scholarly journals Effects of normobaric hypoxic endurance training on fatigue in patients with multiple sclerosis: a randomized prospective pilot study

2021 ◽  
Author(s):  
Tobias Zrzavy ◽  
Anna Pfitzner ◽  
Peter Flachenecker ◽  
Paulus Rommer ◽  
Uwe Klaus Zettl
Keyword(s):  
Multiple Sclerosis ◽  
Pilot Study ◽  
Endurance Training ◽  
Inpatient Rehabilitation ◽  
Rehabilitation Program ◽  
Pharmacological Intervention ◽  
Rehabilitation Programs ◽  
Hypoxic Conditions ◽  
Prospective Longitudinal ◽  
Walking Endurance

Abstract Background Fatigue is one of the most frequent symptoms in patients with multiple sclerosis (MS), causing a major impact on quality-of-life. Non-pharmacological intervention strategies involve physical activity, which has been shown to reduce fatigue. Training under normobaric hypoxic conditions is thought to improve the response to endurance training and may, therefore, have an additional benefit over normoxic training conditions in MS patients. Objective To compare the effects of endurance training under hypoxic and normoxic conditions on fatigue, mobility and spasticity in patients with MS during inpatient rehabilitation. Methods Thirty-nine patients with MS were assigned within a randomized prospective longitudinal pilot study to (1) a routine clinical rehabilitation program, (2) a routine clinical rehabilitation program + normoxic endurance training and (3) a routine clinical rehabilitation program + hypoxic endurance training for 14 days. Fatigue (WEIMuS and MFIS), spasticity (MSSS-88) and walking endurance (6MinWT) were assessed at days 0, 7 and 14. Results Fatigue scores improved significantly in all groups, but these improvements were reached faster in the groups which additionally received endurance training (normoxic p = 0.004; hypoxic p = 0.002). Spasticity scores were significantly lower in endurance training groups at the end of the study compared to baseline (normoxic p = 0.048, hypoxic p = 0.012), while only the hypoxic group increased significantly in 6MinWT (p = 0.001). Conclusions Our findings demonstrate that endurance training provides substantial benefit to neurological rehabilitation programs. Endurance training under hypoxic conditions could positively influence walking endurance within a 2-week training intervention and warrants further investigations.

Predictors of effectiveness of multidisciplinary rehabilitation treatment on motor dysfunction in multiple sclerosis

2013 ◽  
Vol 20 (7) ◽  
pp. 862-870 ◽  
Author(s):  
G Liberatore ◽  
F Clarelli ◽  
A Nuara ◽  
D Ungaro ◽  
R Gatti ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Outcome Measures ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Rehabilitation Program ◽  
Activity Limitation ◽  
Motor Dysfunction ◽  
Short Term ◽  
Rehabilitation Treatment ◽  
Edss Score

Objectives: To identify clinical predictors of effectiveness of a motor rehabilitation treatment in a cohort of multiple sclerosis (MS) patients. Materials and methods: We analysed 212 consecutive patients who underwent a short-term (3–7 weeks) intensive (two hours per day, five days per week), individualised, goal-oriented inpatient rehabilitation program. Activity limitation and impairment were measured on admission and discharge of the rehabilitation trial using the motor sub-items of the Functional Independence Measure (mFIM) and the Expanded Disability Status Scale (EDSS) score. Multivariate logistic regression models have been tested to evaluate the role of clinical baseline features on rehabilitation effectiveness. Results: According to pre-defined outcome measures, 75.1% of MS patients improved in either activity limitation (≥5 points delta mFIM) or impairment (≥1.0 delta EDSS score if baseline EDSS was ≤5.5, or ≥0.5 if baseline EDSS was >5.5), and 35.4% of MS patients improved in both outcomes. A relapsing-remitting course of disease, a more severe baseline impairment and activity limitation level, a shorter disease duration and a less severe balance dysfunction were predictive of the effectiveness of rehabilitation. Discussion: These data confirm that an intensive inpatient rehabilitation program is able to produce a short-term relevant improvement on clinical and functional outcome measures and suggest some clinical features which can be considered as potential predictors of the outcome of rehabilitative intervention.

