Arntzen EC1,2, Normann B2,3
1Nordland Hospital Trust, Physiotherapy Department, Bodø, Norway, 2UiT The Arctic University of Norway, Health and Care Science, Tromsø, Norway, 3Nordland Hospital Trust, Physiotherapy Department, Norway, Norway
Background: Individuals with multiple sclerosis (MS) may have varied impairments such as somatosensory deficits, paresis, impaired coordination, visual problems and reduced core muscle activation, which often lead to balance and walking problems. Individualized interventions that interlink dynamic core stability and distal movement control with other prerequisites for balance and walking are needed, as are group-based interventions, since such are considered economical efficient.
Purpose: The purpose of the study was to investigate the immediate and long-term effects of six weeks of a new individualized, group-based core-stability and balance intervention called GroupCoreDIST, compared to standard care on balance, trunk control, walking and health-related quality of life in individuals with MS.
Methods: The study was an assessor-blinded prospective randomized controlled trial with 80 ambulant participants (Expanded Disability Status Scores 1-6.5 (EDSS)) who were randomly allocated to the GroupCoreDIST-intervention (n=40) or to standard care (n=40), both conducted in the municipality health care. GroupCoreDIST was initiated by an individual, clinical examination, and thereby tailored exercises in groups of three persons for 60-minutes, three times per week for 6-weeks, led by a trained physiotherapist. Standard care contained 6-weeks of the participant´s normal follow-up.
Assessments were undertaken at baseline, weeks 7, 18 and 30. Outcome measurements were Trunk Impairment Scale-Norwegian Version (TIS-NV), Mini-Balance Evaluation Systems Test (Mini-BESTest), 2 Minute Walk-test (2MWT), 10 Meter Walk-test (10MWT), Multiple Sclerosis Walking Scale-12 (MSWS-12) and Multiple Sclerosis Impact Scale-29-NorwegianVersion (MSIS-29-NV). We used repeated measures mixed models in IBM SPSS-24 for the statistical analysis.
Results: One participant missed all post-tests, leaving 79 subjects for intention-to-treat analysis. Significant effects in the mean difference between groups were found at all time-points for TIS-NV; 2.63 points at 7 weeks (p 0.001), 1.57 points at 18 weeks (p 0.001) and 0.95 points at 30 weeks (p=0.015); Mini-BESTest 1.91 points at 7 weeks (p 0.001), 1.28 points at 18 weeks (p 0.001) and 0.91 points at 30 weeks (p=0.04), and 2MWT 16.7 meter at 7 weeks (p 0.001), 15.08 meter at 18 weeks (p=0.001) and 16.38 meter at 30 weeks (p 0.001). 10MWT, MSIS-29-NV and MSWS-12 demonstrated significant between-group effects at 7 and 18 weeks.
Conclusion(s): The results demonstrate that only six weeks of GroupCoreDIST resulted in significant improvements on balance, trunk control and walking-distance at 7, 18 and 30 weeks, as well as walking-speed and health-related quality of life at 7 and 18 weeks compared to standard care. GroupCoreDIST is an innovative and effective contribution to clinical practice.
Implications: The implications of results highlight the importance of tailored exercises that interlink dynamic core stability and distal movement control with other underlying aspects of balance to improve balance, trunk control, walking and health related quality of life. The results show the benefits of conducting an individual examination prior to group trainings, to allow for individualization in a group-setting. Core control, balance and walking were affected in individuals with both low and higher EDSS values. GroupCoreDIST may therefor be beneficial both in the initial and progressed phases of MS. Group-based training may be economically beneficial and therefor meet changing needs of practice.
Keywords: Multiple sclerosis, balance, trunk control
Funding acknowledgements: The study was financed by the Northern Norway Regional Health Authority (Project Grant 1240).
Purpose: The purpose of the study was to investigate the immediate and long-term effects of six weeks of a new individualized, group-based core-stability and balance intervention called GroupCoreDIST, compared to standard care on balance, trunk control, walking and health-related quality of life in individuals with MS.
Methods: The study was an assessor-blinded prospective randomized controlled trial with 80 ambulant participants (Expanded Disability Status Scores 1-6.5 (EDSS)) who were randomly allocated to the GroupCoreDIST-intervention (n=40) or to standard care (n=40), both conducted in the municipality health care. GroupCoreDIST was initiated by an individual, clinical examination, and thereby tailored exercises in groups of three persons for 60-minutes, three times per week for 6-weeks, led by a trained physiotherapist. Standard care contained 6-weeks of the participant´s normal follow-up.
Assessments were undertaken at baseline, weeks 7, 18 and 30. Outcome measurements were Trunk Impairment Scale-Norwegian Version (TIS-NV), Mini-Balance Evaluation Systems Test (Mini-BESTest), 2 Minute Walk-test (2MWT), 10 Meter Walk-test (10MWT), Multiple Sclerosis Walking Scale-12 (MSWS-12) and Multiple Sclerosis Impact Scale-29-NorwegianVersion (MSIS-29-NV). We used repeated measures mixed models in IBM SPSS-24 for the statistical analysis.
Results: One participant missed all post-tests, leaving 79 subjects for intention-to-treat analysis. Significant effects in the mean difference between groups were found at all time-points for TIS-NV; 2.63 points at 7 weeks (p 0.001), 1.57 points at 18 weeks (p 0.001) and 0.95 points at 30 weeks (p=0.015); Mini-BESTest 1.91 points at 7 weeks (p 0.001), 1.28 points at 18 weeks (p 0.001) and 0.91 points at 30 weeks (p=0.04), and 2MWT 16.7 meter at 7 weeks (p 0.001), 15.08 meter at 18 weeks (p=0.001) and 16.38 meter at 30 weeks (p 0.001). 10MWT, MSIS-29-NV and MSWS-12 demonstrated significant between-group effects at 7 and 18 weeks.
Conclusion(s): The results demonstrate that only six weeks of GroupCoreDIST resulted in significant improvements on balance, trunk control and walking-distance at 7, 18 and 30 weeks, as well as walking-speed and health-related quality of life at 7 and 18 weeks compared to standard care. GroupCoreDIST is an innovative and effective contribution to clinical practice.
Implications: The implications of results highlight the importance of tailored exercises that interlink dynamic core stability and distal movement control with other underlying aspects of balance to improve balance, trunk control, walking and health related quality of life. The results show the benefits of conducting an individual examination prior to group trainings, to allow for individualization in a group-setting. Core control, balance and walking were affected in individuals with both low and higher EDSS values. GroupCoreDIST may therefor be beneficial both in the initial and progressed phases of MS. Group-based training may be economically beneficial and therefor meet changing needs of practice.
Keywords: Multiple sclerosis, balance, trunk control
Funding acknowledgements: The study was financed by the Northern Norway Regional Health Authority (Project Grant 1240).
Topic: Neurology; Disability & rehabilitation
Ethics approval required: Yes
Institution: Regional Committee for Medical and Health Research Ethics in Norway
Ethics committee: REK South-East
Ethics number: 2014/1715-7
All authors, affiliations and abstracts have been published as submitted.
