EFFECTS ON BALANCE AND WALKING WITH A CORE STABILITY EXERCISE PROGRAM IN PEOPLE WITH MULTIPLE SCLEROSIS

Forsberg A.1,2, Carling A.1,2, Nilsagård Y.2,3
1Region Örebro County, Physiotherapy Department, University Hospital Örebro, Örebro, Sweden, 2Örebro University, Faculty of Medicine and Health, Örebro, Sweden, 3Region Örebro County, Health Care Management, Örebro, Sweden

Background: Imbalance is common in people with multiple sclerosis (PwMS), and walking activities are often associated with a higher risk of falls. In collaboration with a network of clinically based physical therapists, a group-based balance exercise program was developed that targeted factors of importance in maintaining balance; Core stability, Dual tasking, Sensory strategies (the CoDuSe program). The CoDuSe exercise program has been evaluated in two separate samples of PwMS1,2 where participants were randomized to either early or late intervention start using a waiting list design. 1Nilsagard YE, von Koch LK, Nilsson M, Forsberg AS. Balance Exercise Program Reduced Falls in People With Multiple Sclerosis: A Single-Group, Pretest-Posttest Trial. Archives of Physical Medicine and Rehabilitation 2014; 95: 2428-34.
2Carling A, Forsberg A, Gunnarsson M, Nilsagård Y. CoDuSe group exercise program improves balance and reduces falls in people with multiple sclerosis: a multi-centre, randomized, controlled pilot study. Accepted by the Multiple Sclerosis Journal.

Purpose: The purpose was to investigate the effects of the CoDuSe program on balance, walking, and perceived walking limitations in a larger sample of PwMS.

Methods: Data from the two randomized controlled trials1,2 were combined (n=121). Altogether 58 participants were randomized to early intervention group. Participants starting late with the intervention acted as controls (n=63). The intervention consisted of physiotherapy-led group exercises twice weekly for 7 weeks with the CoDuSe program. Participants in the control group were asked to continue with their usual daily activities. Assessments were performed pre- and post (week 8) intervention. Outcome measures were the Berg Balance Scale (BBS) that includes 14 items of static and dynamic balance. Items are rated 0–4, with a maximum of 56. Walking was assessed with the Timed Up and Go (TUG) test where time is registered from rising from a chair, walking 3 meters, turning around, walking back, and siting down again. Perceived limitations were assessed with the 12-item MS Walking Scale (MSWS-12) that consists of 12 items rated from 1 (not at all limited) to 5 (extremely limited). Scores are transformed giving a maximum of 100.

Results: There were significant between group differences in change on the BBS (p=0.006) and the MSWS-12 (p=0.0008) between assessments in favor of the CoDuSe intervention. On the BBS mean improvement of 2.19 points (confidence interval 0.64; 3.73) was found, and on the MSWS-12 a mean improvement of the total score at -7.11 (confidence interval (-11.18; -3.03). There was no significant difference between groups for the TUG test.

Conclusion(s): Improved balance and reduced perceived walking limitations were found after exercising with the CoDuSe exercise program compared to the control group.

Implications: Physiotherapist can use the CoDuSe program for balance training for PwMS.

Funding acknowledgements: Uppsala-Örebro Regional Research Council [RFR-306241], Norrbacka-Eugenia Foundation [ 814/12], Research Committee of Region Örebro County [ OLL-216421 and OLL-317511].

Topic: Neurology

Ethics approval: Regional Ethics Committee in Uppsala-Örebro (no 2012/117 and 2014/302).


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