Abstract
A prospective, randomized, three-arm, evaluator blinded study to demonstrate the feasibility of a telerehabilitation (TR) program in individuals with ambulatory deficits secondary to Multiple Sclerosis (MS) and evaluate its efficacy when compared to conventional on-site physical therapy (PT) was completed. Thirty participants were evaluated at baseline and randomized to one of three groups with intervention lasting 8 weeks: Group 1 (control)- customized unsupervised home-based exercise program (HEP) 5 days a week; Group 2 (TR)- remote PT supervised via audio/visual real-time telecommunication twice weekly; Group 3 (PT)- in-person PT at the medical facility twice weekly. Outcomes included patient reported outcomes (PROs) obtained through questionnaires, and measurements of gait and balance performed with bedside tests and a computerized system. Functional gait assessment improved from baseline in all three groups. There were no significant differences between the TR and the conventional PT groups for a variety of outcome measures. TR is a feasible method to perform PT in persons with MS and has comparable efficacy to conventional in-person PT as measured by patient reported outcomes and objective outcomes of gait and balance.
Highlights
A prospective, randomized, three-arm, evaluator blinded study to demonstrate the feasibility of a telerehabilitation (TR) program in individuals with ambulatory deficits secondary to Multiple Sclerosis (MS) and evaluate its efficacy when compared to conventional on-site physical therapy (PT) was completed
Gait dysfunction has been identified by persons with multiple sclerosis (MS) as the most concerning limitation (Cameron & Wagner, 2011; Heesen et al, 2008), and is a common manifestation with surveys establishing that 41% have ambulatory deficits and 54% experience imbalance (Larocca, 2011)
Participants were assigned to an unsupervised customized exercise program, or to supervised adaptable sessions with the treating physical therapist either through telecommunication or in-person, all lasting eight weeks, resulting in the three study groups: Group 1- unsupervised home-based exercise program (HEP) five days a week; Group 2- remote PT supervised via audio/visual real-time telecommunication twice weekly (TR group); Group 3- HEP plus in-person PT at the Oklahoma Medical Research Foundation (OMRF) Multiple Sclerosis Center of Excellence PT facility two times weekly (PT group)
Summary
A prospective, randomized, three-arm, evaluator blinded study to demonstrate the feasibility of a telerehabilitation (TR) program in individuals with ambulatory deficits secondary to Multiple Sclerosis (MS) and evaluate its efficacy when compared to conventional on-site physical therapy (PT) was completed. Functional improvement of established physical deficits can be achieved through different interventions to include neurorehabilitation methods such as physical therapy (PT) These treatments aim to reduce existing disabilities and increase functional independence. Access and adherence to specialized PT interventions are limited by a variety of factors such as availability, geographical location, mobility limitations, time constraint, transportation difficulties, health insurance coverage, and financial burden (Petajan & White, 1999; Rio et al, 2005). Addressing these barriers is an important and necessary step in improving patient care in MS. Performing the program in the home setting could facilitate adherence, adapt to the real life environment, improve self-reliability, and generate a therapeutic alliance with the caregiver
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