Effects of Robot-Assisted Gait Training in Patients With Multiple Sclerosis: A Single-Blinded Randomized Controlled Study

Technology-Based Physical Rehabilitation for Balance in Patients With Multiple Sclerosis: A Systematic Review and Meta-analysis

OBJECTIVE

To synthesize the current evidence on technology-based physical rehabilitation for balance in people with multiple sclerosis and to compare its effectiveness with that of conventional physical therapy.

DATA SOURCES

A comprehensive search of databases including CENTRAL Scopus, CINAHL, PsycINFO, PubMed, and PEDro was conducted up to March 2024.

STUDY SELECTION

Studies were selected based on predefined inclusion criteria.

DATA EXTRACTION

Data extraction and quality assessment were performed independently by 2 reviewers. Statistical analyses were conducted using a random effects model.

DATA SYNTHESIS

A total of 24 studies involving 985 participants were included. The meta-analysis revealed that compared with conventional physical therapy, technology-based physical rehabilitation significantly improved balance outcomes by 0.16 (95% CI, 0.04- 0.29; P=.027) with moderate heterogeneity (I²=39.1%). Subgroup analyses were performed by intervention modality (robotic assistive gait training, exergaming, and telerehabilitation), and only exergaming interventions had a medium effect on balance in this population of 0.29 (95% CI, 0.08-0.251; P=.03).

CONCLUSIONS

Among technology-based physical rehabilitation approaches, exergaming interventions have shown promising effectiveness in improving balance in people with multiple sclerosis. Despite the moderate heterogeneity, the findings support the use of exergaming as a viable option. Further high-quality randomized controlled trials are needed to confirm these results.

Robotic assisted and exoskeleton gait training effect in mental health and fatigue of multiple sclerosis patients. A systematic review and a meta-analysis

PURPOSE

Robotic and Exoskeleton Assisted Gait Training (REAGT) has become the mainstream gait training module. Studies are investigating the psychosocial effects of REAGT mostly as secondary outcomes. Our systematic review and meta-analysis aims to investigate the effects of REAGT in MS patients' mental health and fatigue.

MATERIALS AND METHODS

We searched the electronic databases (Scopus, PubMed, Pedro, Cochrane Trials, Dare) for RCT studies fulfilling our inclusion criteria. A meta-analysis of available assessment tools was conducted calculating the summary mean differences in two different timepoints, before and after the intervention using random-effects models.

RESULTS

The systematic search of the electronic databases identified 302 studies. Seven RCT studies were considered eligible for data extraction and meta-analysis, according to our eligibility criteria. We were able to obtain adequate data to proceed with a quantitative synthesis for QoL SF36-MC (Mental Component), QoL SF-36 mental and psychosocial subscales, Multiple Sclerosis Quality of Life-54-Mental Health Composite (MSQoL-54-MHC), Patient's Health Questionnaire (PHQ-9) and Fatigue Severity Scale (FSS).

CONCLUSIONS

Overall, REAGT seems to have a positive effect to Quality of Life, especially in MS patients' perspective of General and Mental Health and a slight positive effect in depression as measured by PHQ-9.Implications for rehabilitationMultiple Sclerosis (MS) decreases physical and non-physical aspects of patients' quality of life perspective.Rehabilitation strategy must take into consideration the non-physical effects of a training intervention.Robotic and Exoskeleton Gait Training has a positive effect in MS patients' non-physical quality of life and a slight positive effect in depression.

Effectiveness of robotic rehabilitation for gait and balance in people with multiple sclerosis: a systematic review

This review investigated the effectiveness of robotic-assisted gait training (RAGT) in improving gait and balance performance in adults with multiple sclerosis (MS). Databases and registers were searched from inception to December 2023 to identify randomized controlled trials (RCTs) that analyzed the effects of RAGT on gait speed, function, balance, fatigue, and adverse events. Three reviewers screened studies for eligibility and extracted key information such as participants and intervention characteristics, as well as outcomes of interest. The reviewers assessed the risk of bias of included studies using Cochrane Risk of Bias tool. From the 948 records identified, 8 RCTs were included, involving 335 participants. The studies have demonstrated significant heterogeneity in patient characteristics, intervention protocols, and outcomes measured. The risk of bias assessment revealed concerns, mainly in terms of performance and detection bias. The evidence is uncertain on the effectiveness of RAGT on balance and gait in people with MS, but a multimodal rehabilitation approach, including RAGT, should be encouraged. No serious adverse events seem to be associated with RAGT, suggesting that these interventions are generally safe for use in people with MS. Further studies of higher methodological quality should be led to confirm these positive results.

