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Marand LA, Roohi-Azizi M, Dehkordi SN. The relationship between trunk function and spasticity in people with multiple sclerosis. J Bodyw Mov Ther 2025; 42:162-166. [PMID: 40325663 DOI: 10.1016/j.jbmt.2024.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 11/11/2024] [Accepted: 12/08/2024] [Indexed: 05/07/2025]
Abstract
BACKGROUND As People with multiple sclerosis (PWMS) experience greater disability, their ability to control their trunk diminishes, indicating that trunk control should be a focus as the disease advances. Spasticity is another complication that leads to disability in people with multiple sclerosis is spasticity. Patients who do not have proper trunk control and an inappropriate length-tension relationship have less capacity for lower extremity movements and high tonicity in the lower limb muscles. METHODS Sixty-six women and men with multiple sclerosis between the ages of 20-50 who have moderate disability participated in this study. An evaluation of the relationship between trunk control and spasticity has been carried out. Trunk motor control was assessed using the Trunk Impairment Scale (TIS) and spasticity was assessed using the Multiple Sclerosis Spasticity Scale-88 (MSSS-88). Trunk motor control was assessed with the Trunk Impairment Scale (TIS) and spasticity with the Multiple Sclerosis Spasticity Scale 88 (MSSS-88). RESULTS The MSSS-88 total score was negatively correlated with the TIS score (b = -0.011, 95% CI: 0.018 to -0.003, P = 0.006). A 1-point increase in the MSSS-88 total score was associated with a 0.011-point decrease in the TIS score. CONCLUSION It was revealed that the Trunk function was associated with spasticity in PWMS. The core function has an inverse relationship with spasticity. The better the core functions of PWMS, the less spasticity they will have.
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Affiliation(s)
- Laleh Abadi Marand
- Neuromusculoskeletal Rehabilitation Research Center, University of Social Welfare and Rehabilitation sciences, Tehran, Iran
| | - Mahtab Roohi-Azizi
- Rehabilitation Research Center, Department of Basic Sciences in Rehabilitation, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Shohreh Noorizadeh Dehkordi
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Özbaş E, Fil Balkan A, Salcı Y, Akyol B, Acar Özen NP, Tuncer MA. Reliability and validity of the community balance and mobility scale in individuals with multiple sclerosis. Acta Neurol Belg 2025; 125:385-393. [PMID: 39704738 DOI: 10.1007/s13760-024-02701-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Accepted: 12/13/2024] [Indexed: 12/21/2024]
Abstract
AIMS This study aims to evaluate the reliability and validity of the Community Balance and Mobility Scale (CB&M) in people with multiple sclerosis (PwMS). METHODS A total of 65 PwMS (Expanded Disability Status Scale (EDSS) ≤ 5.5) were included in the study. Test-retest, internal consistency (item-total score correlation, Cronbach's alpha coefficient) intra-rater, and inter-rater reliability were investigated for the reliability of the CB&M. For intra-rater and inter-rater reliability, CB&M measurements of 34 PwMS were videotaped. The validity of the CB&M was assessed through criterion (predictive and concurrent validity) and construct validity. Construct validity was evaluated using hypothesis testing which included examining correlations with EDSS, Timed Up and Go Test (TUG), and Dynamic Gait Index (DGI). RESULTS Test-retest reliability demonstrated a good to excellent correlation (ICC = 0.995, p < 0.001). Cronbach's alpha was 0.971 (p < 0.001). Intra-rater (ICC = 0.993, p < 0.001) and inter-rater reliability (ICC = 0.986, p < 0.001) of the CB&M were also good to excellent. Cohen's kappa range values of the scale vary between 0.958 - 0.665, and the percentage agreement varies between 97% and 75%. For the convergent validity of CB&M, strong correlations were observed with EDSS (r=-0.831, p < 0.001), TUG (r=-0.854, p < 0.001), and DGI (r = 0.865, p < 0.001). Additionally, the CB&M demonstrated an excellent correlation with the BBS (r = 0.907, p < 0.001). The scale exhibited no floor-ceiling effect. CONCLUSION CB&M is a reliable and valid tool for assessing balance and mobility in PwMS and offers significant advantages for evaluating balance in PwMS, as it provides comprehensive information about the balance and mobility requirements essential for community living.
