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

Abstract Background Balance, mobility impairments and falls are problematic for people with multiple sclerosis (MS). The “Balance Right in MS (BRiMS)” intervention, a 13-week home and group-based exercise and education programme, aims to improve balance and minimise falls. This study aimed to evaluate the feasibility of undertaking a multi-centre randomised controlled trial and to collect the necessary data to design a definitive trial. Methods This randomised controlled feasibility study recruited from four United Kingdom NHS clinical neurology services. Patients ≥ 18 years with secondary progressive MS (Expanded Disability Status Scale 4 to 7) reporting more than two falls in the preceding 6 months were recruited. Participants were block-randomised to either a manualised 13-week education and exercise programme (BRiMS) plus usual care, or usual care alone. Feasibility assessment evaluated recruitment and retention rates, adherence to group assignment and data completeness. Proposed outcomes for the definitive trial (including impact of MS, mobility, quality of life and falls) and economic data were collected at baseline, 13 and 27 weeks, and participants completed daily paper falls diaries. Results Fifty-six participants (mean age 59.7 years, 66% female, median EDSS 6.0) were recruited in 5 months; 30 randomised to the intervention group. Ten (18%) participants withdrew, 7 from the intervention group. Two additional participants were lost to follow up at the final assessment point. Completion rates were &gt; 98% for all outcomes apart from the falls diary (return rate 62%). After adjusting for baseline score, mean intervention—usual care between-group differences for the potential primary outcomes at week 27 were MS Walking Scale-12v2: − 7.7 (95% confidence interval [CI] − 17.2 to 1.8) and MS Impact Scale-29v2: physical 0.6 (CI − 7.8 to 9), psychological − 0.4 (CI − 9.9 to 9). In total, 715 falls were reported, rate ratio (intervention:usual care) for falls 0.81 (0.41 to 2.26) and injurious falls 0.44 (0.41 to 2.23). Conclusions Procedures were practical, and retention, programme engagement and outcome completion rates satisfied a priori progression criteria. Challenges were experienced in completion and return of daily falls diaries. Refinement of methods for reporting falls is therefore required, but we consider a full trial to be feasible. Trial registration ISRCTN13587999 Date of registration: 29 September 2016 </jats:sec

Aerobic Capacity in Persons with Multiple Sclerosis: A Systematic Review and Meta-Analysis

Background: Aerobic capacity (VO<inf>2max</inf>) is a strong health and performance predictor and is regarded as a key physiological measure in the healthy population and in persons with multiple sclerosis (PwMS). However, no studies have tried to synthesize the existing knowledge regarding VO<inf>2max</inf> in PwMS. Objectives: The objectives of this study were to (1) systematically review the psychometric properties of the VO<inf>2max</inf> test; (2) systematically review the literature on VO<inf>2max</inf> compared with healthy populations; (3) summarize correlates of VO<inf>2max</inf>; and (4) to review and conduct a meta-analysis of longitudinal exercise studies evaluating training-induced effects on VO<inf>2max</inf> in PwMS. Data Sources and Study Selection: A systematic literature search of six databases (PubMed, EMBASE, Cochrane Library, PEDro, CINAHL and SPORTDiscus) was performed. To be included, the study had to (1) enrol participants with definite MS according to defined criteria; (2) assess aerobic capacity (VO<inf>2max</inf>) by means of a graded exercise test to voluntary exhaustion; (3) had undergone peer review; and (4) be available in English, Danish or Dutch. Study Appraisal and Synthesis Methods: The psychometric properties of the VO<inf>2max</inf> test in PwMS were reviewed with respect to reliability, validity and responsiveness. Simple Pearson correlation analysis was used to assess the relation between key study characteristics and the reported mean VO<inf>2max</inf>. The methodological quality of the intervention studies was evaluated using the original 11-item Physiotherapy Evidence Database (PEDro) scale. A random coefficient model was used to summarize individual, weighted, standardized effects of studies that assessed the effects of exercise on aerobic capacity in PwMS. Results: A total of 40 studies, covering 165 healthy controls and 1,137 PwMS, fulfilled the inclusion criteria. VO<inf>2max</inf> testing in PwMS can be considered a valid measure of aerobic capacity, at least in PwMS having low-to-mild disability, and an ∼10 % change between two tests performed on separate days can be considered the smallest reliable change (with 95 % certainty) in VO<inf>2max</inf> in PwMS. The average body-weight-adjusted VO<inf>2max</inf> was significantly lower in PwMS (25.5 ± 5.2 mL·kg−1·min−1) compared with healthy controls (30.9 ± 5.4 mL·kg−1·min−1). The analysis of VO<inf>2max</inf> correlates revealed associations with a variety of outcomes covering all levels of the International Classification of Functioning, Disability and Health (ICF) model. The meta-analysis showed that aerobic training in PwMS may improve VO<inf>2max</inf> by as much as 3.5 mL·kg−1·min−1. Conclusions: A valid and reliable test can be performed, in at least ambulant PwMS, by the gold standard whole-body maximal exercise test. Aerobic capacity in PwMS is impaired compared with healthy people, and is significantly associated with factors on all levels of the ICF model, including disease severity. Aerobic training can improve aerobic capacity in PwMS to a degree that is associated with secondary health benefits

