be superior in group I compared with group III. Similarly, all measures except the 6MWT were found to be superior in group II compared with group III. Changes in BBS and MusiQol were found to be superior in group I compared with group II. CONCLUSION In comparison with no intervention, exergaming with Nintendo Wii Fit and Balance Trainer improves balance, increases functionality, reduces fatigue severity, and increases quality of life in PwMS.
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Grazioli E, Tranchita E, Borriello G, Cerulli C, Minganti C, Parisi A. The Effects of Concurrent Resistance and Aerobic Exercise Training on Functional Status in Patients with Multiple Sclerosis. Curr Sports Med Rep 2019; 18:452-457. [DOI: 10.1249/jsr.0000000000000661] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Hayes S, Galvin R, Kennedy C, Finlayson M, McGuigan C, Walsh CD, Coote S. Interventions for preventing falls in people with multiple sclerosis. Cochrane Database Syst Rev 2019; 11:CD012475. [PMID: 31778221 PMCID: PMC6953359 DOI: 10.1002/14651858.cd012475.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is one of the most prevalent diseases of the central nervous system with recent prevalence estimates indicating that MS directly affects 2.3 million people worldwide. Fall rates of 56% have been reported among people with MS in a recent meta-analysis. Clinical guidelines do not outline an evidence-based approach to falls interventions in MS. There is a need for synthesised information regarding the effectiveness of falls prevention interventions in MS. OBJECTIVES The aim of this review was to evaluate the effectiveness of interventions designed to reduce falls in people with MS. Specific objectives included comparing: (1) falls prevention interventions to controls and; (2) different types of falls prevention interventions. SEARCH METHODS We searched the Trials Register of the Cochrane Multiple Sclerosis and Rare Diseases of the CNS Group, Cochrane Central Register of Controlled Trials (2018 Issue 9); MEDLINE (PubMed) (1966 to 12 September 2018); Embase (EMBASE.com) (1974 to 12 September 2018); Cumulative Index to Nursing and Allied Health Literature (EBSCOhost) (1981 to 12 September 2018); Latin American and Caribbean Health Science Information Database (Bireme) (1982 to 12 September 2018); ClinicalTrials.gov; and World Health Organization International Clinical Trials Registry Platform; PsycINFO (1806 to 12 September 2018; and Physiotherapy Evidence Database (1999 to 12 September 2018). SELECTION CRITERIA We selected randomised controlled trials or quasi-randomised trials of interventions to reduce falls in people with MS. We included trials that examined falls prevention interventions compared to controls or different types of falls prevention interventions. Primary outcomes included: falls rate, risk of falling, number of falls per person and adverse events. DATA COLLECTION AND ANALYSIS Two review authors screened studies for selection, assessed risk of bias and extracted data. We used a rate ratio (RaR) and 95% confidence interval to compare falls rate between groups. For risk of falling, we used a risk ratio (RR) and 95% CI based on the number of fallers in each group. MAIN RESULTS A total of 839 people with MS (12 to 177 individuals) were randomised in the 13 included trials. The mean age of the participants was 52 years (36 to 62 years). The percentage of women participants ranged from 59% to 85%. Studies included people with all types of MS. Most trials compared an exercise intervention with no intervention or different types of falls prevention interventions. We included two comparisons: (1) Falls prevention intervention versus control and (2) Falls prevention intervention versus another falls prevention intervention. The most common interventions tested were exercise as a single intervention, education as a single intervention, functional electrical stimulation and exercise plus education. The risk of bias of the included studies mixed, with nine studies demonstrating high risk of bias related to one or more aspects of their methodology. The evidence was uncertain regarding the effects of exercise versus control on falls rate (RaR of 0.68; 95% CI 0.43 to 1.06; very low-quality evidence), number of fallers (RR of 0.85; 95% CI 0.51 to 1.43; low-quality evidence) and adverse events (RR of 1.25; 95% CI 0.26 to 6.03; low-quality evidence). Data were not available on quality of life outcomes comparing exercise to control. The majority of other comparisons between falls interventions and controls demonstrated no evidence of effect in favour of either group for all primary outcomes. For the comparison of different falls prevention interventions, the heterogeneity of intervention types across studies prohibited the pooling of data. In relation to secondary outcomes, there was evidence of an effect in favour of exercise interventions compared to controls for balance function with a SMD of 0.50 (95% CI 0.09 to 0.92), self-reported mobility with a SMD of 16.30 (95% CI 9.34 to 23.26) and objective mobility with a SMD of 0.28 (95% CI 0.07 to 0.50). Secondary outcomes were not assessed under the GRADE criteria and results must be interpreted with caution. AUTHORS' CONCLUSIONS The evidence regarding the effects of interventions for preventing falls in MS is sparse and uncertain. The evidence base demonstrates mixed risk of bias, with very low to low certainty of the evidence. There is some evidence in favour of exercise interventions for the improvement of balance function and mobility. However, this must be interpreted with caution as these secondary outcomes were not assessed under the GRADE criteria and as the results represent data from a small number of studies. Robust RCTs examining the effectiveness of multifactorial falls interventions on falls outcomes are needed.
