Physiotherapy and exercise interventions for the treatment of people with multiple sclerosis with moderate to severe mobility impairment

Multiple sclerosis (MS) is a disease of the central nervous system. It is characterised by both demyelination and degeneration. It is progressive in nature and can lead to severe disability, functional limitations and a poor quality of life (QoL). Many people with MS (PwMS) live with some form of physical impairment. Physiotherapy plays an important role in the management of physical symptoms. A review of the literature highlighted that a multitude of physiotherapy and exercise interventions have been evaluated in PwMS. These studies, however, included PwMS with varying levels of mobility. No randomised controlled trial has previously evaluated the effect of a physiotherapy intervention specifically on PwMS with moderate to severe mobility impairment. The overall aim of this research was to evaluate the effect of three community based interventions on PwMS who mobilise with at least bilateral assistance. Participants (n=111) were allocated to ten weekly hour long sessions of group physiotherapy, individual physiotherapy, yoga or a control group. The effect of treatment was analysed using baseline and post intervention (Week 12) data. The data at follow up (Week 24) was analysed separately. A post hoc analysis was performed to explore the variables that may influence outcome. Outcomes measures used at each time point were the Multiple Sclerosis Impact Scale-29v2 (MSIS- 29v2), Modified Fatigue Impact Scale (MFIS), Berg Balance Scale (BBS), and the six minute walk test (6MWT). The study revealed that there was a significant treatment effect for group physiotherapy, individual physiotherapy and yoga on the BBS (p<0.05). There were significant improvements on the MSIS-29v2 and the MFIS for group and individual physiotherapy (p<0.05). There was a trend for worsening for yoga and a trend for improvement in the control group. There was a significant improvement on the 6MWT for individual physiotherapy and a trend for improvement for group physiotherapy. These improvements were not maintained at week 24. Baseline scores on the BBS and sensation contributed significantly to a higher score on the BBS at outcome. The results of the analysis on falls revealed a high prevalence of falls in this cohort, a significant reduction in the number of falls and fallers post intervention for group physiotherapy. The results of this research suggest group physiotherapy is as effective as individual physiotherapy in improving balance, impact of MS and fatigue and in reducing falls. This has implications for service delivery for this population of PwMS. Group therapy may reduce the financial cost for health care providers and have added benefits for PwMS. These results need to be confirmed by comparing them to a larger, matched control group. Future research needs to establish the effect of yoga in PwMS with moderate to severe mobility limitations and other variables that may predict outcome need to be explored.