Balance Right in Multiple Sclerosis (BRiMS): a feasibility randomised controlled trial of a falls prevention programme

The effect of exercise on mental health and health-related quality of life in individuals with multiple sclerosis: A Systematic review and meta-analysis

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.

Safety of exercise training in multiple sclerosis: An updated systematic review and meta-analysis

BACKGROUND

A review of the safety profile of exercise training in multiple sclerosis (MS) has not been conducted since 2013.

OBJECTIVE

We undertook a systematic review and meta-analysis of randomised controlled trials (RCTs) of exercise training published since 2013 and quantified estimated population risks of clinical relapse, adverse events (AE) and serious adverse event (SAE).

METHODS

Articles reporting safety outcomes from comparisons of exercise training with non-exercise among persons with MS were identified. The risk of bias was established from study's internal validity assessed using Physiotherapy Evidence Database (PEDro). Rates and estimated mean population relative risks (RRs; 95% confidence interval (CI)) of safety outcomes were calculated, and random-effects meta-analysis estimated the mean RR.

RESULTS

Forty-six interventions from 40 RCTs (N = 1780) yielded 46, 40 and 39 effects for relapse, AE, adverse effects and SAE, respectively. The mean population RRs ((95% CI), p-value) for relapse, AE and SAE were 0.95 ((0.61, 1.48), p = 0.82), 1.40 ((0.90, 2.19), p = 0.14) and 1.05 ((0.62, 1.80), p = 0.85), respectively. No significant heterogeneity is observed for any outcome.

CONCLUSION

In studies that reported safety outcomes, there was no higher risk of relapse, AE, adverse effects or SAE for exercise training than the comparator. Exercise training may be promoted as safe and beneficial to persons with MS.

Self-management of falls in people with multiple sclerosis: A scoping review

OBJECTIVE

Falls are common in people with multiple sclerosis. There is rising interest in how the multifactorial and chronic nature of fall risk among people with multiple sclerosis can be addressed through self-management. Thus, the aims were to investigate the extent and the scope of publications on self-management of falls in people with multiple sclerosis, and to identify how the concept of self-management was defined and used.

DATA SOURCES

A systematic literature search in Medline, Cochrane, Web of Science and PsycInfo was conducted to identify publications until July 2022.

REVIEW METHODS

Published methodological guidance was followed. Articles targeting: (1) people with multiple sclerosis, (2) falls, and (3) self-management were selected. Of 1656 records, 203 publications were assessed for eligibility, of which 173 did not meet the inclusion criteria, and 16 publications did not contain empirical data. The type of publication, study focus, and study design was extracted. If applicable, key findings, self-management tasks and skills, and the definition of self-management were extracted.

RESULTS

Fourteen original articles met all inclusion criteria. Ten articles represented six different fall prevention interventions. Three publications were randomized controlled trials. Self-management content was variable and not comprehensive in nature. None of the 14 publications included a self-management definition.

CONCLUSION

The limited number of original articles and the even fewer intervention studies show that the research on self-management of falls in people with multiple sclerosis is in its infancy. To progress in the research area of self-management of falls, a more robust, consensus-based description of self-management frameworks and activities is needed.

Online self-management fall prevention intervention for people with multiple sclerosis: a feasibility study protocol of a parallel group randomised trial

INTRODUCTION

Falls among people with multiple sclerosis (PwMS) are common and associated with injuries, fear of falling and low health-related quality of life. Considerations of behavioural, environmental, psychological and physical influences (including ambulation status) are needed to meet fall prevention needs for PwMS. Thus, using a codesign process involving key stakeholders a novel online self-management fall prevention intervention was created specifically for ambulatory and non-ambulatory PwMS. The feasibility, acceptability, fidelity and outcome of this complex intervention will be explored. Findings will inform a future full-scale randomised controlled trial.

METHODS AND ANALYSIS

A mixed-method design will be used. Forty-eight PwMS, stratified for ambulation level, will be randomised to control (n=24) or intervention (n=24). Both groups will receive a brochure about fall risk factors and fall prevention. The intervention is group-based (eight PwMS in each group); will be delivered online; and involve six, 2-hour weekly sessions and a booster session 8 weeks after the sixth session. Each intervention group will be led by a trained facilitator. Data collection will be performed at baseline, and after seven and 18 weeks. Outcome measures will capture data on fall prevention behaviours, fear of falling, falls self-efficacy, social and everyday activities, perceived impact of MS and number of falls. Feasibility of recruitment process, data collection procedures, outcome measures, and delivery, and intervention acceptability, fidelity and outcomes will be evaluated. Both quantitative and qualitative methods will be used.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the Swedish Ethical Review Authority (registration number 2021-04817). Results will be disseminated in peer-review journals, at conferences, research meetings, in social media and through the patient organisation Neuro Sweden.

TRIAL REGISTRATION NUMBER

NCT04317716.

Free From Falls education and exercise program for reducing falls in people with multiple sclerosis: A randomized controlled trial

BACKGROUND

People with multiple sclerosis (PwMS) fall frequently. Community-delivered exercise and education reduce falls in older adults, but their efficacy in multiple sclerosis (MS) is unknown.

OBJECTIVES

To evaluate the impact of the Free From Falls (FFF) group education and exercise program on falls in PwMS.

METHODS

This was a prospective, assessor-blinded, two-arm parallel randomized controlled trial. Ninety-six participants were randomized to FFF (eight weekly 2 hour sessions) or the control condition (a fall prevention brochure and informing their neurologist of their fall history). Participants counted falls prospectively from enrollment through 6 months following intervention. Effects on fall frequency were evaluated by the Bayesian analysis.

RESULTS

The modeled mean fall frequency pre-intervention was 1.2 falls/month in the FFF group (95% credible intervals (CIs) = 0.8-2.0) and 1.4 falls/month in the control group (95% CI = 0.9-2.1). Fall frequency decreased by 0.6 falls/month in both groups over time (nadir 4-6 months post-intervention: FFF 0.6 falls/month (95% CI = 0.4-0.9); control 0.8 falls/month (95% CI = 0.5-1.1)).

CONCLUSION

In-person group exercise and education are not superior to written education and neurologist-initiated interventions for preventing falls in PwMS.