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Affiliation(s)
- Ezgi Özbaş
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey.
- Institute of Health Sciences, Neurology Physiotherapy Doctorate Program, Hacettepe University, Samanpazari, Ankara, 06230, Turkey.
| | - Ayla Fil Balkan
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Yeliz Salcı
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Betül Akyol
- Faculty of Sport Sciences, Inonu University, Malatya, Turkey
| | | | - Meryem Aslı Tuncer
- Faculty of Medicine, Neurology Department, Hacettepe University, Ankara, Turkey
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Deodato M, Fornasaro M, Martini M, Zelesnich F, Sartori A, Galmonte A, Buoite Stella A, Manganotti P. Comparison of different telerehabilitation protocols for urogenital symptoms in females with multiple sclerosis: a randomized controlled trial. Neurol Sci 2024; 45:5501-5509. [PMID: 39223424 PMCID: PMC11470853 DOI: 10.1007/s10072-024-07742-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024]
Abstract
Telerehabilitation has been suggested to be equally effective than in-person rehabilitation, and could be helpful to increase participation and reduce barriers. People with multiple sclerosis (MS) often present urogenital dysfunctions, impairing independence and quality of life (QoL). Since the different available telerehabilitation protocols, the present study aimed to compare a live video urogenital rehabilitation intervention protocol (REMOTE) with a home-based pre-recorded video protocol (SELF). A randomized-controlled trial was performed, with 14 females with MS being allocated in the REMOTE group (36 ± 9 y) and 14 females in the SELF group (37 ± 7 y). Both telerehabilitation protocols were identical in terms of contents (including pelvic floor training and relaxation exercises), frequency and duration, consisting of 10 sessions of 45 min each, every 5 days. Questionnaires were administered at the beginning and the end of the study: Short Form Health Survey 36 (SF-36), Beck Depression Inventory (BDI), Female Sexual Function Index (FSFI), International Consultation on Incontinence Questionnaire (ICIQ) symptoms and related QoL, the main outcome being ICIQ incontinence score. Despite most of the outcomes improved in both groups, REMOTE was found to be more effective than SELF in most of the SF-36 domains (from p < 0.001 pη2 0.555 to p = 0.044 pη2 0.147), FSFI (p = 0.001 pη2 0.373), ICIQ (p = 0.003 pη2 0.291). Despite the home-based pre-recorded videos could be effective in improving urogenital symptoms, live video urogenital rehabilitation results in larger improvements. Telerehabilitation should be encouraged for urogenital dysfunctions in females with MS, and pre-recorded videos could represent an alternative when live sessions are not available. Clinical trial registration This randomized controlled trial was registered on ClinicalTrials.gov with the number NCT05984095.
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Affiliation(s)
- Manuela Deodato
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34100, Trieste, Italy
| | - Mia Fornasaro
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34100, Trieste, Italy
| | - Miriam Martini
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34100, Trieste, Italy
- PhD program in Personalized Medicine and Innovative Therapies, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Francesca Zelesnich
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34100, Trieste, Italy
| | - Arianna Sartori
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital (ASUGI), University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Alessandra Galmonte
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34100, Trieste, Italy
| | - Alex Buoite Stella
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34100, Trieste, Italy.
