What does a structured review of the effectiveness of exercise interventions for persons with multiple sclerosis tell us about the challenges of designing trials?

2009 ◽  
Vol 15 (4) ◽  
pp. 412-421 ◽  
Author(s):  
M Asano ◽  
DJ Dawes ◽  
A Arafah ◽  
C Moriello ◽  
NE Mayo
Keyword(s):  
Multiple Sclerosis ◽  
Psychosocial Functioning ◽  
Methodological Quality ◽  
Exercise Prescription ◽  
Regular Exercise ◽  
Exercise Interventions ◽  
Positive Effects ◽  
Mesh Terms ◽  
Evidence Database

Objective The goal of this review is to ascertain the extent to which the current body of research on the role of exercise in multiple sclerosis (MS) provides sufficiently strong evidence to guide regular exercise prescription. Methods We searched CINAHL, COCHRANE, EMBASE, and MEDLINE between 1950 and December 2007 with combinations of MeSH terms and keywords. We assessed the methodological quality of selected randomized controlled trials (RCTs) of exercise interventions using the Physiotherapy Evidence Database scale and evaluated the effects of the exercise interventions by calculating effect sizes (ES) for the target outcomes. Results Eleven RCTs met the criteria, all with acceptable methodological quality. The ES ranged from −0.36 to 3.50 on the target outcomes. Only one study had 95% confidence intervals clearly excluding a value of 0. Measures of body functions and structures and activities were the most common target outcomes of interventions. Conclusion Although there was some evidence to support positive effects of exercise on physical and psychosocial functioning and on quality of life, our review revealed insufficient research in this area, making it difficult to guide regular exercise prescription. Furthermore, it also emphasizes the methodological challenges in these RCTs leading us to believe that there is a great need for high quality RCTs in this area, contributing evidence for regular exercise and physical activity prescription for persons with MS.

scholarly journals Exercise Interventions for Improving Flexibility in People with Multiple Sclerosis: A Systematic Review and Meta-Analysis

Medicina ◽  
2019 ◽  
Vol 55 (11) ◽  
pp. 726
Author(s):  
Torres-Pareja ◽  
Sánchez-Lastra ◽  
Iglesias ◽  
Suárez-Iglesias ◽  
Mendoza ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Systematic Review ◽  
Range Of Motion ◽  
Methodological Quality ◽  
Assessment Tool ◽  
Meta Analysis ◽  
Preliminary Evidence ◽  
Control Group ◽  
Exercise Interventions

Background and objectives: People with multiple sclerosis (MS) often experience limitations in joint range of motion, which is linked to spasticity and continued inactivity. Low flexibility levels in this population have been linked to postural problems and muscular pain. Therefore, the purpose of this study was to conduct a systematic review and a meta-analysis aimed at identifying the characteristics and methodological quality of investigations studying the effects of exercise interventions on the flexibility levels of people with MS. Materials and Methods: Three electronic databases (MEDLINE/PubMed, SPORTDiscus and Scopus) were systematically searched up to May 2019 for intervention studies focused on the effects of exercise on the flexibility levels of people with MS. A meta-analysis, including randomized controlled trials (RCT), which reported information regarding the effects of exercise on flexibility, was also conducted. The methodological quality of included studies was assessed using the Physiotherapy Evidence Database, and the Quality Assessment Tool for Before–After Studies, with no control group. The quality of the information reported, regarding the programs conducted, was assessed by means of the Consensus on Exercise Reporting Template (CERT) scale. Results: Seven studies, four RCTs and three uncontrolled investigations were finally selected. The methodological quality of the RCTs was considered “poor” in one study, and “good” and “excellent” in two studies and one investigation, respectively. The three uncontrolled studies showed a methodological quality between “fair” and “poor”. Following the CERT scale, four studies were graded as “high” and three as “low”. Findings from the meta-analysis indicated no significant effects on hamstring flexibility, or the range of motion in the hips, knees or ankles. Conclusions: There is preliminary evidence from individual studies which indicates that people with MS can improve their lower limb flexibility following participation in physical exercise programs, but the meta-analysis did not confirm these findings.

