Telerehabilitation in Multiple Sclerosis: Results of a Randomized Feasibility and Efficacy Pilot Study
DOI:
https://doi.org/10.5195/ijt.2018.6256Abstract
A prospective, randomized, three-arm, evaluator blinded study to demonstrate the feasibility of a telerehabilitation (TR) program in individuals with ambulatory deficits secondary to Multiple Sclerosis (MS) and evaluate its efficacy when compared to conventional on-site physical therapy (PT) was completed. Thirty participants were evaluated at baseline and randomized to one of three groups with intervention lasting 8 weeks: Group 1 (control)- customized unsupervised home-based exercise program (HEP) 5 days a week; Group 2 (TR)- remote PT supervised via audio/visual real-time telecommunication twice weekly; Group 3 (PT)- in-person PT at the medical facility twice weekly. Outcomes included patient reported outcomes (PROs) obtained through questionnaires, and measurements of gait and balance performed with bedside tests and a computerized system. Functional gait assessment improved from baseline in all three groups. There were no significant differences between the TR and the conventional PT groups for a variety of outcome measures. TR is a feasible method to perform PT in persons with MS and has comparable efficacy to conventional in-person PT as measured by patient reported outcomes and objective outcomes of gait and balance.
References
Berg, K. O., Wood-Dauphinee, S. L., Williams, J. I., & Maki, B. (1992). Measuring balance in the elderly: Validation of an instrument. Canadian Journal of Public Health, 83(Suppl 2), S7-11.
Blum, L., & Korner-Bitensky, N. (2008). Usefulness of the Berg Balance Scale in stroke rehabilitation: A systematic review. Physical Therapy, 88, 559-566. doi:10.2522/ptj.20070205
Burke, T. N., Franca, F. J., Ferreira de Meneses, S. R., Cardoso, V. I., & Marques, A. P. (2010). Postural control in elderly persons with osteoporosis: Efficacy of an intervention program to improve balance and muscle strength: A randomized controlled trial. American Journal of Physical Medicine & Rehabilitation, 89, 549-556. doi:10.1097/PHM.0b013e3181ddccd2
Cameron, M. H., & Wagner, J. M. (2011). Gait abnormalities in multiple sclerosis: pathogenesis, evaluation, and advances in treatment. Current Neurology and Neuroscience Reports, 11, 507-515. doi:10.1007/s11910-011-0214-y
Dlugonski, D., Moll, R.W., Mohr, D.D., & Sandroff, B.M. (2012). Internet-delivered behavioral intervention to increase physical activity in persons with multiple sclerosis: Sustainability and secondary outcomes. Psychology, Health & Medicine, 17, 636-51.
Finkelstein, J., Lapshin, O., Castro, H., Cha, E., & Provance, P. G. (2008). Home-based physical telerehabilitation in patients with multiple sclerosis: A pilot study. Journal of Rehabilitation Research and Development, 45, 1361-1373.
Finlayson, M. L., Peterson, E. W., & Cho, C. C. (2006). Risk factors for falling among people aged 45 to 90 years with multiple sclerosis. Archives of Physical Medicine and Rehabilitation, 87, 1274-1279; quiz 1287. doi:10.1016/j.apmr.2006.06.002
Fischer, J.S., LaRocca, N.G., Miller, D.M., Ritvo, P.G., Andrews, H, & Paty D. (1999). Recent developments in the assessment of quality of life in multiple sclerosis (MS). Multiple Sclerosis, 4, 251-259.
Fisk, J.D., Ritvo, P.G., Ross L, Haase, D.A., Marrie, T.J., & Schlech, W.F. (1994). Measuring the functional impact of fatigue: Initial validation of the fatigue impact scale. Clinical Infectious Diseases, 1, 79-83.
Fjeldstad, C., Pardo, G., Bemben, D., & Bemben, M. (2011). Decreased postural balance in multiple sclerosis patients with low disability. International Journal of Rehabilitation Research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation, 34(1), 53-58. doi:10.1097/MRR.0b013e32833d6ccb
Frevel, D., & Maurer. M. (2015). Internet-based home training is capable to improve balance in multiple sclerosis: A comparative trial with hippotherapy. European Journal of Physical and Rehabilitation Medicine, 51, 23-30.
Giesser, B. (2015). Exercise in the management of persons with multiple sclerosis. Therapeutic Advances in Neurological Disorders, 8, 123-130.
