Chronic Lower Limb Oedema in People with Multiple Sclerosis: An Evaluation of Progressive Resistance Exercise

The study was conducted to better understand the prevalence and impact of CLLO in pwMS and to explore the potential benefits of progressive resistance exercise (PRE) for its management.

This mixed methods was performed in two hospitals in Riyadh, Saudi Arabia, and consisted of three phases:

• Phase One: The aim was to evaluate the prevalence and to determine the main characteristics of those at increased risk of developing CLLO among 269 pwMS attending the two hospitals. Univariate and bivariate analyses were conducted using SPSS software. Variables such as age, weight, body mass index (BMI), and disease duration were examined to determine risk factors for developing CLLO.
• Phase Two: Those who were found to have CLLO during phase one were invited to participate in phase two. The effectiveness of a 12-week PRE program in managing CLLO in 15 pwMS with bilateral CLLO was assessed besides the impact of CLLO on pain and quality of life. Limb circumference, quality of life (QoL), and pain were measured pre- and post-intervention using the LYMQOL tool and the Short Form McGill Pain Questionnaire (SF-MPQ).
• Phase Three: This phase explored participants’ experiences with the PRE intervention and assessed physiotherapists’ knowledge of CLLO in pwMS. Ten pwMS and five specialist lymphoedema physiotherapists were interviewed, and the data was analyzed using the Framework Method.

In Phase One, 21 out of 269 pwMS (8%) were found to have bilateral CLLO. Significant differences were observed between those with and without CLLO in variables such as age, weight, BMI, and disease duration, but not gender.
In Phase Two, 14 participants completed the 12-week PRE program. Although there was no significant reduction in overall leg volume, some segmental reductions were observed. Participants reported improvements in pain, as measured by the SF-MPQ tool, and an increase in QoL as assessed by the LYMQOL tool.
In Phase Three, three themes emerged from participant interviews: their experiences before and after PRE intervention and the observation of “small but meaningful changes.” Physiotherapists highlighted a lack of awareness regarding CLLO in pwMS and current lymphoedema practices.

Although the PRE program did not significantly reduce limb volume in pwMS with CLLO, it improved quality of life and reduced pain. Qualitative findings indicated positive changes in physical and psychological well-being, suggesting secondary benefits from PRE. The study also highlighted a lack of awareness among healthcare providers about CLLO in pwMS, emphasizing the need for better education and individualized treatment plans.

The sample size of phases 1 & 2 was small, the findings should be interpreted with caution and cannot be generalized to other groups.