The effect of cervical mobilization on joint position sense, balance and gait in patients with multiple sclerosis: a randomized crossover study.

OBJECTIVE: To investigate the effect of cervical mobilization on joint position sense, balance and gait in multiple sclerosis (MS) patients. METHODS: Sixteen MS patients received traditional rehabilitation and traditional rehabilitation+cervical mobilization treatments in different orders, 2 days a week for 4 weeks. For the cervical mobilization, joint traction and shifts with myofascial release techniques were applied. Joint position sense was evaluated from the bilateral knee and ankle joints with a digital goniometer, balanced with the Berg Balance Test (BBT), the Functional Reach Test, and gait with the Dynamic Gait Index (DGI) and the Timed 25-Foot Walk Test. RESULTS: Improvements were determined in joint position sense, balance, gait with both treatment methods (p < 0.05). With the addition of cervical mobilization to traditional treatment, there was observed to be an increased effect carried over in knee joint position sense and BBT (p < 0.05). The BBT and DGI scores improved in the group applied with cervical mobilization following the washout period (p < 0.05). CONCLUSIONS: Cervical mobilization could be effective in improving joint position sense, balance and gait, and accelerated improvements in a short time. The application of cervical mobilization could be a supportive treatment method to improve position sense, balance and gait in patients with MS.

Efficacy of remote exercise and physiotherapy programs on depressive symptoms in people with multiple sclerosis - A systematic review and meta-analysis.

BACKGROUND: The prevalence of depression in Multiple Sclerosis (MS) is common and negatively affects the quality of life of patients. The studies of the effect of remote forms of treatment conclude that it is a fairly easy process to carry out and with very good results for patients. Thus, the purpose of this systematic review and meta-analysis is to investigate randomized controlled trials on the effectiveness of remote forms of exercise and physiotherapy on the depressive symptoms of people with MS. METHODS: A literature search was conducted in PubMed, Scopus, PsychInfo, SportDiscus, Web of Science and ResearchGate databases. The keywords for the search were: telerehabilitation, telecounseling, tele, telephone, physiotherapy, physical therapy, rehabilitation, therapeutic exercise, exercise, depression, depressive disorders, multiple sclerosis and MS. In addition, some inclusion and exclusion criteria were defined for the selection of the final studies, which were also evaluated with the PEDro scale for their quality. RESULTS: Among the initial 176 studies found, 6 were included in the systematic review. The development of a remote individualized exercise program based on assessment, personal goals and daily life of the patient, as well as a program based on motor imagery training, showed beneficial effects on depression in people with MS, which are considered possibly equivalent to those of in-person intervention. Μeta-analysis revealed that remote exercise and physiotherapy programs are significantly more effective than control group interventions for the management of depression in people with MS (random effects model, Hedges' g = -0.41, 95%CI = -0.74,-0.09, SE = 0.17, p = 0.01). The sub-group analysis showed that studies that had chosen not to have their control group carry out any form of intervention had more significant outcomes than the others. CONCLUSION: Through telephone communication or other electronic monitoring systems, can be achieved an effective treatment of people with depression and MS, based on exercise and physiotherapy. However, more studies are deemed necessary to find the most appropriately designed and therapeutic forms of remote intervention.

Training-dependent plasticity and far transfer effect enhanced by Bobath rehabilitation in Multiple Sclerosis.

BACKGROUND: Multiple Sclerosis (MS) is a disease that often results in motor and/or cognitive disability. Despite the increasing availability of effective drug therapies, rehabilitation is very important means of counteracting the progression of disability and improving physical function, impacting social participation and improving quality of life. Several rehabilitation approaches can be used in the context of neuro-motor rehabilitation, but there is insufficient evidence for them in the literature. OBJECTIVES: This study has the twofold purpose of: (i) investigate whether rehabilitation according to Bobath Concept can improve balance and some aspects of cognitive function in MS patients; (ii) explore whether the ability to improve postural control, an indirect index of adaptive neuroplasticity, is preserved in MS patients and whether it can be improved with rehabilitation. METHOD: This is an independent wait-listed study. Forty people with MS (pwMS) were enrolled: patients in the Bobath group underwent 8 weeks of rehabilitation according to the Bobath Concept. For aim 1, pwMS were assessed at baseline (T0), at the end of the 8 weeks of treatment (T1) and after 8 weeks of observation (T2) with motor and cognitive scales. For aim 2, the same 40 pwMS were matched with healthy controls and were subjected to a postural learning task using the force platform at T0, T1 and T2. RESULTS: Patients in Bobath group scored better on balance and cognitive function at T1, but this improvement was not maintained at T2. All patients were less accurate than controls in the postural learning task at each assessment; however, patients also demonstrated an increase in accuracy after training, similar to that of healthy controls. The learning curve was better for patients randomized to the active group than the waitlist at T1 time, but this advantage was not maintained at the T2 assessment. CONCLUSION: In light of the results, this study supports the use of rehabilitation according to Bobath Concept to improve balance control and some executive functions in MS. Despite worse baseline performance, pwMS were able to learn a postural control task on par with healthy controls. Also, supports the hypothesis that adaptive plasticity is preserved despite MS and can be promoted by rehabilitation.