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Affiliation(s)
- Sara Hayes
- University of LimerickSchool of Allied Health, Ageing Research Centre, Health Research InstituteLimerickIreland
| | - Rose Galvin
- University of LimerickDepartment of Clinical Therapies, Faculty of Education and Health SciencesCastletroyLimerickIreland
| | - Catriona Kennedy
- Robert Gordon UniversitySchool of Nursing and MidwiferyGarthdee RoadAberdeenUKAB10 7QG
| | - Marcia Finlayson
- Queen's UniversitySchool of Rehabilitation Therapy31 George StreetKingstonONCanada
| | - Christopher McGuigan
- St. Vincent's University Hospital & University College DublinDepartment of NeurologyElm ParkDublinIreland
| | - Cathal D Walsh
- Department of Mathematics and StatisticsHealth Research Institute (HRI) and MACSIUniversity of LimerickIreland
| | - Susan Coote
- University of LimerickDepartment of Clinical Therapies, Faculty of Education and Health SciencesCastletroyLimerickIreland
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Arntzen EC, Øberg GK, Gallagher S, Normann B. Group-based, individualized exercises can provide perceived bodily changes and strengthen aspects of self in individuals with MS: a qualitative interview study. Physiother Theory Pract 2019; 37:1080-1095. [PMID: 31657262 DOI: 10.1080/09593985.2019.1683923] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Group-based physiotherapy is effective for individuals with MS; nevertheless individualization within groups is questioned and little is known regarding individuals´ experiences with individualization in small groups.Objective: We aimed to explore the short- and long-term experiences of individuals with MS participating in a 6-week, group-based, individualized physiotherapy-intervention.Methods: Within a randomized controlled trial (RCT), 25 in-depth interviews with a strategic sample of 13 people (9 women; age 25-79 years old; European Disability Status Scale (EDSS) 1-6.5) were conducted at weeks 7 and 30 using systematic text condensation, with dynamic systems theory and phenomenology as analytical frameworks.Results: The main categories were: 1) movement control, orientation and insights: Bodily improvements were associated with targeted exercises, specific adjustments by the physiotherapist, emotional engagement and re-access to activities; and 2) the individual within the group: Equal distributions of one-to-one interactions and attention were important for experiencing success. Less attention and improvements turned attention toward own disability. Physical changes felt particularly emotional short term, implying that individuals' feelings of ownership and control of body and movement, new views of themselves and changed affordances in daily life were involved.Conclusion: Equally distributed attention and engagement, targeted exercises and hands-on adjustments resulting in visible and perceived bodily changes were experienced as key factors of individualization in small groups.