scholarly journals Comparing two interdisciplinary occupational rehabilitation programs for employees on sick leave: a mixed-method design study protocol

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Monica Eftedal ◽  
Torill H. Tveito ◽  
Ulrik Gensby ◽  
M. Kamrul Islam ◽  
Stein Atle Lie ◽  
...  
Keyword(s):  
Sick Leave ◽  
Return To Work ◽  
Mixed Method ◽  
Common Mental Disorders ◽  
Inpatient Rehabilitation ◽  
Occupational Rehabilitation ◽  
Rehabilitation Program ◽  
Interdisciplinary Teams ◽  
Full Time ◽  
Rehabilitation Programs

Abstract Background Musculoskeletal disorders (MSDs) and common mental disorders (CMDs) are the most frequent reasons for long-term sick leave and work disability. Occupational rehabilitation programs are used to help employees return to work (RTW). However, knowledge regarding the effect of these programs is scarce, and even less is known about which programs are best suited for which patients. This study aims to compare the RTW results of two interdisciplinary occupational rehabilitation programs in Norway, as well as to examine the delivery and reception of the two programs and explore the active mechanisms of the participants’ RTW processes. Methods/design We will use a mixed-method convergent design to study the main outcome. Approximately 600 participants will be included in the study. Eligible study participants will be aged 18–60 years old and have been on sick leave due to MSDs, CMDs, or both for at least 6 weeks. Interdisciplinary teams at both participating clinics will deliver complex occupational rehabilitation programs. The inpatient rehabilitation program has a duration of 4 weeks and is full time. The outpatient program has a duration of 3 months and involves weekly sessions. The primary outcome is RTW. Secondary outcomes are differences in the incremental cost for an averted sick leave day, cost utility/benefit, and differences between the programs regarding improvements in known modifiable obstacles to RTW. Subgroup analyses are planned. The researchers will be blinded to the intervention groups when analyzing the quantitative RTW data. Discussion This study aims to provide new insights regarding occupational rehabilitation interventions, treatment targets, and outcomes for different subgroups of sick-listed employees and to inform discussions on the active working mechanisms of occupational rehabilitation and the influence of context in the return-to-work process. Trial registration Current controlled trials ISRCTN12033424, 15.10.2014, retrospectively registered.

scholarly journals Speed but Not Smoothness of Gait Reacts to Rehabilitation in Multiple Sclerosis

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Philipp Gulde ◽  
Joachim Hermsdörfer ◽  
Peter Rieckmann
Keyword(s):  
Multiple Sclerosis ◽  
Short Distance ◽  
Walking Speed ◽  
State Of The Art ◽  
Inpatient Rehabilitation ◽  
Rehabilitation Programs ◽  
Therapy Goals ◽  
Movement Smoothness ◽  
Gait Parameters ◽  
Private Specialist

Introduction. Improved gait is one of the leading therapy goals in multiple sclerosis. A plethora of clinical timed trials and state-of-the-art technology-based approaches are available to assess gait performance. Objectives. To examine what aspects of gait react to inpatient rehabilitation in MS and which parameters should be best assessed. Design. In this longitudinal study, we examined the performance of 76 patients with MS to shed further light on factors influencing gait, associations between tests, and the reaction to inpatient rehabilitation during an average time span of 16 d. Setting. Private specialist clinic for inpatient neurorehabilitation. Main Outcome Measures. Clinical walk tests (timed 25-foot walk test at normal pace, maximum pace over 10 m or 6 min) and IMU-based measures of movement smoothness. Results. All gait parameters were strongly intercorrelated (all p < 0.05 ), and a model multiple linear regression for the 6MWT revealed short distance velocity (10 m) and movement smoothness as predictors in a strong model ( R 2 adjusted 0.75, p < 0.01 ). A second model with natural pace on short distance and movement smoothness was almost equally strong ( R 2 adjusted 0.71, p < 0.01 ). Patients improved their walking speed ( p < 0.01 ), but not smoothness ( p = 0.08 – 0.12 ), over the course of rehabilitation. Conclusions. Since we were not able to observe improvements in smoothness of gait, we conclude that rehabilitation programs should be adapted to the patient’s physiological capacities in order to allow for such improvements in smoothness of gait. Externally valid gait capacity (6MWT) could be predicted by a single walk for 10 s at natural pace.