scholarly journals Effectiveness of interventions to prevent falls for people with multiple sclerosis, Parkinson’s disease and stroke: an umbrella review

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nicola O’Malley ◽  
Amanda M. Clifford ◽  
Mairéad Conneely ◽  
Bláthín Casey ◽  
Susan Coote
Keyword(s):  
Risk Factors ◽  
Multiple Sclerosis ◽  
Systematic Reviews ◽  
Methodological Quality ◽  
Falls Prevention ◽  
Umbrella Review ◽  
Falls Risk ◽  
Prevention Interventions ◽  
Evidence Table

Abstract Background The implementation of condition-specific falls prevention interventions is proving challenging due to lack of critical mass and resources. Given the similarities in falls risk factors across stroke, Parkinson’s Disease (PD) and Multiple Sclerosis (MS), the development of an intervention designed for groups comprising of people with these three neurological conditions may provide a pragmatic solution to these challenges. The aims of this umbrella review were to investigate the effectiveness of falls prevention interventions in MS, PD and stroke, and to identify the commonalities and differences between effective interventions for each condition to inform the development of an intervention for mixed neurological groups. Methods A systematic literature search was conducted using 15 electronic databases, grey literature searches and hand-screening of reference lists. Systematic reviews of studies investigating the effects of falls prevention interventions in MS, PD and stroke were included. Methodological quality of reviews was assessed using the A MeaSurement Tool to Assess Systematic Reviews 2. A matrix of evidence table was used to assess the degree of overlap. The Grading of Recommendations Assessments, Development and Evaluation framework was used to rate the quality of evidence. Findings were presented through narrative synthesis and a summary of evidence table. Results Eighteen reviews were included; three investigating effectiveness of falls prevention interventions in MS, 11 in PD, three in stroke, and one in both PD and stroke. Exercise-based interventions were the most commonly investigated for all three conditions, but differences were identified in the content and delivery of these interventions. Low to moderate quality evidence was found for the effectiveness of exercise-based interventions at reducing falls in PD. Best available evidence suggests that exercise is effective at reducing falls in stroke but no evidence of effect was identified in MS. Conclusions The findings suggest that exercise-based interventions are effective at reducing falls in PD, however, the evidence for MS and stroke is less conclusive. A strong theoretical rationale remains for the use of exercise-based interventions to address modifiable physiological falls risk factors for people with MS, PD and stroke, supporting the feasibility of a mixed-diagnosis intervention. Given the high overlap and low methodological quality of primary studies, the focus should be on the development of high-quality trials investigating the effectiveness of falls prevention interventions, rather than the publication of further systematic reviews.

Self-Management of Multiple Sclerosis

2017 ◽  
pp. 382-405
Author(s):  
Malachy Bishop ◽  
Michael Frain
Keyword(s):  
Quality Of Life ◽  
Multiple Sclerosis ◽  
Psychosocial Functioning ◽  
Self Management ◽  
Effective Practices ◽  
Health And Wellness ◽  
Critical Component ◽  
Research Directions ◽  
Neurological Condition

Multiple sclerosis (MS) is a chronic neurological condition that can impact one’s health and functioning, role participation, and quality of life in a wide variety of ways. Self-management is increasingly recognized as a critical component of MS care and a person-directed approach to health and wellness. Given the range of ways that MS may affect physical and cognitive as well as psychosocial functioning, effective and comprehensive MS self-management may require a broad range of knowledge and resources. Thus this chapter explores current perspectives on MS self-management, evaluates the research evidence and current research directions, and identifies effective practices in MS self-management.