Effects of hippotherapy simulation exercise vs. conventional home exercises on muscle strength and balance in people with multiple sclerosis: A randomized controlled trial.

OBJECTIVE: To determine the efficacy of hippotherapy simulation exercise on the improvement of muscle strength, balance, spasticity, and quality of life in individuals with multiple sclerosis (MS). DESIGN: Randomized controlled trial. SETTING: Outpatient clinic at the rehabilitation clinic of University of Usak, Turkey PARTICIPANTS: Individuals with MS (n = 40) participated in this randomized clinical study. INTERVENTIONS: Patients in both groups received 36 treatment sessions, 3 times per week for 12 consecutive weeks. Subjects in the study group performed hippotherapy simulation exercise via a hippotherapy simulator device. The control group received conventional home exercises. MAIN OUTCOME MEASURES: The primary outcome measures included the Monitoring My Multiple Sclerosis (MMMS) Scale, the Berg Balance Scale (BBS), and the Timed Up and Go (TUG) test; quadriceps muscle strength was measured with a dynamometer. RESULTS: At the level of physical activity, post-intervention MMMS measures showed significant differences in both cases. TUG was significantly lower, and muscle strength and BBS were significantly higher in both post-interventions. No outcome measure showed a significant difference between the groups at both post-intervention and follow-up. CONCLUSIONS: The results of this study in the field of hippotherapy simulation exercise for people with MS indicate a positive effect on health conditions, balance, mobility skills, and muscle strength. Further studies are necessary to confirm these preliminary results.

Comparing the effects of vestibular rehabilitation with and without lavender oil scents as an olfactory stimulus on balance, fear of falling down and activities of daily living of people with multiple sclerosis: a randomized clinical trial.

PURPOSE: To evaluate the effect of using lavender oil as an olfactory stimulus with vestibular rehabilitation (VR) on balance, fear of falling down, and activities of daily living of people with multiple sclerosis. METHODS: Forty participants were randomly assigned into experimental and control groups. The experimental group did the VR exercises while smelling the lavender oil scents. The control group did the VR exercises without it. Both groups did the exercises in ten 45-min sessions. We assessed the participants with the timed up and go (TUG) test, Berg balance scale (BBS), fall efficacy scale - international (FES-I), and the 29-item multiple sclerosis impact scale (MSIS-29). We did the tests at the baseline and after the last exercise session. RESULTS: The experimental group performed significantly better in the BBS (p = 0.007), TUG (p = 0.045), and FES-I (p = 0.016) tests as well as in the MSIS-29's psychological subscale (p = 0.034) than did the control group. CONCLUSIONS: Using lavender oil as olfactory stimulus while doing the VR exercises can improve balance and reduce fear of falling down compared to doing the VR exercises without it in people with multiple sclerosis.Implications for rehabilitationIt seems that using lavender oil, as an olfactory stimulus, while doing vestibular rehabilitation exercises can improve balance and reduce fear of falling down in people with multiple sclerosis compared to doing the vestibular rehabilitation exercises without it.This treatment significantly alleviates the psychological effects of multiple sclerosis on daily life such as sleeping problems, feeling unwell, anxious, tense, depressed, etc.

The content and effects of trunk rehabilitation on trunk and upper limb performance in people with multiple sclerosis: a systematic review.