scholarly journals Searching for the “Active Ingredients” in Physical Rehabilitation Programs Across Europe, Necessary to Improve Mobility in People With Multiple Sclerosis: A Multicenter Study

2019 ◽  
Vol 33 (4) ◽  
pp. 260-270 ◽  
Author(s):  
Alon Kalron ◽  
Peter Feys ◽  
Ulrik Dalgas ◽  
Tori Smedal ◽  
Jennifer Freeman ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Total Duration ◽  
Real Life ◽  
Rehabilitation Program ◽  
Physical Rehabilitation ◽  
Individual Therapy ◽  
Future Research ◽  
Rehabilitation Programs ◽  
Therapy Goals ◽  
Passive Mobilization

Background. Physical rehabilitation programs can lead to improvements in mobility in people with multiple sclerosis (PwMS). Objective. To identify which rehabilitation program elements are employed in real life and how they might affect mobility improvement in PwMS. Methods. Participants were divided into improved and nonimproved mobility groups based on changes observed in the Multiple Sclerosis Walking Scale–12 following multimodal physical rehabilitation programs. Analyses were performed at group and subgroup (mild and moderate-severe disability) levels. Rehabilitation program elements included setting, number of weeks, number of sessions, total duration, therapy format (individual, group, autonomous), therapy goals, and therapeutic approaches. Results. The study comprised 279 PwMS from 17 European centers. PwMS in the improved group received more sessions of individual therapy in both subgroups. In the mildly disabled group, 60.9% of the improved received resistance training, whereas, 68.5% of the nonimproved received self-stretching. In the moderately-severely disabled group, 31.4% of the improved, received aerobic training, while 50.4% of the nonimproved received passive mobilization/stretching. Conclusions. We believe that our findings are an important step in opening the black-box of physical rehabilitation, imparting guidance, and assisting future research in defining characteristics of effective physical rehabilitation.

scholarly journals Cognitive rehabilitation program in patients with multiple sclerosis: A pilot study

Neurología ◽  
2021 ◽  
Author(s):  
R.M. Jiménez-Morales ◽  
Y. Broche-Pérez ◽  
Y. Macías-Delgado ◽  
C. Sebrango ◽  
S. Díaz-Díaz ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Pilot Study ◽  
Cognitive Rehabilitation ◽  
Rehabilitation Program

scholarly journals Immersive Virtual Reality to Improve Outcomes in Veterans With Stroke: Protocol for a Single-Arm Pilot Study (Preprint)

2021 ◽  
Author(s):  
Johanna E Tran ◽  
Christopher A Fowler ◽  
Jemy Delikat ◽  
Howard Kaplan ◽  
Marie M Merzier ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Pilot Study ◽  
Upper Extremity ◽  
Stroke Rehabilitation ◽  
Inpatient Rehabilitation ◽  
The United States ◽  
Rehabilitation Program ◽  
Neurologic Recovery ◽  
Research Activities ◽  
Hand Dexterity

