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Telerehabilitation in multiple sclerosis: results of a randomized, 3-arm, rater blinded, feasibility and efficacy pilot study; gait and balance report
Author(s):
G. Pardo
,
G. Pardo
Affiliations:
A. Thiessen
,
A. Thiessen
Affiliations:
C. Fjeldstad
C. Fjeldstad
Affiliations:
ECTRIMS Online Library. Pardo G. Sep 15, 2016; 146979; 120
Dr. Gabriel Pardo
Dr. Gabriel Pardo
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Abstract
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Abstract: 120

Type: Oral

Abstract Category: RIMS - Multi-disciplinary rehabilitation

Background: MS commonly results in physical and cognitive disability. Functional improvement of established physical deficits can be achieved through rehabilitation methods to include physical therapy (PT). Access to specialized rehabilitation services is limited due to a variety of factors (availability, geographical distance, mobility, transportation, financial). Telecommunication technology offers the capacity to supervise and direct a PT program remotely through audio and visual real-time communication.

Objectives: Demonstrate the feasibility of a tele-health rehabilitation program in individuals with ambulatory deficits secondary to MS and to evaluate its efficacy when compared to conventional physical therapy.

Methods: This was a single-center, prospective, randomized, three-arm, evaluator blinded, 8-week study. Thirty individuals were included (female 69%, mean age 54.7 years, RMS 60%. SPMS 23%, PPMS 17%, mean EDSS 4.3). A home-based exercise program (HEP) was performed unsupervised 5 days a week for 8 weeks. Interventions were as follows: Group 1- HEP alone; Group 2- HEP plus remote PT supervised via audio and visual real-time telecommunication 2-3 times per week; Group 3- HEP plus in-person PT at the medical facility 2-3 times per week. Outcomes were multiple measurements of gait and balance, and patient reported outcomes (reported separately). Selected outcomes were performed with a computerized system (Neurocom SmartBalance).

Results: Functional gait assessment improved in all groups from baseline (group 1 p=0.0002, group 2 p=0.0006, group 3 p=0.009) and were no different between the telerehabilitation and the conventional PT groups (p=0.73). Other outcomes that were similar for groups 2 and 3 were: Gait- T25FW p=0.95, stride length p=0.64; Balance- Berg balance scale p=0.98, step width p=0.91, tandem sway p=0.78, tandem width p=0.24, limits of stability p=0.90, sensory organization test p=0.92. One participant dropped out due to an MS relapse.

Conclusions:
Telerehabilitation is a convenient and practical method to perform PT in MS individuals and has comparable efficacy to conventional in-person PT as measured by objective outcomes of gait and balance. Patient-reported outcomes were also favorable and are presented separately. Telerehabilitation should be researched further and used more extensively as a mean to improve function and quality of life in MS.

Disclosure:

Gabriel Pardo, MD: nothing to disclose.

Amy Thiessen, PT: nothing to disclose.

Cecilie Fjeldstad, PhD: nothing to disclose.

This project was funded in part by the National Multiple Sclerosis Society

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