Fysieke fitheid bij Multipele Sclerose

Multipele sclerose (MS) is progressieve, chronische, neurologische aandoening waarbij de medische behandeling vooralsnog gericht is op het tegengaan van progressie. Met een diagnose gemiddeld rond een leeftijd tussen de 20-40 jaar, is MS de meest frequente neurologische aandoening onder jongvolwassenen. Het is bekend dat patiënten met MS over het algemeen een inactieve levensstijl hanteren met als gevolg dat er, naast de ziekteprogressie, ook een vicieuze cirkel van deconditionering en fysieke inactiviteit intreedt. Een groot deel van de ziekenhuisopnames van patiënten met MS is heden ten dage dan ook gerelateerd aan comorbiditeit, vergelijkbaar met gezonde maar inactieve mensen

Aerobic Capacity in Persons with Multiple Sclerosis: a Systematic Review and Meta-Analysis : A Systematic Review and Meta-Analysis

Background Aerobic capacity (VO2max) is a strong health and performance predictor and is regarded as a key physiological measure in the healthy population and in persons with multiple sclerosis (PwMS). However, no studies have tried to synthesize the existing knowledge regarding VO2max in PwMS. Objectives The objectives of this study were to (1) systematically review the psychometric properties of the VO2max test; (2) systematically review the literature on VO2max compared with healthy populations; (3) summarize correlates of VO2max; and (4) to review and conduct a meta-analysis of longitudinal exercise studies evaluating training-induced effects on VO2max in PwMS. Data Sources and Study Selection A systematic literature search of six databases (PubMed, EMBASE, Cochrane Library, PEDro, CINAHL and SPORTDiscus) was performed. To be included, the study had to (1) enrol participants with definite MS according to defined criteria; (2) assess aerobic capacity (VO2max) by means of a graded exercise test to voluntary exhaustion; (3) had undergone peer review; and (4) be available in English, Danish or Dutch. Study Appraisal and Synthesis Methods The psychometric properties of the VO2max test in PwMS were reviewed with respect to reliability, validity and responsiveness. Simple Pearson correlation analysis was used to assess the relation between key study characteristics and the reported mean VO2max. The methodological quality of the intervention studies was evaluated using the original 11-item Physiotherapy Evidence Database (PEDro) scale. A random coefficient model was used to summarize individual, weighted, standardized effects of studies that assessed the effects of exercise on aerobic capacity in PwMS. Results A total of 40 studies, covering 165 healthy controls and 1,137 PwMS, fulfilled the inclusion criteria. VO2max testing in PwMS can be considered a valid measure of aerobic capacity, at least in PwMS having low-to-mild disability, and an similar to 10% change between two tests performed on separate days can be considered the smallest reliable change (with 95% certainty) in VO2max in PwMS. The average body-weight-adjusted VO2max was significantly lower in PwMS (25.5 +/- 5.2 mL.kg(-1).min(-1)) compared with healthy controls (30.9 +/- 5.4 mL.kg(-1).min(-1)). The analysis of VO2max correlates revealed associations with a variety of outcomes covering all levels of the International Classification of Functioning, Disability and Health (ICF) model. The meta-analysis showed that aerobic training in PwMS may improve VO2max by as much as 3.5 mL.kg(-1).min(-1). Conclusions A valid and reliable test can be performed, in at least ambulant PwMS, by the gold standard whole-body maximal exercise test. Aerobic capacity in PwMS is impaired compared with healthy people, and is significantly associated with factors on all levels of the ICF model, including disease severity. Aerobic training can improve aerobic capacity in PwMS to a degree that is associated with secondary health benefits

Fysieke fitheid bij Multipele Sclerose

Multipele sclerose (MS) is progressieve, chronische, neurologische aandoening waarbij de medische behandeling vooralsnog gericht is op het tegengaan van progressie. Met een diagnose gemiddeld rond een leeftijd tussen de 20-40 jaar, is MS de meest frequente neurologische aandoening onder jongvolwassenen. Het is bekend dat patiënten met MS over het algemeen een inactieve levensstijl hanteren met als gevolg dat er, naast de ziekteprogressie, ook een vicieuze cirkel van deconditionering en fysieke inactiviteit intreedt. Een groot deel van de ziekenhuisopnames van patiënten met MS is heden ten dage dan ook gerelateerd aan comorbiditeit, vergelijkbaar met gezonde maar inactieve mensen