INTRODUCTION: Persons with multiple sclerosis (pwMS) could have an impaired trunk and reduced postural control, which negatively impacts activities of daily living. Evidence is growing to consider the positive effects of trunk training on fall incidence and balance problems. Effects on trunk and upper limb performance is unknown. This systematic review provides an overview of trunk training programs and their effects in MS, specifically focusing on the content of training modalities and the effects on trunk and upper limb performance. EVIDENCE ACQUISITION: Two electronic databases were used: PubMed and Web Of Science (WOS). Intervention studies (with- and without control group) published in English, investigating the effects of active trunk training on trunk and upper limb performance in pwMS, were included. EVIDENCE SYNTHESIS: Sixteen studies met the criteria, investigating different rehabilitation modalities. The included interventions in the review varied between more generic postural interventions such as Pilates (N.=8) and Ai Chi (N.=1), with a focus on abdominal muscle activation, breathing, neutral position and lower extremity movements. Further, specifically developed trunk training programs like GroupCoreDIST/ SIT / CoDuSe (N.=6) and Bobath based trunk training (N.=1) are detected, with the main focus on trunk strengthening and dynamic movements. An overall improvement in trunk performance was reported in several tests on trunk strength, stability and coordination. While the majority of the programs integrated the upper limb, only half of them used upper limb outcome measures to evaluate the effect. Here, overall significant improvements were found for the upper limb. CONCLUSIONS: This systematic review showed that different types of trunk training programs can improve trunk and upper limb function in PwMS. The findings of this review suggest that a focus on trunk training to achieve effects on upper limb is reasonable. Future research is needed to further explore relations and the effect sizes.

Medical Therapeutic Yoga for multiple sclerosis: examining self-efficacy for physical activity, motivation for physical activity, and quality of life outcomes.

PURPOSE: Multiple Sclerosis (MS) is an incurable neurodegenerative disease that results in deficits in physical and cognitive function, and often fosters low levels of self-efficacy for physical activity, motivation for physical activity, and quality of life [1]. Drug therapies, physical therapy rehabilitation, and lifestyle modifications such as increased physical activity are standard protocol for symptom management, yet persons with MS tend to be physically inactive [2,3]. Additionally, single-modality interventions do not inherently address the challenges faced concurrently by individuals with MS [4,5]. METHODS: This project examined the effects of a 5-week holistic biopsychosocial Medical Therapeutic Yoga program on physical activity behavior outcomes in individuals diagnosed with MS. A mixed-methods approach was used to examine self-efficacy for physical activity, motivation for physical activity, and quality of life outcomes in 15 participants. RESULTS: Quantitative measures demonstrated increased self-efficacy (t(14) = -2.23, p = 0.042), and emotional quality of life (t(14) = -2.66, p = 0.019). Responses to an open-ended written questionnaire and follow-up interviews indicated overall positive response to the program including increases in self-efficacy for physical activity, motivation for physical activity, and quality of life. These results may help future holistic programming for individuals with MS incorporate behavioral interventions with therapeutic rehabilitation to increase physical activity adherence.IMPLICATIONS FOR REHABILITATIONMultiple sclerosis is a neurological disease impacting physical and cognitive functioning that may be managed with a combination of drug therapies, rehabilitation, and physical activity.Individuals diagnosed with multiple sclerosis tend to be physically inactive and physical inactivity is a challenge for optimal disease management.Medical Therapeutic Yoga offers an interdisciplinary biopsychosocial framework to simultaneously address the behavioral challenges and physical impairments facing individuals diagnosed with multiple sclerosis.Health care providers should consider developing programs that use a biopsychosocial framework to aid in developing long-term adherence in health behaviors such as physical activity participation.

Effects of brain-computer interface with functional electrical stimulation for gait rehabilitation in multiple sclerosis patients: preliminary findings in gait speed and event-related desynchronization onset latency.

Objective.Brain-computer Interfaces (BCI) with functional electrical stimulation (FES) as a feedback device might promote neuroplasticity and hence improve motor function. Novel findings suggested that neuroplasticity could be possible in people with multiple sclerosis (pwMS). This preliminary study explores the effects of using a BCI-FES in therapeutic intervention, as an emerging methodology for gait rehabilitation in pwMS.Approach.People with relapsing-remitting, primary progressive or secondary progressive MS were evaluated with the inclusion criteria to enroll the nine participants required by the statistically computed sample size. Each patient trained with a BCI-FES during 24 sessions distributed in eight weeks. The effects were evaluated on gait speed (Timed 25 Foot Walk), walking ability (12-item Multiple Sclerosis Walking Scale), quality of life measures, the true positive rate as the BCI-FES performance metric and the event-related desynchronization (ERD) onset latency of the sensorimotor rhythms.Main results.Seven patients completed the therapeutic intervention. A statistically and clinically significant post-treatment improvement was observed in gait speed, as a result of a reduction in the time to walk 25 feet (-1.99 s,p= 0.018), and walking ability (-31.25 score points,p= 0.028). The true positive rate showed a statistically significant improvement (+15.87 score points,p= 0.018). An earlier ERD onset latency (-180 ms) after treatment was found.Significance.This is the first study that explored gait rehabilitation using BCI-FES in pwMS. The results showed improvement in gait which might have been promoted by changes in functional brain connections involved in sensorimotor rhythm modulation. Although more studies with a larger sample size and control group are required to validate the efficacy of this approach, these results suggest that BCI-FES technology could have a positive effect on MS gait rehabilitation.