BACKGROUND Over the last decade, virtual reality (VR) has emerged as a cutting-edge technology in stroke rehabilitation. VR is defined as a type of computer-user interface that implements real-time simulation of an activity or environment allowing user interaction via multiple sensory modalities. In a stroke population, VR interventions have been shown to enhance motor, cognitive, and psychological recovery when utilized as a rehabilitation adjunct. VR has also demonstrated noninferiority to usual care therapies for stroke rehabilitation. OBJECTIVE The proposed pilot study aims to (1) determine the feasibility and tolerability of using a therapeutic VR platform in an inpatient comprehensive stroke rehabilitation program and (2) estimate the initial clinical efficacy (effect size) associated with the VR platform using apps for pain distraction and upper extremity exercise for poststroke neurologic recovery. METHODS This study will be conducted in the Comprehensive Integrated Inpatient Rehabilitation Program at the James A Haley Veterans’ Hospital. Qualitative interviews will be conducted with 10 clinical staff members to assess the feasibility of the VR platform from the clinician perspective. A prospective within-subject pretest-posttest pilot design will be used to examine the tolerability of the VR platform and the clinical outcomes (ie, upper extremity neurologic recovery, hand dexterity, pain severity) in 10 veteran inpatients. A VR platform consisting of commercially available pain distraction and upper extremity apps will be available at the participants’ bedside for daily use during their inpatient stay (approximately 4-6 weeks). Clinician interviews will be analyzed using qualitative descriptive analysis. Cohen <i>d</i> effect sizes with corresponding 95% CIs will be calculated for upper extremity neurologic recovery, hand dexterity, and pain. The proportion of participants who achieve minimal clinically important difference after using the VR platform will be calculated for each clinical outcome. RESULTS This study was selected for funding in August 2020. Institutional review board approval was received in October 2020. The project start date was December 2020. The United States Department has issued a moratorium on in-person research activities secondary to COVID-19. Data collection will commence once this moratorium is lifted. CONCLUSIONS Our next step is to conduct a large multi-site clinical trial that will incorporate the lessons learned from this pilot feasibility study to test the efficacy of a VR intervention in inpatient rehabilitation and transition to home environments. When VR is used in patients’ rooms, it serves to provide additional therapy and may reduce clinician burden. VR also presents an opportunity similar to home-based practice exercises. VR can be implemented in both clinical settings and people’s own homes, where engagement in ongoing self-management approaches is often most challenging. This unique experience offers the potential for seamless transition from inpatient rehabilitation to the home. INTERNATIONAL REGISTERED REPORT PRR1-10.2196/26133

scholarly journals Design, Development, and Testing of an App for Dual-Task Assessment and Training Regarding Cognitive-Motor Interference (CMI-APP) in People With Multiple Sclerosis: Multicenter Pilot Study

10.2196/15344 ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. e15344 ◽  
Author(s):  
Andrea Tacchino ◽  
Renee Veldkamp ◽  
Karin Coninx ◽  
Jens Brulmans ◽  
Steven Palmaers ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Working Memory ◽  
Information Processing ◽  
Pilot Study ◽  
Processing Speed ◽  
Perceived Exertion ◽  
Rehabilitation Program ◽  
Information Processing Speed ◽  
Motor Tasks ◽  
Assessment Tests

Background Interest toward dual-task training (DTT) is increasing as traditional interventions may not prepare patients to adequately face the challenges of most activities of daily living. These usually involve simultaneous cognitive and motor tasks, and they often show a decline in performance. Cognitive-motor interference (CMI) has been investigated in different neurological populations, but limited evidence is present for people with multiple sclerosis (MS). The use of computerized tools is mandatory to allow the application of more standardized assessment and rehabilitation intervention protocols and easier implementation of multicenter and multilanguage studies. Objective To describe the design and development of CMI-APP, an adaptive and interactive technology tablet-based app, and to present the preliminary results of a multicenter pilot study involving people with MS performed in several European centers for evaluating the feasibility of and adherence to a rehabilitation program based on CMI-APP. Methods CMI-APP includes user-friendly interfaces for personal data input and management, assessment of CMI, and DTT. A dedicated team developed CMI-APP for Android tablets above API level 14 (version 4.0), using C# as the programming language and Unity and Visual Studio as development tools. Three cognitive assessment tests for working memory, information processing speed, and sustained attention and four motor assessment tests for walking at different difficulty levels were implemented. Dual cognitive-motor tasks were performed by combining single cognitive and motor tasks. CMI-APP implements exercises for DTT involving the following 12 cognitive functions: sustained attention, text comprehension, verbal fluency, auditory discrimination, visual discrimination, working memory, information processing speed, auditory memory, visual memory, verbal analog reasoning, visual analog reasoning, and visual spatial planning, which can be performed during walking or stepping on the spot. Fifteen people with MS (mean age 52.6, SD 8.6 years; mean disease duration 9.4, SD 8.4 years; mean Expanded Disability Status Scale score 3.6, SD 1.1) underwent DTT (20 sessions). Adherence to the rehabilitation program was evaluated according to the percentage of performed sessions, perceived exertion during the training (Borg 15-point Ratings of Perceived Exertion [RPE] Scale), and subjective experience of the training (Intrinsic Motivation Inventory [IMI]). Results The adherence rate was 91%. DTT was perceived as “somewhat difficult” (mean RPE Scale score 12.6, SD 1.9). IMI revealed that participants enjoyed the training and felt that it was valuable and, to some extent, important, without feelings of pressure. They felt competent, although they did not always feel they could choose the exercises, probably because the therapist chose the exercises and many exercises had few difficulty levels. Conclusions CMI-APP is safe, highly usable, motivating, and well accepted for DTT by people with MS. The findings are fundamental for the preparation of future large-sample studies examining CMI and the effectiveness of DTT interventions with CMI-APP in people with MS.