scholarly journals Effectiveness of Vestibular Training for Balance and Dizziness Rehabilitation in People with Multiple Sclerosis: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 9 (2) ◽  
pp. 590 ◽  
Author(s):  
Cristina García-Muñoz ◽  
María-Dolores Cortés-Vega ◽  
Alberto Marcos Heredia-Rizo ◽  
Rocío Martín-Valero ◽  
María-Isabel García-Bernal ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Systematic Review ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Vestibular Rehabilitation ◽  
Exercise Interventions ◽  
Cochrane Database ◽  
Balance Development ◽  
Evidence Database ◽  
Experimental Group

Postural instability and dizziness are commonly observed in people with multiple sclerosis (PwMS). The aim of this systematic review was to evaluate the evidence for the use of vestibular rehabilitation, in comparison with other exercise interventions or no intervention, to treat balance impairments and dizziness in PwMS. An electronic search was conducted by two independent reviewers in the following databases: MEDLINE (Pubmed), Scopus, the Physiotherapy Evidence Database (PEDro), Web of Science (WOS), Lilacs, CINHAL and the Cochrane Database of Systematic Reviews (CDSR). A quality assessment was performed using the PEDro scale and the Cochrane Risk of Bias Tool. When possible, the data were pooled in a meta-analysis (95%CI). This systematic review followed the PRISMA guideline statement and was registered in the PROSPERO database (CRD42019134230). Seven studies were included, with a total of 321 participants analysed. Compared with no intervention, vestibular rehabilitation was more effective for balance development (SMD = 2.12; 95% CI = 0.49, 3.75; p = 0.01; I2 = 89%) and dizziness symptoms improvement (SMD = −17.43; 95% CI = −29.99, −4.87; p= 0.007; I2= 66%). Compared with other exercise interventions, improvements in favour of the experimental group were observed, but statistical significance for the differences between groups was not reached.

scholarly journals Immunomodulatory and anti-inflammatory effects of probiotics in multiple sclerosis: a systematic review

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Mohammad Morshedi ◽  
Reza Hashemi ◽  
Sara Moazzen ◽  
Amirhossein Sahebkar ◽  
Elaheh-Sadat Hosseinifard
Keyword(s):  
Multiple Sclerosis ◽  
Systematic Review ◽  
Inflammatory Markers ◽  
Methodological Quality ◽  
Inflammatory Responses ◽  
Dynamic Balance ◽  
Favorable Effect ◽  
Beneficial Effects ◽  
Inflammatory Parameters

AbstractMultiple sclerosis (MS) is an inflammatory and autoimmune neurological disorder which leads to demyelination. Although the etiology of MS is yet to be known, it appears that regulating the immune system and suppressing inflammatory pathways may possibly have a favorable effect on the healing of this disease. Evidence suggests that probiotics consumption via gut microbiome alteration devises beneficial effects in improving immune and inflammatory responses in MS. All articles were systematically searched (in the main databases) for this paper. Two investigators independently scrutinized full texts of the potentially eligible articles. The quality of the study was evaluated using standardized tools. The methodological quality of seven studies included in this review ranged from fair to good. The findings illustrated that there were statistically significant improvements in the static and dynamic balance in patients and animals with MS. In the paper in hand, the effects of probiotics administration on immune and inflammatory markers in MS disease are evaluated. In addition, the limitations and knowledge gaps were reported while proposing a possible mechanism of probiotics therapy in modulating immune and inflammatory responses. This systematic review indicated that the probiotics could improve immune and inflammatory parameters, the cytokines and cells in MS disease. Probiotics may have efficient effects in management and treatment of MS. More studies are required to clarify the effect of supplementation with probiotics and their mechanisms in MS disease.

