Perceptions of participants in a group, community, exercise programme for people with multiple sclerosis

The purpose of this study was to explore the perceptions of people with multiple sclerosis of a community based, group exercise programme. Method. A pragmatic programme evaluation approach using qualitative research design was adopted. Focus groups were used to gather data from 14 participants who had taken part in a RCT of community based exercise interventions for PwMS who used at most a stick to walk outdoors. Data were transcribed verbatim and thematic analysis was used to first identify categories and then to group them into themes. Results.Three themes emerged, psychological benefits, physical benefits, and knowledge gained.The psychological benefits included the role of the group as a social and motivational factor, empowerment, confidence, hope, sense of achievement, and pride. Physical benefitswere improved energy and reduced fatigue and improved ability and participation. Knowledge gained caused a shift from thoughts that exercise might do harm, to sufficient knowledge that would give participants confidence to exercise themselves. The role of the group was a key element in the positive outcomes. Conclusions. The qualitative analysis supports the findings of the main trial confirming positive effects of community exercise interventions by reducing the impact of MS and fatigue and improving participation

A focus group study of students perceptions of reflection

Reflective practice is a learning strategy that involves thinking critically about one’s actions and is a recognised cornerstone of continuing professional development or CPD.1 With the present climate of accountability, physiotherapists have also embraced the call for evidence-based practice (EBP) and clinical effectiveness to underpin their practice. An essential component of continually developing as a professional and being clinically effective is critical self-appraisal through reflection. The reflective practice module within the undergraduate physiotherapy programme at University of Limerick (UL) is a first within physiotherapy curricula in Ireland

Improving the symptoms and quality of life: for people living with Multiple Sclerosis through exercise and physiotherapy

There are over 9,000 people living with Multiple Sclerosis (MS) in Ireland. While there have been significant advances in pharmaceutical treatments to reduce the rate and severity of MS relapses, exercise and rehabilitation remain the cornerstone for the treatment of the symptoms and resulting disability for people with MS

Home-based pilates for symptoms of anxiety, depression and fatigue among persons with multiple sclerosis: An 8-week randomized controlled trial

Background: Symptoms of anxiety, depression and fatigue are common comorbidities among persons with multiple sclerosis (PwMS). A previous pilot study supported Pilates as a feasible exercise modality that may improve these outcomes among PwMS. Objective: To quantify the effects of 8 weeks of home-based Pilates on symptoms of anxiety, depression and fatigue among PwMS. Methods: A total of 80 PwMS (69 female) were randomized to twice-weekly home-based Pilates guided by a DVD) or wait-list control. Validated questionnaires assessed anxiety, depressive and fatigue symptoms at baseline, weeks 2, 4, 6 and 8. Using intention to treat, repeated measures analysis of covariance (RM-ANCOVA) adjusted for baseline physical activity examined between-group differences across time. Hedges’ d quantified the magnitude of differences in outcome change. Sensitivity analyses examined female-only samples. Results: Group × time interactions were statistically significant for all outcomes (all p ⩽ 0.005). Pilates significantly reduced (all p ⩽ 0.03) depressive symptoms (Quick Inventory of Depressive Symptomatology, d = 0.70; Hospital Anxiety and Depression Scale-Depression, d = 0.74), anxiety (State-Trait Anxiety Inventory, d = 0.30; Hospital Anxiety and Depression Scale-Anxiety, d = 0.49), cognitive (d= 0.44), physical (d = 0.78), psychosocial (d = 0.56) and total fatigue (d = 0.76). Female-only results were materially the same. Conclusion: Home-based Pilates significantly improved anxiety, depressive and fatigue symptoms among PwMS with minimal-to-mild mobility disability, including moderate-to-large, clinically meaningful improvements in depressive and fatigue symptoms

Physiotherapy and exercise for people with mild and moderate multiple sclerosis - a pilot study.

Multiple Sclerosis (MS) is a chronic demyelinating and degenerative disease of the Central Nervous System. Because of the widespread patterns of the lesions, the clinical manifestations of the disease are varied. A cause of Multiple Sclerosis has yet to be identified so treatments remain relatively ineffective. Thus, people with MS have a lifelong need for rehabilitation and interventions from allied health professionals. Recent evidence recommends that people with mild MS participate in exercise programmes consisting of both progressive resistance exercise and aerobic exercise. Literature also suggests that balance rehabilitation can be effective in people with moderate MS

Which outcome measure is most appropriate for a falls prevention programme?