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Affiliation(s)
| | | | - Shaun Gallagher
- The Lillian and Morrie Moss Chair of Excellence in Philosophy, Department of Philosophy, University of Memphis, Memphis, TN, USA
| | - Britt Normann
- Department of Physiotherapy, Nordland Hospital Trust, Bodø, Norway.,UiT, The Arctic University of Norway, Tromsø, Norway
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Byrnes KL, Whillier S. Effects of Nonpharmaceutical Treatments on Symptom Management in Adults With Mild or Moderate Multiple Sclerosis: A Meta-analysis. J Manipulative Physiol Ther 2019; 42:514-531. [DOI: 10.1016/j.jmpt.2018.12.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/08/2018] [Accepted: 12/03/2018] [Indexed: 10/25/2022]
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Effectiveness of Physiotherapy Interventions on Spasticity in People With Multiple Sclerosis: A Systematic Review and Meta-Analysis. Am J Phys Med Rehabil 2019; 97:793-807. [PMID: 29794531 DOI: 10.1097/phm.0000000000000970] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The aim of the study was to examine the effectiveness of physiotherapy (PT) interventions on spasticity in people with multiple sclerosis. DESIGN A systematic search was performed using PRISMA guidance. Studies evaluate the effect of PT interventions on spasticity were included. People with multiple sclerosis, spasticity, disability and PT interventions characteristics were extracted in included studies. Level of evidence was synthesized by the Grade of Recommendation, Assessment, Development and Evaluation approach. Meta-analyses were performed by calculating Hedges g at 95% confidence interval. RESULTS A total of 29 studies were included in the review, and 25 were included in the meta-analyses. The included PT interventions were exercise therapy, electrical stimulation, radial shock wave therapy, vibration, and standing. The review and meta-analyses showed different evidences of benefits and nonbenefits for PT interventions on some spasticity outcomes. The best quality evidences were for beneficial effects of exercise therapy especially robot gait training and outpatient exercise programs on self-perceived spasticity and muscle tone respectively. The review results were positive regarding the acute effects, follow-up measurements, safety, progressive MS, and nonambulatory people with multiple sclerosis. The included articles were heterogeneous and badly reported in PT interventions and people with multiple sclerosis characteristics. CONCLUSIONS Physiotherapy interventions can be a safe and beneficial option for spasticity in people with multiple sclerosis. No firm conclusion can be drawn on overall spasticity. Further researches in different spasticity aspects are needed.
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Smith M, Barker R, Williams G, Carr J, Gunnarsson R. The effect of exercise on high-level mobility in individuals with neurodegenerative disease: a systematic literature review. Physiotherapy 2019; 106:174-193. [PMID: 31477333 DOI: 10.1016/j.physio.2019.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 02/27/2019] [Accepted: 04/25/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To investigate the effect of exercise on high-level mobility (i.e. mobility more advanced than independent level walking) in individuals with neurodegenerative disease. DATA SOURCES A systematic literature search was conducted in Medline, CINAHL, Scopus, SportDiscus and PEDro. STUDY SELECTION Randomised controlled trials of exercise interventions for individuals with neurodegenerative disease, with an outcome measure that contained high-level mobility items were included. High-level mobility items included running, jumping, bounding, stair climbing and backward walking. Outcome measures with high-level mobility items include the High Level Mobility Assessment Tool (HiMAT); Dynamic Gait Index; Rivermead Mobility Index (RMI) or modified RMI; Functional Gait Assessment and the Functional Ambulation Category. STUDY APPRAISAL Quality was evaluated with the Cochrane Risk of Bias Tool. RESULTS Twenty-four studies with predominantly moderate to low risk of bias met the review criteria. High-level mobility items were included within primary outcome measures for only two studies and secondary outcome measures for 22 studies. Eight types of exercise interventions were investigated within which high-level mobility tasks were not commonly included. In the absence of outcome measures or interventions focused on high-level mobility, findings suggest some benefit from treadmill training for individuals with multiple sclerosis or Parkinson's disease. Progressive resistance training for individuals with multiple sclerosis may also be beneficial. With few studies on other neurodegenerative diseases, further inferences cannot be made. CONCLUSION Future studies need to specifically target high-level mobility in the early stages of neurodegenerative disease and determine the impact of high-level mobility interventions on community participation and maintenance of an active lifestyle. Systematic review registration number PROSPERO register for systematic reviews (registration number: CRD42016050362).
