The meaningfulness of exploring one's own limits through interactions and enjoyment in outdoor high-intensity physiotherapy for people with multiple sclerosis: a qualitative study

Background and purposePhysical activity (PA) is often reduced in people with MS (pwMS), even when disability is low. Understanding the perspectives of pwMS on interventions aiming to improve PA is important to inform the development of such services. The aim of this study was to explore the experiences of pwMS participating in an outdoor, high-intensity and balance exercise group intervention.MethodsThis qualitative study was nested within an RCT exploring a novel intervention integrating sensorimotor exercises with high-intensity intervals of running/walking. Individual, in-depth interviews with the intervention group (n = 15; 12 women, 3 men; age 38–66; EDSS score 0–3.5) were conducted postintervention (mean days = 14), analyzed using a phenomenological-inspired approach with systematic text condensation, and interpreted based on enactive theory.ResultsFour categories were generated: (1) Exploration of one's own physical abilities: Challenging one's own limits was perceived by all participants to improve movement performance and/or intensity level. Such bodily changes engendered strong positive feelings. Some negative consequences of high-intensity training were described, increasing a feeling of loss. (2) New insights and beliefs: Participants experienced enhanced beliefs in their own capabilities, which they integrated in activities outside the intervention. (3) An engaging environment: The group setting was perceived as supportive, and the outdoor environment was perceived as stimulating activity. (4) Professional leadership, tailoring and co-creation of enjoyment: Physiotherapist-led, individualized interactions were regarded as necessary to safely revisit prior activities, such as running. Co-creating enjoyment facilitated high-intensity training and intervention adherence.DiscussionHigh-intensity training combined with detailed exercises in a physiotherapy outdoor group was perceived to create meaningful bodily changes and enhance PA and prospects for both PA and life. Importantly, however, some negative experiences were also reported from the high-intensity training. Enactive theory allowed for the illumination of new perspectives: the importance of embodiment for self-efficacy and of tailored physiotherapy and an outdoor-group environment for exploring one's own limits to physical capabilities. These aspects should inform future exercise interventions in pwMS with low disability

Utprøving av intervensjon for optimalisering av funksjon, fysisk aktivitet og arbeidsdeltakelse ved multippel sklerose

publishedVersio

The effect of exercise and physical activity-interventions on step count and intensity level in individuals with multiple sclerosis: a systematic review and meta-analysis of randomized controlled trials

BackgroundReduced physical activity is a worldwide challenge in individuals with multiple sclerosis (MS). The aim of this systematic review and meta-analysis was to identify devise-measured effects of physical activity, exercise and physiotherapy-interventions on step count and intensity level of physical activity in individuals with MS.MethodsA systematic search of the databases of PubMed (including Medline), Scopus, CINHAL and Web of Science was carried out to retrieve studies published in the English language from the inception to the first of May 2023. All trials concerning the effectiveness of different types of exercise on step count and intensity level in people with MS were included. The quality of the included studies and their risk of bias were critically appraised using The modified consolidated standards of reporting trials and the Cochrane Risk of Bias tool, respectively. The pooled standardized mean difference (SMD) and 95% CI of the step-count outcome and moderate to vigorous intensity level before versus after treatment were estimated in both Intervention and Control groups using the random effect model. The Harbord test were used to account for heterogeneity between studies and assess publication bias, respectively. Further sensitivity analysis helped with the verification of the reliability and stability of our review results.ResultsA total of 8 randomized clinical trials (involving 919 individuals with MS) were included. The participants (including 715 (77.8%) female and 204 (22.2%) male) had been randomly assigned to the Intervention (n = 493) or Control group (n = 426). The pooled mean (95% CI) age and BMI of participants were 49.4 years (95% CI: 47.4, 51.4 years) and 27.7 kg/m2 (95% CI: 26.4, 29 kg/m2), respectively. In terms of the comparison within the Intervention and the Control groups before and after the intervention, the results of the meta-analysis indicate that the pooled standardized mean difference (SMD) for step-count in the Intervention group was 0.56 (95% CI: -0.42, 1.54), while in the Control group it was 0.12 (95% CI: -0.05, 0.28). Furthermore, there was no significant difference in the pooled SMD of step-count in the physical activity Intervention group compared to the Controls after the intervention (pooled standard mean difference = 0.19, 95% CI: -0.36,0.74). Subgroup analysis on moderate to vigorous intensity level of physical activity revealed no significant effect of the physical activity intervention in the Intervention group compared to the Control group after the intervention, or within groups before and after the intervention. Results of meta regression showed that age, BMI, duration of disease and Expanded Disability Status Scale (EDSS) score were not the potential sources of heterogeneity (all p > 0.05). Data on the potential harms of the interventions were limited.ConclusionThe results of this meta-analysis showed no significant differences in step count and moderate to vigorous physical activity level among individuals with MS, both within and between groups receiving physical activity interventions. More studies that objectively measure physical activity are needed.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD4202234362

Intra- and inter-rater reliability of the Mini-Balance Evaluation Test (Mini-BESTest) in individuals with stroke

ABSTRACT Background: Mini-Balance Evaluation Systems Test (Mini-BESTest) is a new and promising measure for evaluation of dynamic balance, but intra- and inter-rater reliability in individuals with stroke have not yet been examined. Objective: The aim of this study was to assess the within raters’ (intra-rater) and between raters’ (inter-rater) reliability of the Mini-BESTest in adults with stroke. Design: Measurement study of intra- and inter-rater reliability. Methods: Thirty adults, twenty-five with stroke and five without were strategically recruited according to six different ambulatory levels. Mini-BESTest performance of participants were filmed and then scored by three raters twice, with four weeks between the sessions. For total scores on the Mini-BESTest, relative reliability was investigated for by calculating Intraclass correlation coefficients (ICC1.1 and ICC3.1). Absolute reliability was investigated for by calculating Bland-Altman plots, within-subject standard deviation (sw) and smallest detectable difference (SDD). For individual items, Cohen’s kappa (k) and percentages agreement were calculated. Results: For both intra- and inter-rater assessments very high relative reliability (ICCs≥.98) and absolute reliability (agreement of scores in Bland-Altman plots, and low sw and SDD) of the Mini-BESTest total score were shown. Kappa values for the individual items ranged between 0.33-1.00. The majority of items (intra-rater=95.6%, inter-rater=73.4%) showed very good or good agreement (k≥.63). Only one item (inter-rater=2.2%) showed fair agreement (k=.33). Limitations: Results should not be generalized to individuals with major cognitive impairments, as they were not included in this study. Conclusions: This study shows a very high intra- and inter-rater reliability of the Mini-BESTest in adults with stroke. The majority of the individual items showed very good or good agreement, some moderate and one item fair agreement. Key words: Intra- and inter-rater reliability, balance, balance measure, Mini-BESTest, strok