Self-efficacy predicts self-reported health status in multiple sclerosis

2004 ◽  
Vol 10 (1) ◽  
pp. 61-66 ◽  
Author(s):  
A Riazi ◽  
A J Thompson ◽  
J C Hobart
Keyword(s):  
Multiple Sclerosis ◽  
Health Status ◽  
Self Efficacy ◽  
Psychological Impact ◽  
Inpatient Rehabilitation ◽  
Walking Ability ◽  
Rehabilitation Programs ◽  
Reported Health ◽  
Self Reported Health Status ◽  
Challenging Situation

Self-efficacy is a belief that one can competently cope with a challenging situation. If self-efficacy is a strong predicto r of health status in multiple sclerosis (MS), it may be an important area to target in clinical practice, as such beliefs may be modifiable. The aim of this study was to examine the predictive value of self-efficacy on self-reported health status in MS. Eighty-nine people with MS completed the Multiple Sclerosis Self-efficacy Scale (MSSE function and control scales), the Multiple Sclerosis Impact Scale (MSIS-29), and the Multiple Sclerosis Walking Scale (MSWS-12) at two time points: 1) admission to an inpatient rehabilitation unit (n=43) or for steroid treatment for relapses (n=46); and 2) discharge (rehabilitation group) or six weeks later (steroid group). Multiple regression analyses examined whether baseline and changes in self-efficacy predict changes in self-reported health status. Both baseline and changes in self-efficacy were strong and independent predictors of changes in health status (P-values ranged from 0.025 to B-0.001). That is, pretreatment self-efficacy scores and increases in self-efficacy scores from baseline to follow-up (improvement), were significantly associated with decreases (improvement) in perceived walking ability and physical and psychological impact of MS. The findings suggest that self-efficacy predicts improvement in health status and that self-efficacy would be an important domain to measure and manage actively in education and rehabilitation programs.

SMART4Pain: Feasibility of a Two-Arm Pilot Study of an Integrated Rehabilitation Program for Adolescents and Their Parents for Improving Pain Management

Adolescents ◽  
2021 ◽  
Vol 1 (4) ◽  
pp. 481-499
Author(s):  
Alessandro Failo ◽  
Paola Venuti ◽  
Patrizia Villotti ◽  
Stefan Schmalholz ◽  
Nicola Chistè ◽  
...  
Keyword(s):  
Pilot Study ◽  
Treatment Options ◽  
Rehabilitation Program ◽  
Open Label ◽  
Face To Face ◽  
Rehabilitation Programs ◽  
Pain Intervention ◽  
The Face ◽  
Outpatient Settings ◽  
The Impact

Chronic pain in youth has an unsung etiology and limited treatment options. Affected adolescents show difficulties in different functioning domains, and their parents can develop associated distress, which negatively influences the adolescent’s capacity to adjust to pain. The aims of this study are the following: (1) to develop an internet-delivered (online) pain intervention (SMART4Pain) program for adolescents and their parents, and to test its feasibility and acceptability; (2) to evaluate, in adolescents, the impact of the face-to-face, randomized, two-armed (i.e., CBT or biofeedback), open-label pilot study, developed together with the online program. The overall program consisted of six sessions scheduled over six weeks. Twenty adolescents (N = 20) and their parents (N = 20) completed the entire program and are included in this study. The results showed that all interventions were feasible and acceptable, as well as potentially effective in improving quality of life. Only the group receiving the biofeedback intervention showed some improvements in psychological indicators of stress. In conclusion, more research is needed to better understand and develop new, multimodal rehabilitation programs in outpatient settings.

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