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital (ASUGI), University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy.
| | - Paolo Manganotti
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34100, Trieste, Italy
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital (ASUGI), University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
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Amatya B, Khan F, Song K, Galea M. Effectiveness of Non-Pharmacological Interventions for Spasticity Management in Multiple Sclerosis: A Systematic Review. Ann Rehabil Med 2024; 48:305-343. [PMID: 39497494 PMCID: PMC11540453 DOI: 10.5535/arm.240064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 08/26/2024] [Accepted: 09/05/2024] [Indexed: 11/08/2024] Open
Abstract
This systematic review aims to determine the effectiveness of non-pharmacological interventions for the management of spasticity in people with multiple sclerosis (pwMS). A comprehensive literature search in health science databases (MEDLINE, Embase, CENTRAL, CINHAL) was performed to identify randomized controlled trials (RCTs) (up to April 2024). Manual searching in journals and screening of the reference lists of identified studies were conducted. Two authors independently selected the studies, assessed the methodological quality, and summarized the evidence. A meta-analysis was not feasible due to the methodological, clinical, and statistical diversity of the included studies. Overall, 32 RCTs (n=1,481 participants) investigated various types of non-pharmacological interventions including: physical activity, transcranial magnetic stimulation (intermittent theta burst stimulation [iTBS], repetitive transcranial magnetic stimulation [rTMS]), electromagnetic therapy, transcutaneous electrical nerve stimulation, vibration therapy, shock wave therapy, self-management educational programs, and acupuncture. All studies scored 'low' on the methodological quality assessment, implying a high risk of bias. The findings suggest 'moderate to low certainty' evidence for physical activity programs used in isolation or combination with other interventions (pharmacological or non-pharmacological), and for iTBS/rTMS with or without adjuvant exercise therapy in improving spasticity in adults with MS. There is 'very low certainty' evidence supporting the use of other modalities for treating spasticity in this population. Despite a wide range of non-pharmacological interventions used for the management of spasticity in pwMS, there is a lack of conclusive evidence for many. More robust trials with larger sample sizes and longer-term follow-ups are needed to build evidence for these interventions.
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Affiliation(s)
- Bhasker Amatya
- Department of Rehabilitation Medicine, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Rehabilitation, Peter MacCallum Cancer Centre, Parkville, Australia
- Australian Rehabilitation Research Centre, Royal Melbourne Hospital, Parkville, Australia
| | - Fary Khan
- Department of Rehabilitation Medicine, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Rehabilitation, Peter MacCallum Cancer Centre, Parkville, Australia
- Australian Rehabilitation Research Centre, Royal Melbourne Hospital, Parkville, Australia
| | - Krystal Song
- Department of Rehabilitation Medicine, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Australian Rehabilitation Research Centre, Royal Melbourne Hospital, Parkville, Australia
| | - Mary Galea
- Department of Rehabilitation Medicine, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Australian Rehabilitation Research Centre, Royal Melbourne Hospital, Parkville, Australia
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Choobsaz H, Sangtarash F, Javaherian M, Hadizadeh M. Investigating the effects of core stability training on balance and gait in people with multiple sclerosis: A systematic review and meta-analysis. Mult Scler Relat Disord 2024; 87:105686. [PMID: 38850684 DOI: 10.1016/j.msard.2024.105686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/21/2024] [Accepted: 05/13/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND AND OBJECTIVES Balance disorders are a common concern in people with multiple sclerosis (PwMS). Core stability exercises are recommended as one of the treatment principles of rehabilitation in patients with balance disorders. This systematic review and meta-analysis investigate the effects of core stabilization exercises (CSE) on balance in PwMS. METHODS Online databases were searched from 1980 to December 15, 2022, including PubMed/Medline, Scopus, Web of Science, CINAHL, PEDro, Embase, and ProQuest to identify randomized controlled trials (RCTs) investigating the effects of CSE on balance in PwMS. The methodological qualities of the included studies were assessed using the modified Cochrane risk bias tool for randomized trials. Random-effect meta-analyzes were performed on the Berg balance test and Biodex balance system outcomes. RESULTS Seven RCTs were included in this study. A total of 379 patients (EDSS<6) were enrolled in the included studies. All researchers had applied CSE within six to ten weeks with the frequency of two to three sessions/week. According to qualitative results, core stability exercise significantly changes the most balanced outcomes. The meta-analyses illustrated that allocated participants to experimental groups had statistically significantly higher Berg balance test scores (standardized mean difference: 1.1; 95 % CI: [0.1, 2.1]) and insignificant lower Biodex score (standardized mean difference: -0.59; 95 % CI: [-1.09, -0.09]) compared to the control groups. CONCLUSION Six to ten weeks of CSEs is an effective therapeutic strategy for balance improvement in PwMS that can help improve balance, especially in patients with moderate disability levels (EDSS3.5-6). Further randomized clinical trials are needed to compare the efficacy of CSEs and routine balance training in PwMS.
