Review of active therapeutic interventions in 255 people with multiple sclerosis undergoing inpatient rehabilitation
Photo by Markus Winkler / Unsplash
Key Takeaway
Consider the TI documentation catalogue for routine MNR in people with multiple sclerosis.
This source is a multicentre single-arm pragmatic clinical trial review focusing on people with multiple sclerosis undergoing multidisciplinary neurological rehabilitation. The scope includes active therapeutic interventions such as gait training, robot-assisted gait training, strength, task-oriented, dual-task, endurance, coordination, and balance training. The primary outcome assessed clinically meaningful effects on mobility, while secondary outcomes included mobility-related goal attainment and the development of a standardized documentation catalogue.
The main results indicate that over 88% of the 255 participants achieved or exceeded their therapy goals. Clinically meaningful changes were observed for the MSWS-12, Five Times Sit-to-Stand Test, and walking perception, speed, and distance. Goal achievers demonstrated significantly greater improvements in walking metrics than non-achievers. No difference was found between groups regarding sit-to-stand performance.
Safety data, including adverse events and discontinuations, were not reported. The authors note that the therapeutic intervention catalogue serves as a reliable and practical tool for documenting interventions in routine multidisciplinary neurological rehabilitation. Because this is a single-arm design without a comparator, causal inferences regarding the interventions are limited. Practice relevance is tempered by the absence of a control group and lack of reported safety information.
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View Original Abstract ↓
BACKGROUND: Improved understanding of effective therapeutic interventions (TI) is required to optimise mobility outcomes in people with multiple sclerosis (pwMS) undergoing multidisciplinary neurological rehabilitation (MNR). The primary objective was to explore clinically meaningful effects of active TI on mobility during inpatient MNR. Secondary objectives were to assess mobility-related goal attainment and to develop and evaluate a standardised TI documentation catalogue.
METHODS: A TI catalogue and manual were developed and refined based on moderate interrater reliability from 12 video-recorded therapy sessions rated by eight clinicians. Usability was assessed by 47 physiotherapists using the System Usability Scale (SUS). Mobility outcomes included the 12-item Multiple Sclerosis Walking Scale (MSWS-12), 2-Minute Walk Test (2 MWT), Five Times Sit-to-Stand Test (5-TSTS), and Timed 25-Foot Walk. Effect sizes were calculated for individual and group-based TI. Goal attainment was measured using Goal Attainment Scaling.
RESULTS: The TI catalogue showed good usability (mean SUS score 72.3). Significant improvements were observed across all mobility outcomes, with clinically meaningful changes for MSWS-12, 2MWT and 5-TSTS. Gait training variants, robot-assisted gait training, strength, task-oriented, dual-task, endurance, coordination, and balance training showed medium-to-large effect sizes. Goal achievers demonstrated significantly greater improvements in walking perception, speed, and distance than non-achievers, with no difference in sit-to-stand performance. Over 88% of 255 pwMS achieved or exceeded their therapy goals.
CONCLUSIONS: The TI catalogue is a reliable and practical tool for documenting TI in routine MNR. Several interventions, particularly stair gait training, strength training, and robot-assisted gait training, were associated with clinically meaningful mobility improvements in pwMS.
TRIAL REGISTRATION: The study was prospectively registered with the German Clinical Trials Register (DRKS00025216 and DRKS00030391).
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