Physical Activity and the Health of Wheelchair Users: A Systematic Review in Multiple Sclerosis, Cerebral Palsy, and Spinal Cord Injury.

OBJECTIVE: To understand the benefits and harms of physical activity in people who may require a wheelchair with a focus on people with multiple sclerosis (MS), cerebral palsy (CP), and spinal cord injury (SCI). DATA SOURCES: Searches were conducted in MEDLINE, Cumulative Index to Nursing and Allied Health, PsycINFO, Cochrane CENTRAL, and Embase (January 2008 through November 2020). STUDY SELECTION: Randomized controlled trials, nonrandomized trials, and cohort studies of observed physical activity (at least 10 sessions on 10 days) in participants with MS, CP, and SCI. DATA EXTRACTION: We conducted dual data abstraction, quality assessment, and strength of evidence. Measures of physical functioning are reported individually where sufficient data exist and grouped as "function" where data are scant. DATA SYNTHESIS: No studies provided evidence for prevention of cardiovascular conditions, development of diabetes, or obesity. Among 168 included studies, 44% enrolled participants with MS (38% CP, 18% SCI). Studies in MS found walking ability may be improved with treadmill training and multimodal exercises; function may be improved with treadmill, balance exercises, and motion gaming; balance is likely improved with balance exercises and may be improved with aquatic exercises, robot-assisted gait training (RAGT), motion gaming, and multimodal exercises; activities of daily living (ADL), female sexual function, and spasticity may be improved with aquatic therapy; sleep may be improved with aerobic exercises and aerobic fitness with multimodal exercises. In CP, balance may be improved with hippotherapy and motion gaming; function may be improved with cycling, treadmill, and hippotherapy. In SCI, ADL may be improved with RAGT. CONCLUSIONS: Depending on population and type of exercise, physical activity was associated with improvements in walking, function, balance, depression, sleep, ADL, spasticity, female sexual function, and aerobic capacity. Few harms of physical activity were reported in studies. Future studies are needed to address evidence gaps and to confirm findings.

Influence of a High-Impact Multidimensional Rehabilitation Program on the Gut Microbiota of Patients with Multiple Sclerosis.

Multiple sclerosis (MS) is a neurodegenerative inflammatory condition mediated by autoreactive immune processes. Due to its potential to influence host immunity and gut-brain communication, the gut microbiota has been suggested to be involved in the onset and progression of MS. To date, there is no definitive cure for MS, and rehabilitation programs are of the utmost importance, especially in the later stages. However, only a few people generally participate due to poor support, knowledge, and motivation, and no information is available on gut microbiota changes. Herein we evaluated the potential of a brief high-impact multidimensional rehabilitation program (B-HIPE) in a leisure environment to affect the gut microbiota, mitigate MS symptoms and improve quality of life. B-HIPE resulted in modulation of the MS-typical dysbiosis, with reduced levels of pathobionts and the replenishment of beneficial short-chain fatty acid producers. This partial recovery of a eubiotic profile could help counteract the inflammatory tone typically observed in MS, as supported by reduced circulating lipopolysaccharide levels and decreased populations of pro-inflammatory lymphocytes. Improved physical performance and fatigue relief were also found. Our findings pave the way for integrating clinical practice with holistic approaches to mitigate MS symptoms and improve patients' quality of life.

Rehabilitation in multiple sclerosis in 2021.