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Affiliation(s)
- Haniyeh Choobsaz
- Liver Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Sangtarash
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Javaherian
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | - Monavar Hadizadeh
- Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Du L, Xi H, Zhang S, Zhou Y, Tao X, Lv Y, Hou X, Yu L. Effects of exercise in people with multiple sclerosis: a systematic review and meta-analysis. Front Public Health 2024; 12:1387658. [PMID: 38660348 PMCID: PMC11039920 DOI: 10.3389/fpubh.2024.1387658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 03/26/2024] [Indexed: 04/26/2024] Open
Abstract
Background A growing body of studies have examined the effect of exercise in people with multiple sclerosis (MS), while findings of available studies were conflicting. This meta-analysis aimed to explore the effects of exercise on balance, walking ability, walking endurance, fatigue, and quality of life in people with MS. Methods We searched PubMed, Web of Science, Scopus, and Cochrane databases, through March 1, 2024. Inclusion criteria were: (1) RCTs; (2) included an intervention and control group; (3) had people with MS as study subjects; (4) had balance, walking ability, walking endurance, fatigue, or quality of life as the outcome measures. Exclusion criteria were: (1) non-English publications; (2) animal model publications; (3) review articles; and (4) conference articles. A meta-analysis was conducted to calculate weighted mean difference (WMD) and 95% confidence interval (CI). Cochrane risk assessment tool and Physiotherapy Evidence Database (PEDro) scale were used to evaluate the methodological quality of the included studies. Results Forty studies with a total of 56 exercise groups (n = 1,300) and 40 control groups (n = 827) were eligible for meta-analysis. Exercise significantly improved BBS (WMD, 3.77; 95% CI, 3.01 to 4.53, P < 0.00001), TUG (WMD, -1.33; 95% CI, -1.57 to -1.08, P < 0.00001), MSWS-12 (WMD, -2.57; 95% CI, -3.99 to -1.15, P = 0.0004), 6MWT (WMD, 25.56; 95% CI, 16.34 to 34.79, P < 0.00001), fatigue (WMD, -4.34; 95% CI, -5.83 to -2.84, P < 0.00001), and MSQOL-54 in people with MS (WMD, 11.80; 95% CI, 5.70 to 17.90, P = 0.0002) in people with MS. Subgroup analyses showed that aerobic exercise, resistance exercise, and multicomponent training were all effective in improving fatigue in people with MS, with resistance exercise being the most effective intervention type. In addition, a younger age was associated with a larger improvement in fatigue. Furthermore, aerobic exercise and multicomponent training were all effective in improving quality of life in people with MS, with aerobic exercise being the most effective intervention type. Conclusion Exercise had beneficial effects in improving balance, walking ability, walking endurance, fatigue, and quality of life in people with MS. Resistance exercise and aerobic exercise are the most effective interventions for improving fatigue and quality of life in people with MS, respectively. The effect of exercise on improving fatigue was associated with the age of the participants, with the younger age of the participants, the greater the improvement in fatigue. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=371056, identifier: CRD42022371056.
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Affiliation(s)
- Liwen Du
- Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport University, Beijing, China
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
| | - Haoyu Xi
- Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport University, Beijing, China
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
| | - Shiyan Zhang
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
| | - Yilun Zhou
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
| | - Xifeng Tao
- School of Physical Education, Xihua University, Chengdu, China
| | - Yuanyuan Lv
- China Institute of Sport and Health Science, Beijing Sport University, Beijing, China
| | - Xiao Hou
- Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport University, Beijing, China
- School of Sport Sciences, Beijing Sport University, Beijing, China
| | - Laikang Yu
- Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport University, Beijing, China
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
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