Gutierrez, R. O., Galan Del Rio, F., Cano de la Cuerda, R., Alguacil Diego, I. M., Gonzalez, R. A., & Page, J. C. (2013). A telerehabilitation program by virtual reality-video games improves balance and postural control in multiple sclerosis patients. NeuroRehabilitation, 33, 545-554. doi:10.3233/NRE-130995
Heesen, C., Bohm, J., Reich, C., Kasper, J., Goebel, M., & Gold, S. M. (2008). Patient perception of bodily functions in multiple sclerosis: Gait and visual function are the most valuable. Multiple Sclerosis, 14, 988-991. doi:10.1177/1352458508088916
Khan, F., Amatya, B., Kesselring, J., & Galea, M. (2015). Telerehabilitation for persons with multiple sclerosis. Cochrane Database of Systematic Reviews(4), CD010508. doi:10.1002/14651858.CD010508.pub2
Kurtzke, J. F. (1983). Rating neurologic impairment in multiple sclerosis: An expanded disability status scale (EDSS). Neurology, 33, 1444-1452.
Larocca, N. G. (2011). Impact of walking impairment in multiple sclerosis: Perspectives of patients and care partners. Patient, 4, 189-201. doi:10.2165/11591150-000000000-00000
Marrie, R.A., Miller, D.M., Chelune, G.J., & Cohen, J.A. (2003). Validity and reliability of the MSQLI in cognitively impaired patients with multiple sclerosis. Multiple Sclerosis, 6, 621-626
Motl, R., & Pilutti, L.A. (2012). The benefits of exercise training in multiple sclerosis. Nature Reviews Neurology, 8, 487-497.
Nilsagard, Y., Lundholm, C., Denison, E., & Gunnarsson, L. G. (2009). Predicting accidental falls in people with multiple sclerosis -- a longitudinal study. Clinical Rehabilitation, 23, 259-269. doi:10.1177/0269215508095087
Ondo, W., Warrior, D., Overby, A., Calmes, J., Hendersen, N., Olson, S., & Jankovic, J. (2000). Computerized posturography analysis of progressive supranuclear palsy: A case-control comparison with Parkinson's disease and healthy controls. Archives of Neurology, 57, 1464-1469.
Ortiz-Gutierrez, R., Cano-de-la-Cuerda, R., Galan-del-Rio, F., Alguacil-Diego, I. M., Palacios-Cena, D., & Miangolarra-Page, J. C. (2013). A telerehabilitation program improves postural control in multiple sclerosis patients: A Spanish preliminary study. International Journal of Environmental Research and Public Health, 10, 5697-5710. doi:10.3390/ijerph10115697
Petajan, J. H., & White, A. T. (1999). Recommendations for physical activity in patients with multiple sclerosis. Sports Medicine, 27, 179-191.
Powell, L. E., & Myers, A. M. (1995). The Activities-specific Balance Confidence (ABC) Scale. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 50A(1), M28-34.
Rio, J., Porcel, J., Tellez, N., Sanchez-Betancourt, A., Tintore, M., Arevalo, M. J., . . . Montalban, X. (2005). Factors related with treatment adherence to interferon beta and glatiramer acetate therapy in multiple sclerosis. Multiple Sclerosis, 11, 306-309.
Rigby, S.A., Domenech, C., Thornton, E.W., Tedman, S., & Young, C.A. (2003). Development and validation of a self-efficacy measure for people with multiple sclerosis: The Multiple Sclerosis Self-efficacy Scale. Multiple Sclerosis, 9(1), 73-81.
Sandroff, B., Dulugonski, D, Weikert, Y., Suh, Y., Balantrapu, R., & Moti, R.W. (2012). Physical activity and multiple sclerosis: New insights regarding inactivity. Acta Neurologica Scandinavica, 126, 256-262.
The R Foundation. (2016). R: A language and environment for statistical computing. Retrieved from https://www.r-project.org/
Walker, M. L., Austin, A. G., Banke, G. M., Foxx, S. R., Gaetano, L., Gardner, L. A., . . . Penn, L. (2007). Reference group data for the functional gait assessment. Physical Therapy, 87, 1468-1477. doi:10.2522/ptj.20060344
Downloads
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:
- The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
- Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
- The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
- Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site;
- The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
- Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
- The Author represents and warrants that:
- the Work is the Author’s original work;
- the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
- the Work is not pending review or under consideration by another publisher;
- the Work has not previously been published;
- the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
- the Work contains no libel, invasion of privacy, or other unlawful matter.
- The Author agrees to indemnify and hold Publisher harmless from Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.
Revised 7/16/2018. Revision Description: Removed outdated link.