Physiotherapy and exercise interventions for people with multiple sclerosis with minimal gait impairment

Multiple Sclerosis (MS) is a demyelinating, degenerative disease of themcentral nervous system. It is the leading cause of disability in young adults for which there is no cure. In a disease that has no cure, minimising its impact is arguably the main goal of intervention. The literature review demonstrated that exercise results in many important outcomes for People with MS (PwMS) with minimal gait impairment. However no community-based interventions have been evaluated. A large (N = 372), multi-centred, block-randomised, waiting list controlled trial was conducted with the primary objective of establishing the efficacy of three community-based exercise interventions. These were Physiotherapy (PT)-led exercise, Yoga and Fitness Instructor (FI)-led exercise delivered over an hour a week for ten weeks. The second objective was to establish if there was a difference between interventions. The third objective was to investigate the results at 3-month follow-up. The final objective was to establish predictors of outcome after the intervention period. Outcomes used were the Multiple Sclerosis Impact Scale-29, v 2 (MSIS-29, v2), the Modified Fatigue Impact Scale (MFIS) and the Six Minute Walk Test (6MWT). This study found that there was a significant improvement in the MSIS-29, v2 and the MFIS due to all interventions (p<0.05) and no change in the control. There was a significant improvement in the 6MWT due to PT-led and FI-led exercise interventions. There was no change in 6MWT in the Yoga group (p>0.05) and a trend towards worsening in the control. There were significant differences between the PT-led group and yoga (p<0.05) and FI-led exercise and yoga (p<0.05). At 3 month follow-up there was a statistically significant worsening of all of the positive findings. However outcomes remained significantly improved from baseline for the MSIS-29, v 2 (psychological component) and for the MFIS (p<0.05). Fifty-seven per cent of the variance in outcome was accounted for through five predictor variables. This study demonstrated important outcomes for PwMS. These findings suggest that some of the needs for PwMS with minimal gait impairment can be met in community settings which may ease the burden of health service delivery. This challenges the current model of one to one pysiotherapy in a medical setting. Future research should attend to developing interventions to increase long term exercise participation and explore other variables that may influence outcome.