Patients with multiple sclerosis, despite advances in therapy, often suffer from locomotor impairment that limits their mobility and affect quality of life. Rehabilitation is part of the treatment of MS and has shown its beneficial effects in numerous studies. While traditional rehabilitation techniques remain in the limelight, new technologies are emerging and make it possible to improve the management of disabling symptoms. The aim of this update is to synthesize the new therapy techniques proposed in rehabilitation for patients with multiple sclerosis according to the symptoms as balance, gait, upper limb disorders, fatigue, spasticity and disease progression published over the past 5 years. With regard to balance and walking disorders, neuromotor rehabilitation, physical exercise, rhythmic auditory stimulation, gait robot training and exergaming are effective. Only physical exercise has shown a positive effect on fatigue management. Spasticity is improved by classic rehabilitation techniques however non-invasive brain stimulation are promising. The rehabilitation of upper limb dysfunctions uses various effective techniques such as the repetition of functional tasks in real or virtual situations. In case of a more severe disability, arm robots can be used to relearn the impaired movement. Action observation training in real or virtual situations is also effective. Finally, under certain conditions the constraint induced movement therapy is proposed. The effects of rehabilitation are not only positive on the pyramidal symptoms and fatigue but also increase neuroplasticity and perhaps a neuroprotective effect as shown in some studies.

Is Aerobic or Resistance Training the Most Effective Exercise Modality for Improving Lower Extremity Physical Function and Perceived Fatigue in People With Multiple Sclerosis? A Systematic Review and Meta-analysis.

OBJECTIVE: The purpose of this systematic review was to investigate whether aerobic training (AT) or resistance training (RT) is most effective in terms of improving lower limb physical function and perceived fatigue in persons with multiple sclerosis (PwMS). DATA SOURCES: Nine databases (MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health, Allied and Complementary Medicine Database, Physiotherapy Evidence Database, SPORTDiscus, PsycINFO, Web of Science, and Scopus) were electronically searched in April 2020. STUDY SELECTION: Included studies were randomized controlled trials (RCTs) involving PwMS attending 1 of 2 exercise interventions: AT or RT. Studies had to include at least 1 objective or self-reported outcome of lower extremity physical function and/or perceived fatigue. DATA EXTRACTION: Data were extracted using a customized spreadsheet, which included detailed information on patient characteristics, interventions, and outcomes. The methodological quality of the included studies was independently assessed by 2 reviewers using the Tool for Assessment of Study Quality for Reporting on Exercise rating scale. DATA SYNTHESIS: Twenty-seven articles reporting data from 22 RCTS (AT=14, RT=8) including 966 PwMS. The 2 modalities were found to be equally effective in terms of improving short walk test (AT: effect size [ES]=0.33 [95% confidence interval (CI), -1.49 to 2.06]; RT: ES=0.27 [95% CI, 0.07-0.47]) and long walk test performance (AT: ES=0.37 [95% CI, -0.04 to 0.78]; RT: ES=0.36 [95% CI, -0.35 to 1.08]), as well as in reducing perceived fatigue (AT: ES=-0.61 [95% CI, -1.10 to -0.11]; RT: ES=-0.41 [95% CI, -0.80 to -0.02]). Findings on other functional mobility tests along with self-reported walking performance were sparse and inconclusive. CONCLUSIONS: AT and RT appear equally highly effective in terms of improving lower extremity physical function and perceived fatigue in PwMS. Clinicians can thus use either modality to target impairments in these outcomes. In a future perspective, head-to-head exercise modality studies are warranted. Future MS exercise studies are further encouraged to adapt a consensus "core battery" of physical function tests to facilitate a detailed comparison of results across modalities.

High-intensity interval training and energy management education, compared with moderate continuous training and progressive muscle relaxation, for improving health-related quality of life in persons with multiple sclerosis: study protocol of a randomized controlled superiority trial with six months' follow-up.