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Affiliation(s)
- Moira Smith
- College of Healthcare Sciences, Building 043-114, James Cook University, Townsville, Queensland 4811, Australia.
| | - Ruth Barker
- College of Healthcare Sciences, James Cook University, Cairns, Queensland 4878, Australia.
| | | | - Jennifer Carr
- College of Healthcare Sciences, James Cook University, Cairns, Queensland 4878, Australia.
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Occupational Therapy in Fatigue Management in Multiple Sclerosis: An Umbrella Review. Mult Scler Int 2019; 2019:2027947. [PMID: 31016045 PMCID: PMC6448334 DOI: 10.1155/2019/2027947] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/31/2019] [Accepted: 03/06/2019] [Indexed: 12/27/2022] Open
Abstract
Background. Fatigue is one of the most invalidant symptoms of Multiple Sclerosis (MS) that negatively affects occupational and work performance and social participation. Occupational therapy (OT) assessment and treatment of impairments related to fatigue can have a significant and positive impact on the quality of life. Methods. An umbrella review has been carried out to provide rehabilitative decision makers in healthcare with insight into the role of OT in fatigue management in Multiple Sclerosis. The question is, what type of treatment provided by occupational therapist is more effective in reducing fatigue in Multiple Sclerosis? A search of literature published until June 2018 was undertaken by three independent reviewers using PubMed, PEDro, and Cochrane Library database including systematic reviews and meta-analyses of the last 10 years. Results. 10 studies were selected (5 systematic reviews, 1 meta-analysis, 3 reviews, and 1 guideline). Conclusions. Fatigue management programs have moderate evidence; other strategies such as OT strategies and telerehabilitation show low evidence.
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Dybesland AR, Normann B. Group physiotherapy targeting core stability and balance in individuals with multiple sclerosis. ‘Movement analyses and individualisations: potent change-making tools’. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2018.1496473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Britt Normann
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromso, Norway
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Scheidler AM, Kinnett-Hopkins D, Learmonth YC, Motl R, López-Ortiz C. Targeted ballet program mitigates ataxia and improves balance in females with mild-to-moderate multiple sclerosis. PLoS One 2018; 13:e0205382. [PMID: 30335774 PMCID: PMC6193654 DOI: 10.1371/journal.pone.0205382] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 09/25/2018] [Indexed: 11/30/2022] Open
Abstract
Background Multiple sclerosis (MS) is a disease of the central nervous system that causes ataxia and deficits in balance. Exercise-based therapies have been identified as integral to the recovery of motor function in MS, but few studies have investigated non-traditional movement interventions. We examined a targeted ballet program (TBP) designed to mitigate ataxia and improve balance in females with mild-to-moderate relapsing-remitting MS. Methods and findings Twelve females with mild-to-moderate disability due to MS were assessed for study eligibility for the study. Ten participants met the inclusion criteria. Two were lost to unrelated health complications. Eight participants completed the TBP. The TBP met twice a week for 60 minutes for 16 weeks. Assessments included (a) the International Cooperative Ataxia Rating Scale (ICARS), (b) the Mini-Balance Evaluations Systems Test (Mini-BESTest), (c) smoothness of movement during a five-meter walk, and (d) balance in a step to stand task before and after the TBP. There were no TBP-related adverse events. Single-tailed paired samples t-tests and Wilcoxon tests were conducted. Improvements were observed in ICARS (p = 7.11E-05), Mini-BESTest (p = 0.001), smoothness of movement in the left (p = 0.027) and right (p = 0.028) sides of the body, and balance in a step-to-stand task in the back (p = 0.025) direction. Results yielded 42% and 58% improvements in the mean Mini-BESTest and ICARS scores, respectively. Conclusions This study adds to current research by providing support for a TBP intervention targeting ataxia and balance in MS. The TBP was well tolerated, improved balance, and mitigated ataxia. Clinical improvements were larger than those of previous studies on physical rehabilitation in MS with similar outcome measures. Trial registration ISRCTN ISRCTN67916624.