Review: Multiple sclerosis and physical exercise: recommendations for the application of resistance-, endurance- and combined training

2008 ◽  
Vol 14 (1) ◽  
pp. 35-53 ◽  
Author(s):  
U. Dalgas ◽  
E. Stenager ◽  
T. Ingemann-Hansen
Keyword(s):  
Multiple Sclerosis ◽  
Physical Exercise ◽  
Endurance Training ◽  
Exercise Prescription ◽  
Moderate Intensity ◽  
Physiological Profile ◽  
Combined Training ◽  
Beneficial Effects ◽  
Training Modality

This review summarizes the existing knowledge regarding the effects of physical exercise in patients suffering from multiple sclerosis (MS). Furthermore, recommendations are given regarding exercise prescription for MS patients and for future study directions. Previously, MS patients were advised not to participate in physical exercise. During recent years, it has been increasingly acknowledged that exercise benefits MS patients. The requirement for exercise in MS patients is emphasized by their physiological profile, which probably reflects both the effects of the disease per se and the reversible effects of an inactive lifestyle. To date the effects of exercise have only been studied in moderately impaired MS patients with an EDSS score of less than 7. Evidence exists for recommending participation in endurance training at low to moderate intensity, as the existing literature demonstrates that MS patients can both tolerate and benefit from this training modality. Also, resistance training of moderate intensity seems to be well tolerated and to have beneficial effects on MS patients, but the methodological quality of the existing evidence is in general low and the number of studies is limited. Only two studies have evaluated the effects of combined resistance- and endurance training, making solid conclusions regarding this training modality impossible. Multiple Sclerosis 2008; 14: 35—53. http://msj.sagepub.com

scholarly journals Resistance Training and Stroke: A Critical Analysis of Different Training Programs

2017 ◽  
Vol 2017 ◽  
pp. 1-11 ◽  
Author(s):  
Bruno Bavaresco Gambassi ◽  
Hélio José Coelho-Junior ◽  
Paulo Adriano Schwingel ◽  
Fabiano de Jesus Furtado Almeida ◽  
Tânia Maria Gaspar Novais ◽  
...  
Keyword(s):  
Resistance Training ◽  
Resistance Exercise ◽  
Critical Analysis ◽  
Muscle Power ◽  
Physical Conditioning ◽  
Exercise Programs ◽  
Positive Effects ◽  
Control Comparison ◽  
Evidence Database

The aim of this study was to carry out a literature review on the overall benefits of resistance training (RT) after stroke and undertake a critical analysis of the resistance exercise programs surveyed (rest interval between sets and exercises, number of sets, number of repetitions, intensity, duration of training, and weekly frequency). To obtain articles for the review, we searched PubMed, Google Scholar, and Physiotherapy Evidence Database (PEDro). Inclusion criteria were considered using the PICO (population, intervention, control/comparison, and outcome variables) model. The following characteristics were recorded for all articles: type of study, author, year of publication, participants (time after stroke, sample size, and age), benefits of RT, and structured resistance exercise programs. Positive effects of training were found on anxiety status, quality of life, muscle hypertrophy, cognitive function, strength, and muscle power. Only 5 studies described the main variables of RT in detail. Lack of control of some variables of RT may negatively affect the results of this practice. The findings of the present study may further inform health and physical conditioning professionals on the importance and necessity of using the main variables in the search for benefits for individuals with stroke.

scholarly journals Effects of Extracorporeal Shockwave Therapy on Clinical and Neurophysiological Indices of Spasticity Inpatients With Upper Motor Neuron Lesions: A Systematic Review and Meta-analysis

2021 ◽  
Vol 22 (1) ◽  
pp. 28-47
Author(s):  
Fereshteh Poursaeed ◽  
◽  
Nahid Tahan ◽  
Farideh Dehghan Manshadi ◽  
Ali Reza Akbarzade Bagheban ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Shock Wave ◽  
Clinical Trials ◽  
Cerebral Palsy ◽  
Motor Neuron ◽  
Methodological Quality ◽  
Meta Analysis ◽  
Shock Wave Therapy ◽  
Shockwave Therapy