The efficacy of physiotherapeutic treatment is best assessed, and thus justified, by the use of an appropriate outcome measure. The Irish Health Service Executive (HSE) in its 2004 Standard recommended that the clinician is obliged to; “Take account of the patient’s problems, and where possible (use) a published, standardised, valid, reliable and responsive outcome measure to evaluate the change in the patient’s health status”.1 Regarding mobility, balance and falls risk in an elderly population, a number of such tools exist

The ability of clinical balance measures to identify falls risk in multiple sclerosis: a systematic review and meta-analysis

Objective: To determine the ability of clinical measures of balance to distinguish fallers from non-fallers and to determine their predictive validity in identifying those at risk of falls. Data sources: AMED, CINAHL, Medline, Scopus, PubMed Central and Google Scholar. First search: July 2015. Final search: October 2017. Review methods: Inclusion criteria were studies of adults with a definite multiple sclerosis diagnosis, a clinical balance assessment and method of falls recording. Data were extracted independently by two reviewers. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 scale and the modified Newcastle–Ottawa Quality Assessment Scale. Statistical analysis was conducted for the cross-sectional studies using Review Manager 5. The mean difference with 95% confidence interval in balance outcomes between fallers and non-fallers was used as the mode of analysis. Results: We included 33 studies (19 cross-sectional, 5 randomised controlled trials, 9 prospective) with a total of 3901 participants, of which 1917 (49%) were classified as fallers. The balance measures most commonly reported were the Berg Balance Scale, Timed Up and Go and Falls Efficacy Scale International. Meta-analysis demonstrated fallers perform significantly worse than non-fallers on all measures analysed except the Timed Up and Go Cognitive (p < 0.05), but discriminative ability of the measures is commonly not reported. Of those reported, the Activities-specific Balance Confidence Scale had the highest area under the receiver operating characteristic curve value (0.92), but without reporting corresponding measures of clinical utility. Conclusion: Clinical measures of balance differ significantly between fallers and non-fallers but have poor predictive ability for falls risk in people with multiple sclerosis

Children and young people’s experiences of living with developmental coordination disorder/dyspraxia: A systematic review and meta-ethnography of qualitative research

To date services for children with Developmental Coordination Disorder (DCD) have not been informed by the perspective of children with DCD. This study aimed to synthesise the findings of discrete qualitative studies reporting the lived experiences views and preferences of children and young with DCD using a meta-ethnographic approach to develop new conceptual understanding

Changing Physical activity behavior in people with multiple sclerosis: a systematic review and meta-analysis

Objectives To (1) systematically review the literature on behavioral interventions for people with multiple sclerosis (MS) that aim to change physical activity (PA) behavior; and (2) explore whether these interventions are clinically effective in improving PA, are theory based, and use established behavior change techniques (BCTs). Data Sources A systematic electronic search was conducted on databases EBSCO (including AMED, Biomedical Reference Collection: Expanded, CINHAL, MEDLINE, PsycArticles, PsycInfo), PubMed, EMBASE, and Web of Science from April 2017 to May 2017. Study Selection Studies were included if (1) the interventions aimed to change PA behavior among people with MS; (2) PA was recognized as a primary outcome measure; and (3) they had a randomized controlled trial (RCT) design. Data Extraction The resulting behavioral interventions were coded using the Theory Coding Scheme and the CALO-RE taxonomy to assess theory base and BCTs. A meta-analysis was conducted to assess effectiveness Data Synthesis Fourteen RCTs were included. Combined, there was a significant (P=.0003; d=1.00; 95% confidence interval, .46–1.53) short-term change in self-report PA behavior for studies with nonactive control groups. There was no change in objective or long-term PA. Studies failed to discuss results in relation to theory and did not attempt to refine theory. Fifty percent of BCTs within the CALO-RE were used, with BCTs of “goal-setting” and “action-planning” being the most frequently used. Conclusions Current evidence supports the efficacy of PA intervention on subjective but not objective outcomes. However, conclusions from this review should be interpreted with caution because of the small number of studies included and small sample size. Further, while using theory in intervention design, interventions in this review have not reported the refining of theory. Exploration of the use of additional BCTs to change PA behavior is also required within future interventions

The effect of community exercise interventions for people with MS who use bilateral support for gait

Background. Mobility limitations are a key feature of MS and 25% will require the use of a walking aid 15 years after diagnosis. Few studies have specifically evaluated the effectiveness of physiotherapy and exercise interventions delivered in the community for those with significant disability. Methods. An assessor blind, block randomised, and controlled study recruited participants who required bilateral assistance for gait and who occasionally used wheelchairs for longer distances.They were randomised to 10 weeks of group physiotherapy (balance and strengthening exercises), individual physiotherapy, yoga group, or a control group. Results. Repeated measures ANOVA found significant time effects for physical component ofMSIS-29v2 ( = 7.993, = 0.006) and MFIS ( = 8.695, = 0.004). The group × time interaction was significant for the BBS ( = 4.391, = 0.006). Post hoc analysis revealed no difference between group and individual physiotherapy for BBS. There was no significant difference between groups but the 6MWT improved for individual physiotherapy ( = 0.001) and MSIS-29v2 psychological score for group physiotherapy ( = 0.005). Discussion. This study found that balance and strengthening exercises, delivered in the community to those with significant mobility limitations, improve balance.The effect on walking endurance and patient-reported outcomes are unclear and warrants further investigation with a larger control group with similar baseline characteristics to the intervention groups