BACKGROUND: Persons with multiple sclerosis (PwMS) often have reduced aerobic capacity and report fatigue as the most disabling symptom impacting their health-related quality of life (HRQoL). A multidisciplinary rehabilitation approach is recommended for successful management of symptoms, although there is little supporting evidence. The aim of this study is to evaluate the effect of a multimodal therapy approach, including endurance training and patient education, during a three-week inpatient rehabilitation stay, on HRQoL in PwMS at six months follow-up. Inpatient energy management education (IEME) + high-intensity interval training (HIIT) will be compared with progressive muscle relaxation (PMR) + moderate continuous training (MCT). METHODS: This study has a two-armed single-blind randomized controlled superiority trial design. One hundred six PwMS-related fatigue (relapsing-remitting or chronic progressive phenotypes; Expanded Disability Status Scale (EDSS) ≤ 6.5) will be recruited at the Valens clinic, Switzerland, and randomized into either an experimental (EG) or a control group (CG). EG: participants will perform IEME twice and HIIT three times per week during the three-week rehabilitation stay. IEME is a group-based intervention, lasting for 6.5 h over three weeks. HIIT contains of five 1.5-min high-intensive exercise bouts on a cycle ergometer at 95-100% of peak heart rate (HRpeak), followed by active breaks of unloaded pedalling for 2 min to achieve 60% of HRpeak. CG: participants will perform PMR twice and MCT three times per week during the three-week rehabilitation stay, representing local usual care. PMR consists of six 1-h relaxation group sessions. MCT consists of 24-min continuous cycling at 65% of HRpeak. The primary outcome is HRQoL (Physical and Mental Component Summaries of the Medical Outcome Study 36-item Short Form Health Survey; SF-36), measured at entry to the clinic (baseline, T0), three weeks after T0 (T1) and at four (T2) and six (T3) months after T0. Secondary outcomes comprise cardiorespiratory fitness, inflammatory markers (measured at T0 and T1), fatigue, mood, self-efficacy, occupational performance, physical activity (measured at T0, T1, T2 and T3) and behaviour changes in energy management (measured at T2 and T3). DISCUSSION: This study will provide detailed information on a multimodal therapy approach to further improve rehabilitation for PwMS. TRIAL REGISTRATION: This trial was prospectively registered at ClinicalTrials.gov ( NCT04356248 ; 22 April 2020).

Influence of Multiple Sclerosis on Spatiotemporal Gait Parameters: A Systematic Review and Meta-Regression.

OBJECTIVE: To quantify the effect of multiple sclerosis (MS) on spatiotemporal gait characteristics accounting for disability severity and fall classification. DATA SOURCES: MEDLINE (1946-August 2018), Allied and Complementary Medicine Database (1985-2018 August), and PsycINFO (1806-August 2018) were searched for terms on MS and gait. STUDY SELECTION: Dual independent screening was conducted to identify observational, cross-sectional studies that compared adults with MS grouped according to Expanded Disability Status Scale (EDSS) level or fall history, reported on spatiotemporal gait characteristics, and were published in English. The search retrieved 5891 results, of which 12 studies satisfied the inclusion criteria. DATA EXTRACTION: Two authors worked independently to extract and verify data on publication details, study methodology, participant characteristics, gait outcomes, conclusions, and limitations. Risk of bias was assessed using the QualSyst critical appraisal tool. A random-effects meta-regression and meta-analysis were conducted on pooled data. DATA SYNTHESIS: All studies received quality ratings of very good to excellent and collectively examined 1513 individuals with MS. With every 1-point increase in EDSS, significant changes (P<.05) were observed in gait speed (-0.12 m/s; 95% confidence interval (CI), 0.08-0.15), step length (-0.04 m; 95% CI, 0.03-0.05), step time (+0.04 seconds; 95% CI, 0.02-0.06), step time variability (+0.009 seconds; 95% CI, 0.003-0.016), stride time (+0.08 seconds; 95% CI, 0.03-0.12), cadence (-4.4 steps per minute; 95% CI, 2.3-6.4), stance phase duration (+0.8% gait cycle; 95% CI, 0.1-1.5), and double support time (+3.5% gait cycle; 95% CI, 1.5-5.4). Recent fallers exhibited an 18% (95% CI, 13%-23%) reduction in gait speed compared with nonfallers (P<.001). CONCLUSIONS: This review provides the most accurate reference values to-date that can be used to assess the effectiveness of MS gait training programs and therapeutic techniques for individuals who differ on disability severity and fall classification. Some gait adaptations could be part of adopting a more cautious gait strategy and should be factored into the design of future interventions.

Mindfulness-Based Interventions for the Improvement of Well-Being in People With Multiple Sclerosis: A Systematic Review and Meta-Analysis.

OBJECTIVE: The study aims to meta-analytically review studies about the effects of mindfulness-based interventions (MBIs) on well-being of people with multiple sclerosis (MS). METHODS: Seven electronic databases were searched from June 2018 to September 2018. A systematic review and a meta-analysis were conducted. RESULTS: Twenty-one studies were included in qualitative synthesis, and 10 studies were included in meta-analysis. MBIs are effective with an overall moderate effect size (Hedges' g = 0.70) in improving well-being in people with MS, with lasting effects at the follow-up (g = 0.55). In particular, MBIs demonstrated to highly reduce stress (g = 1.07) and to improve depression and anxiety symptoms with a moderate to large effect at postintervention (g = 0.77 and g = 0.63, respectively). CONCLUSIONS: MBIs represent a valid and effective mind-body intervention to improve the well-being of patients with MS. Further studies should investigate which components of MBIs could be more beneficial for patients with progressive MS. PROSPERO REGISTRATION: CRD42018099704.