Effects of non-pharmacological interventions on gait and balance of persons with Multiple Sclerosis: A narrative review

BACKGROUND

Multiple Sclerosis (MS) is among the most common reasons for disability in young adults. Mobility impairment, primarily related to gait and balance, is ranked as the preeminent concern among persons with MS (PwMS). Gait and balance dysfunction can directly affect the quality of life and activities of daily life in PwMS, hence the importance of effective treatment strategies. Previous studies have demonstrated the positive effect of various non-pharmacological rehabilitation methods, including physiotherapy and electrical stimulation, on gait and mobility in PwMS. Non-pharmacological methods can be tailored to the individual needs and abilities of each patient, allowing healthcare providers to create personalized training programs. Furthermore, these methods typically result in minimal or no side effects.

PURPOSE

This review provides a comprehensive overview of an array of non-pharmacological treatment approaches aimed at enhancing ambulatory performance in PwMS.

METHODS

We performed a narrative review of the original papers available in PubMed, investigating the effects of different nonmedical approaches on the gait and balance performance of the PwMS. Reviewed treatment approaches include "exercise, physical rehabilitation, dual-task (DT) rehabilitation, robot-assisted rehabilitation, virtual reality-assisted rehabilitation, game training, electrical stimulation devices, auditory stimulation, visual feedback, and shoe insoles".

RESULTS AND CONCLUSIONS

Eighty articles were meticulously reviewed. Our study highlights the positive effects of non-pharmacological interventions on patients' quality of life, reducing disability, fatigue, and muscle spasticity. While some methods, including exercise and physiotherapy, showed substantial promise, further research is needed to evaluate whether visual biofeedback and auditory stimulation are preferable over conventional approaches. Additionally, approaches such as functional electrical stimulation, non-invasive brain stimulation, and shoe insoles demonstrate substantial short-term benefits, prompting further investigation into their long-term effects. Non-pharmacological interventions can serve as a valuable complement to medication-based approaches.

Combining robot-assisted therapy with virtual reality or using it alone? A systematic review on health-related quality of life in neurological patients

BACKGROUND

In the field of neurorehabilitation, robot-assisted therapy (RAT) and virtual reality (VR) have so far shown promising evidence on multiple motor and functional outcomes. The related effectiveness on patients' health-related quality of life (HRQoL) has been investigated across neurological populations but still remains unclear. The present study aimed to systematically review the studies investigating the effects of RAT alone and with VR on HRQoL in patients with different neurological diseases.

METHODS

A systematic review of the studies evaluating the impact of RAT alone and combined with VR on HRQoL in patients affected by neurological diseases (i.e., stroke, multiple sclerosis, spinal cord injury, Parkinson's Disease) was conducted according to PRISMA guidelines. Electronic searches of PubMed, Web of Science, Cochrane Library, CINAHL, Embase, and PsychINFO (2000-2022) were performed. Risk of bias was evaluated through the National Institute of Health Quality Assessment Tool. Descriptive data regarding the study design, participants, intervention, rehabilitation outcomes, robotic device typology, HRQoL measures, non-motor factors concurrently investigated, and main results were extracted and meta-synthetized.