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Affiliation(s)
- Andrew M. Scheidler
- Department of Kinesiology and Community Health, University of Illinois, Urbana-Champaign, Illinois, United States of America
| | - Dominique Kinnett-Hopkins
- Department of Kinesiology and Community Health, University of Illinois, Urbana-Champaign, Illinois, United States of America
| | - Yvonne C. Learmonth
- Department of Kinesiology and Community Health, University of Illinois, Urbana-Champaign, Illinois, United States of America
| | - Robert Motl
- Department of Kinesiology and Community Health, University of Illinois, Urbana-Champaign, Illinois, United States of America
| | - Citlali López-Ortiz
- Department of Kinesiology and Community Health, University of Illinois, Urbana-Champaign, Illinois, United States of America
- Joffrey Ballet Academy, The Official School of the Joffrey Ballet, Chicago, Illinois, United States of America
- * E-mail:
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Sharif K, Watad A, Coplan L, Lichtbroun B, Krosser A, Lichtbroun M, Bragazzi NL, Amital H, Afek A, Shoenfeld Y. The role of stress in the mosaic of autoimmunity: An overlooked association. Autoimmun Rev 2018; 17:967-983. [PMID: 30118900 DOI: 10.1016/j.autrev.2018.04.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 04/04/2018] [Indexed: 12/22/2022]
Abstract
Stress is defined as the pscyophysiological reaction in which the steady state is disturbed or threatened. Stress is not always perceived as a negative response. Stress results when environmental demands exceed an individuals' adaptive capacities. Autoimmune diseases are heterogeneous group of chronic diseases which occur secondary to loss of self antigen tolerance. The etiopathogenesis of autoimmune disease is uncertain. Genetic factors as well as environmental factors appear to interplay, leading to a cascade of events resulting in disease onset. Stress has been postulated to play a role in disease onset in the genetically susceptible patients. During the stress response, catecholamines and glucocorticoids are released from locus coeruleus and adrenal gland. These biomolecules exert control over various immune cells in the innate and adaptive arms of the immune system, thereby altering the cytokine profile released. The increase of IL-4 promotes T-helper 2 (Th2) cell differentiation, while the decrease in IL-12 and the increased IL-10 production reduce the number of T-helper 1 (Th1) cells. The relationship between stress and autoimmune diseases is intricate. Stress has been shown to be associated with disease onset, and disease exacerbations in rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel disease, multiple sclerosis, Graves' disease as well as other autoimmune conditions. In certain conditions such as psoriasis, stress has been implicated in delaying lesion clearance upon the application of standard treatment regimes. Finally, psychological therapy and cognitive behavioral therapy aimed to reduce stress levels was shown to be effective in influencing better outcomes in many autoimmune diseases. The purpose of this paper is to closer inspect the clinical evidence regarding the role of stress on influencing the various aspects of disease entities.
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Affiliation(s)
- Kassem Sharif
- Department of Medicine 'B', Israel; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Abdulla Watad
- Department of Medicine 'B', Israel; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Louis Coplan
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Alec Krosser
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Nicola Luigi Bragazzi
- School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Howard Amital
- Department of Medicine 'B', Israel; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Arnon Afek
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Incumbent of the Laura Schwarz-Kipp Chair for Research of Autoimmune Diseases, Tel-Aviv University, Head of The Mosaic of Autoimmunity Project, Saint Petersburg State University, Israel; Head of The Mosaic of Autoimmunity Project, Saint Petersburg State University, Russia.