Evaluating the feasibility and preliminary efficacy of a Cognitive Occupation-Based programme for people with Multiple Sclerosis (COB-MS): protocol for a feasibility cluster-randomised controlled trial.

BACKGROUND: Cognitive difficulties experienced by people with multiple sclerosis (MS) impact their quality of life and daily functioning, from childcare and work, to social and self-care activities. Despite the high prevalence of cognitive difficulties seen in MS, there is a lack of developed programmes that target cognition, while also supporting patients by helping them to function well in everyday life. The Cognitive Occupation-Based programme for people with MS (COB-MS) was developed as a holistic, individualised cognitive rehabilitation intervention. It addresses the wide-ranging symptoms and functional difficulties that present in MS, including the ability to maintain employment, social activities, home management and self-care. The aim of the current research is to evaluate the feasibility and preliminary efficacy of COB-MS for people with MS. The focus is on feasibility outcomes as well as functioning associated with cognitive difficulty and secondary outcomes related to cognition, fatigue and quality of life. METHODS: One hundred and twenty people with MS will be assigned to participate in either the COB-MS programme or a treatment as usual, wait-list control group as part of this single-blind, cluster-randomised controlled feasibility and preliminary efficacy trial of the COB-MS programme. The COB-MS group will participate in an eight-session occupational-based cognitive rehabilitation programme over 9 weeks. The primary outcome measure is the goal attainment scaling at 12 weeks. Participants will be assessed pre-intervention, post-intervention and at 12 weeks post-intervention and 6 months post-intervention. Qualitative evaluations of participants' perspectives will also be examined as part of the feasibility study. DISCUSSION: Results will provide recommendations for a future definitive trial of COB-MS, with respect to both feasibility and preliminary, clinical efficacy. In the event that results indicate efficacy, study findings will suggest that COB-MS requires consideration as a means of enhancing cognitive and daily functioning in people living with MS. TRIAL REGISTRATION: ISRCTN: ISRCTN11462710. Registered on 9 September 2019.

The effects of Clinical Pilates training on walking, balance, fall risk, respiratory, and cognitive functions in persons with multiple sclerosis: A randomized controlled trial.

CONTEXT: Multiple sclerosis (MS) is a chronic progressive and neurodegenerative disease. Exercise programs are needed to maintain and increase functional status in persons with MS (pwMS). Pilates exercises designed by a physiotherapist can enhance participation and functionality in pwMS. OBJECTIVE: The aim of this study was to investigate the effects of Clinical Pilates training on balance, walking, fall risk, respiratory, and cognitive functions in pwMS compared with an active comparator (home exercise training). DESIGN: This study was a randomized controlled study. SETTINGS: This study was designed by researchers at Dokuz Eylül University, Izmir, Turkey. PARTICIPANTS: Forty-two pwMS were included in this randomized controlled trial. MAIN OUTCOME MEASURES: Walking, core stability, balance confidence, respiratory muscle strength, and cognitive functions were assessed before and after the program. INTERVENTIONS: The participants were randomly divided into two groups. The Pilates exercises group (n = 21) received therapy weekly for 8 weeks along with a home exercise program. The home exercise group (n = 21) was given standardized exercises reflecting routine clinical practice. The program compliance was monitored by telephone calls once a week. RESULTS: There were no significant differences in walking speed (p = 0.096), perceived walking ability (p = 0.165), and fear of falling (p = 0.385) between the Pilates and home exercise groups. Clinical Pilates training was superior to the home exercise program in walking endurance (p = 0.001), postural stability (p = 0.028), core stability (p = 0.016), respiratory (maximum inspiratory pressure: p = 0.037, maximum expiratory pressure: p = 0.008), and cognitive functions (p = 0.001-0.007). Clinical Pilates training may be preferred as an alternative method to improve balance, walking, respiratory, and cognitive functions in pwMS.

Evaluating functional electrical stimulation (FES) cycling on cardiovascular, musculoskeletal and functional outcomes in adults with multiple sclerosis and mobility impairment: A systematic review.