RESULTS

The searches identified 3025 studies, of which 70 met the inclusion criteria. An overall heterogeneous configuration was found regarding the study design adopted, intervention procedures and technological devices implemented, rehabilitation outcomes (i.e., related to both upper and lower limb impairment), HRQoL measures administered, and main evidence. Most of the studies reported significant effects of both RAT and RAT plus VR on patients HRQoL, whether they adopted generic or disease-specific HRQoL measures. Significant post-intervention within-group changes were mainly found across neurological populations, while fewer studies reported significant between-group comparisons, and then, mostly in patients with stroke. Longitudinal investigations were also observed (up to 36 months), but significant longitudinal effects were exclusively found in patients with stroke or multiple sclerosis. Finally, concurrent evaluations on non-motor outcomes beside HRQoL included cognitive (i.e., memory, attention, executive functions) and psychological (i.e., mood, satisfaction with the treatment, device usability, fear of falling, motivation, self-efficacy, coping, and well-being) variables.

CONCLUSIONS

Despite the heterogeneity observed among the studies included, promising evidence was found on the effectiveness of RAT and RAT plus VR on HRQoL. However, further targeted short- and long-term investigations, are strongly recommended for specific HRQoL subcomponents and neurological populations, through the adoption of defined intervention procedures and disease-specific assessment methodology.

Relationship of Motor Impairment with Cognitive and Emotional Alterations in Patients with Multiple Sclerosis

Introduction. Multiple sclerosis (MS) is a neurodegenerative disease that, despite mainly affecting women, is more severe in men and causes motor, cognitive and emotional alterations. The objective of this study was to determine the possible relationship between motor, cognitive and emotional alterations. Materials and Methods. This is a descriptive, observational and cross-sectional study, with 67 patients with MS (20 men and 47 women), who were given the following questionnaires: Expanded Disability Status Scale (EDSS), Two-Minute Walk Test (2MWT), Berg Balance Scale, Beck’s Depression Inventory (BDI-II), State-Trait Anxiety Inventory (STAI) and Prefrontal Symptoms Inventory (PSI) to analyze their cognitive level, body mass index (BMI) and percentage of muscle mass. In addition, regression analysis was conducted to study the relationship among variables. Results. No significant differences were found between men and women in any of the variables. Regarding the relationship between parameters, the regression analysis was statistically significant, showing an effect of age on the walking and balance performance (β ≅ −0.4, p < 0.05); in addition, there was a relationship between 2MWT and STAI A/S, indicating that both older age and a high anxiety state could impact walking performance. On the other hand, prefrontal symptoms showed moderate relationships with both anxiety and depression (β ≅ 0.6, p < 0.05); thus, high levels of anxiety and depression could increase prefrontal alterations. Conclusions. There is a relationship between motor and emotional variables. Specifically, state anxiety is related to walking resistance. No relationship was found between depression and cognitive alteration and balance or walking ability. Only age has an effect in these relationships.

The effect of therapeutic exercise on depressive symptoms in people with multiple sclerosis - A systematic review

BACKGROUND

The prevalence of depressive symptoms in people with Multiple Sclerosis (MS) is around 25 - 50% and affects their daily life and general quality of life. Several studies investigating therapeutic exercise have shown highly beneficial effects in preventing or reducing depressive symptoms. The present systematic review was conducted to investigate randomized controlled trials on the effectiveness of therapeutic exercise programs on depressive symptoms in people with MS.

METHODS

A search was performed in PubMed, Scopus, APA Psychnet and ResearchGate. The keywords used were: therapeutic exercise, physiotherapy, physiotherapy, physical therapy, rehabilitation, depression, depressive disorders and multiple sclerosis. In addition, specific inclusion and exclusion criteria were set and the study selection process was conducted by two separate reviewers. The quality of the final studies included in the systematic review was assessed using the PEDro scale.

RESULTS

Out of the total of 934 studies initially identified, 9 studies were finally included. The results showed that physiotherapy interventions, through aerobic exercise, robotic-assisted gait training with or without virtual reality, aerobic exercise combined with Pilates, interval training, video-games and finally clinical Pilates, improve patients' depression and in many cases with much better results compared to classic physiotherapy type interventions.

CONCLUSION

The effect of therapeutic exercise has a positive impact on the depressive symptoms of people with MS. However, future research in this field is necessary to find the most proven curative forms to reduce depressive symptoms and improve the daily life of these patients.