Objective: Spasticity is one of the components of an Upper Motor Neuron (UMN) lesion that occurs usually after a period of flaccidity in the form of velocity-dependent resistance to passive stretch. Spasticity is a significant cause of limited mobility and disability in neurological diseases. There are several clinical approaches to control spasticity. Recently, Shock Wave Therapy (SWT) has been reported to be a new, safe, and effective method for reducing spasticity for people with upper motor neuron lesions. We conducted a meta-analysis of relevant clinical trials to assess the effect of applying SWT on spasticity in UMN lesions. Materials & Methods: An electronic search was performed in PubMed, ISI Web of Science, Scopus, Science Direct, MEDLINE, and Google scholar from January 2005 to January 2020. Studies were included if they measured spasticity with the Modified Ashworth Scale (MAS) or/and neurophysiological indices in patients with stroke, multiple sclerosis, and cerebral palsy. The keywords of muscle hypertonia or spasticity, extracorporeal shock wave therapy, stroke, multiple sclerosis, and cerebral palsy were used. Two independent researchers searched articles, screened eligible studies against the inclusion criteria, and assessed the methodological quality of included studies. The methodological quality of studies was evaluated using the Downs and Black tool. The difference between the means was considered as the effect size in the MAS and Hoffman reflex/motor response (H/M) ratio before and after the intervention with 95% CI in random-effects models. Analyzes were performed using STATA software version 11. Results: The initial search led to the retrieval of 98 studies based on the inclusion and exclusion criteria, of which 24 full-text articles were reviewed and 14 articles were included in the meta-analysis process. All 14 articles had examined the effects of shockwave on the MAS. Four studies with 120 patients had examined the effects of shockwave therapy on the H/M ratio. Significant reduction in MAS grade was observed immediately [I2 = 100%, P<0.001, SMD=1.38 with 95%CI: (0.80, 1.87)] and three months after SWT [I2 = 100%, P<0.001, SMD=1.13 with 95%CI: (0.50, 1.76)] in comparison with the baseline values. ESWT had no significant effects on the H/M ratio [I2 = 97.5%, P<0.001, SMD=1.09 with 95%CI: (-0.54, 2.73)]. Conclusion: SWT can improve spasticity based on the MAS. The lack of SWT effects on the neurophysiological parameter of spasticity supports this opinion that SWT acts on the non-neural component of spasticity. Differences observed in studies in terms of treatment sessions, intervals of treatment sessions, energy density, number of shocks, and follow-up duration need to be examined more closely. More randomized clinical trials are needed in the future to analyze the impact of these factors on the efficacy of SWT for spastic patients.

scholarly journals Post-exercise effects of graduated compression garment use on skeletal muscle recovery and delayed onset muscle soreness: a systematic review

Motricidade ◽  
2018 ◽  
Vol 14 (2-3) ◽  
pp. 129-137 ◽  
Author(s):  
Aline Machado Araujo ◽  
Rodrigo Kohn Cardoso ◽  
Airton José Rombaldi
Keyword(s):  
Methodological Quality ◽  
Muscle Soreness ◽  
Delayed Onset Muscle Soreness ◽  
Compression Stockings ◽  
Muscle Recovery ◽  
Post Exercise ◽  
Positive Effects ◽  
Delayed Onset ◽  
Delayed Muscle Soreness

The study aimed to review the literature on the effects related to post-exercise of graduated compression garments (GCGs) use on muscle recovery and delayed onset muscle soreness. The search was performed in Pubmed/Medline, Bireme, Scielo, and Lilacs electronic databases using the following descriptors in English: "compression clothing", "physical exercise", "recovery", "physical activity", "compression stockings" and "delayed onset muscle soreness". The search resulted in 102 articles and after removing duplicates, applying exclusion criteria and checking the reference lists, nine studies fulfilled the criteria and were included in the review. Seven studies associated the use of GCGs with reduction of delayed muscle soreness and improvement in performance after the use of compression clothes. However, the methodological quality of the studies, using PEDro scale, presented an average of 5.1±0.9 points (out of a total of 11 points), classified as intermediate. In conclusion, although the positive effects of using CGCs on improving recovery and reduction of delayed muscle soreness after physical exercises are almost consensual, the insufficient methodological quality of the included studies requires careful consideration of the results.

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