Web-based physiotherapy for people affected by multiple sclerosis: a single blind, randomized controlled feasibility study

Objective: To examine the feasibility of a trial to evaluate web-based physiotherapy compared to a standard home exercise programme in people with multiple sclerosis. Design: Multi-centre, randomized controlled, feasibility study. Setting: Three multiple sclerosis out-patient centres. Participants: A total of 90 people with multiple sclerosis (Expanded Disability Status Scale 4–6.5). Interventions: Participants were randomized to a six-month individualized, home exercise programme delivered via web-based physiotherapy (n = 45; intervention) or a sheet of exercises (n = 45; active comparator). Outcome measures: Outcome measures (0, three, six and nine months) included adherence, two-minute walk test, 25 foot walk, Berg Balance Scale, physical activity and healthcare resource use. Interviews were undertaken with 24 participants and 3 physiotherapists. Results: Almost 25% of people approached agreed to take part. No intervention-related adverse events were recorded. Adherence was 40%–63% and 53%–71% in the intervention and comparator groups. There was no difference in the two-minute walk test between groups at baseline (Intervention-80.4(33.91)m, Comparator-70.6(31.20)m) and no change over time (at six-month Intervention-81.6(32.75)m, Comparator-74.8(36.16)m. There were no significant changes over time in other outcome measures except the EuroQol-5 Dimension at six months which decreased in the active comparator group. For a difference of 8(17.4)m in two-minute walk test between groups, 76 participants/group would be required (80% power, P > 0.05) for a future randomized controlled trial. Conclusion: No changes were found in the majority of outcome measures over time. This study was acceptable and feasible by participants and physiotherapists. An adequately powered study needs 160 participants

Tradition of reform as reform of tradition: some considerations on the relation of religion and reform

This article begins by questioning the commonly held assumption that tradition is fixed and does not change over time. Reform, which is all about introducing change and bringing newness, must be opposed to tradition. In light of recent scholarly discussion, this article suggests that tradition is a dynamic concept. As traditions undergo constant revision and amendment, the article takes a renewed look at the relationship between reform and tradition. The concept “reform” is understood as a means of change with recourse to the past. Reform, it is argued, while currently more of a highly metaphorical and no less normative concept, proves to be a structural moment of tradition insofar as reform is related to tradition and tradition to reform. This insight is then combined with a reflection on the concept of “invention” with regard to tradition. It is argued that invention is an inherent momentin the structure of tradition. To demonstrate the relationship between reform and tradition, three short case studies aredeveloped, in which the recourse to traditions in reforms turns out to be an innovation and an invention of tradition. These three examples are the Josianic reform in 2 Kings 22-23, Ezra’s reading of the Torah in Nehemiah 8, and the renewal of YHWH worship in Samaria in 2 Kings 17