BACKGROUND: People with Multiple Sclerosis (PwMS) are at an increased risk of diseases associated with low levels of physical activity (PA). Deconditioning may lead to an acceleration in the development of secondary complications from MS, impairing physical function and exacerbating disease progression. Functional Electrical Stimulation (FES) Cycling may provide a suitable lower limb exercise intervention for PwMS with mobility impairment. The effects of FES cycling on cardiovascular, musculoskeletal and functional outcomes for PwMS with mobility impairment are yet to be investigated to date. OBJECTIVE: The objective of this review was to systematically examine the outcomes of PwMS with mobility impairment following FES cycling intervention. METHODS: A systematic search of four electronic databases (MEDLINE, Web of Science, CINAHL and PEDro) from their inception to 8th January 2019 was performed. Inclusion criteria was (1) include human participants with definite diagnosis of MS (2) participants had to be aged 18 years or older (3) include participants with mobility impairment (determined as an average participant EDSS ≥ 6.0) (4) evaluate FES cycling as an intervention study. RESULTS: Initial searches found 1163 studies. 9 of which met the full inclusion criteria: 5 pre-post studies with no control group, 2 randomised controlled trials (RCTs), 1 retrospective study and 1 case study. Two studies had the same participant group and intervention but reported different outcomes. Outcome data was available for n = =76 unique participants, with n = =82 completing a FES cycling intervention. Of the n = =4 papers with clear dropout rates, pooled dropout rate was 25.81%. Two papers reported non-significant improvements in aerobic capacity following a FES cycling intervention. Four papers reported no change in lower limb strength and two papers reported significant reductions in spasticity post training. Four studies failed to provide information regarding adverse events with the other studies reporting n = =10 adverse events across 36 participants. CONCLUSION: Findings suggest FES cycle training may reduce CVD risk alongside trends for a reduction in spasticity post training, however the low quality of the literature precludes any definitive conclusions. FES cycle training appears to be well tolerated in PwMS with mobility impairment, with no serious adverse events.

Effects of Mindfulness-based interventions on physical symptoms in people with multiple sclerosis - a systematic review and meta-analysis.

BACKGROUND: Physical wellbeing is commonly impaired in people with multiple sclerosis (PwMS). This study aims to update our previous systematic review (2014) and conduct a meta-analysis on the efficacy of Mindfulness-based interventions (MBIs) for improving physical symptoms in PwMS. METHODS: In November 2017 we carried out systematic searches for eligible randomised controlled trials (RCTs) in seven major databases, updating our search in July 2018. We used medical subject headings and key words. Two independent reviewers used pre-defined criteria to screen, data extract, quality appraise, and analyse studies. The Cochrane Collaboration risk of bias tool was used to determine study quality. Physical wellbeing was the main outcome of interest. We used the random effects model for meta-analysis, reporting effect sizes as Standardised Mean Difference (SMD). This study is registered with PROSPERO: CRD42018093171. RESULTS: We identified 10 RCTs as eligible for inclusion in the systematic review (including 678 PwMS), whilst seven RCTs (555 PwMS) had data that could be used in our meta-analyses. In general, comorbidity, disability, ethnicity and socio-economic status were poorly reported. MBIs included manualised and tailored interventions, treatment duration 6-9 weeks, delivered face-to-face and online in groups and also individually. For fatigue, against any comparator SMD was 0.24 (0.08 - 0.41), I2=0%; against active comparators only, SMD was 0.10 (-0.14 - 0.34), I2=0%. For pain SMD was 0.16 (-0.46 - 0.79), I2=77%. Three adverse events occurred across all studies. CONCLUSIONS: MBIs appear to be an effective treatment for fatigue in PwMS. The optimal MBI in this context remains unclear. Further research into MBI optimisation, cost- and comparative-effectiveness is required.

Evaluating the effectiveness of cognitive rehabilitation on everyday memory in multiple sclerosis patients.

The aim was to determine the effectiveness of cognitive rehabilitation for everyday memory function in patients with multiple sclerosis. A total of 60 multiple sclerosis patients with cognitive impairment were randomly assigned to three groups, experimental, placebo and control. The groups were well matched in baseline characteristics. Everyday memory was assessed at baseline immediately post-intervention (8 weeks) and five weeks post-intervention. The experimental group received cognitive rehabilitation programme in 1-hour sessions on a weekly basis for 8 weeks. The placebo group received relaxation techniques on a weekly basis for eight weeks and the control group received no intervention. The results indicated that a cognitive rehabilitation programme had a positive effect on the everyday memory of patients in the experimental group post-intervention. However, there was no significant effect of intervention 5 weeks post-intervention. The present study demonstrated that cognitive rehabilitation had a positive effect on the everyday function of the multiple sclerosis patients. However, the effect did not last and that everyday memory function returned to its pre-intervention level.