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Lahelle AF, Øberg GK, Normann B. A group-based, individualized physiotherapy intervention for people with multiple sclerosis-A qualitative study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2018; 23:e1734. [PMID: 30039598 DOI: 10.1002/pri.1734] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/04/2018] [Accepted: 06/15/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND PURPOSE Group-based interventions for people with multiple sclerosis (MS) have gained increased attention in the field of physiotherapy research. However, no studies have investigated whether or how the prevailing principle of individualization is embedded in such interventions. The purpose of this study was to investigate how professional actions and interactions affect individualized exercise adaptations in a group intervention for people with MS. METHODS This study had a qualitative design and investigated and analysed the actions and interactions of six different physiotherapists (PTs) with expertise in neurology and 40 patients (27 female and 13 male, mean age 52.2 years, mean Expanded Disability Status Scale 2.45) in a group-based exercise intervention (GroupCoreDIST) for people with MS. We performed nonparticipatory video observations of 13 group exercise sessions, each consisting of three patients, followed by 13 semistructured in-depth interviews with the PTs. Systematic text condensation analysis was conducted within an enactive theoretical framework. RESULTS The results of our study indicated that the extent of embodied interaction and patient participation affect the possibilities and challenges regarding individualization within a group intervention. Handling, facilitation, emphasis on movement quality, and PTs who invited their patients to play an active role in the encounter enriched the reasoning and decision-making processes and yielded opportunities to adapt exercises to the specific patient's impairments. However, the combination of individuality and collectivity within a group context brings forth challenges in which the PTs are obligated to both preserve the benefits of being in a group and simultaneously attend to individual patients. CONCLUSIONS Our study indicates that despite challenges, the PTs' integration of embodied interaction and mutual participation enables the patients to concurrently benefit from individualization and being in a group. These findings contribute to the question regarding the significance of individual adaptations in group interventions and point toward a need for future effect studies that compare standardized and individualized exercise protocols.
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Affiliation(s)
- Andreas Falck Lahelle
- Department of Health and Care Sciences, University of Tromsø, The Artic University of Norway, Tromsø, Norway
| | - Gunn Kristin Øberg
- Department of Health and Care Sciences, University of Tromsø, The Artic University of Norway, Tromsø, Norway
| | - Britt Normann
- Department of Health and Care Sciences, University of Tromsø, The Artic University of Norway, Tromsø, Norway.,Department of Physiotherapy, Nordland Hospital Trust, Bodø, Norway
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Lahelle AF, Øberg GK, Normann B. Physiotherapy assessment of individuals with multiple sclerosis prior to a group intervention - A qualitative observational and interview study. Physiother Theory Pract 2018; 36:386-396. [PMID: 29985730 DOI: 10.1080/09593985.2018.1488022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Assessment prior to both individual and group interventions is fundamental to neurological physiotherapy practice. However, knowledge is limited regarding how assessments are carried out, particularly assessments conducted prior to group interventions, which have recently gained increasing attention in clinical research. In this qualitative study, we investigated how physiotherapy assessments of patients with multiple sclerosis prior to a group exercise intervention were carried out and what physiotherapists considered vital elements in the assessment process. Data were gathered through 12 qualitative non-participatory video observations followed by in-depth interviews of physiotherapists. Systematic text condensation analysis was conducted within an enactive theoretical framework of participatory sense making. In the assessments, patients' bodily perceptions of movement changes appeared to be vital in establishing patient expectations for the forthcoming intervention. The extent of patient participation and an embodied approach to communication influenced both the physiotherapists' and patients' insights into the patients' movement problems, which were further utilized in the initial intervention planning. Significant differences in context from the assessment to the intervention require a systematic completion of the assessments in the course of the first clinical meeting, which should be considered in the further development of research and clinical practices.
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Affiliation(s)
| | - Gunn Kristin Øberg
- Department of Health and Care Sciences, University of Tromsø, Tromsø, Norway
| | - Britt Normann
- Department of Health and Care Sciences, University of Tromsø, Tromsø, Norway.,Department of Physiotherapy, Nordland Hospital Trust, Bodø, Norway
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