To evaluate the effectiveness of mobile health applications (mHealth apps) containing a physical training component on physical function and physical activity in stroke rehabilitation.
A systematic ...literature search was conducted in three databases for studies published from inception to 12 July 2022. Clinical trials including mHealth apps with a physical training component were included using outcomes of physical function and physical activity. Quality of life was extracted as a secondary outcome.
Five RCTs, two non-RCTs, and four uncontrolled clinical trials were included with a total of 264 stroke survivors. Eleven apps were identified with a physical training component using features of gamification (six apps), exercise prescription (three apps), and physical activity (two apps). Six out of seven studies reported statistically significant improvements in physical function in favor of the experimental group, with the most robust findings for upper extremity function. For physical activity, statistically significant improvements were seen in the experimental groups. Only one study showed significant improvement in quality of life. Overall study quality was fair.
mHealth apps containing a physical training component are promising for physical function and physical activity in stroke rehabilitation. Further research is warranted to confirm these conclusions.
Implications for rehabilitation
Design content of mobile apps with a physical training component were focused on gamification, exercise prescription, and physical activity
Using mobile app-delivered therapy seem promising for improving upper extremity function in stroke rehabilitation
Using mobile apps also supported an increase of physical activity in people with stroke
Studies using mobile apps should report more specifically the dosage of physical training and adherence
Using mobile apps seems promising as an additional tool for clinical work, however, more studies are required to understand their effectiveness in stroke rehabilitation.
The severity of walking impairment in persons with multiple sclerosis (pwMS) at different levels on the expanded disability status scale (EDSS) is unclear. Furthermore, it is unclear if the EDSS is ...differently related to performed- and perceived walking capacity tests.
To quantify walking impairment and perceived impact of MS on walking according to EDSS scores and to examine the relations between these parameters in pwMS.
EDSS was collected by neurologists and walking was assessed by the timed 25ft walk test (T25FWT), two minute walk test (2MWT), six minute walk test (6MWT) and the 12-item MS walking scale (MSWS-12) in 474 PwMS with mild (EDSS 1–4: n=200) to moderate (EDSS 4.5–6.5: n=274) MS. Magnitude of walking impairment was calculated and related to EDSS.
Compared to predicted values in healthy controls, walking speed was reduced by 41.5±25.8% in the 6MWT for the total MS group and by 21.8±20.2% and 55.8±19.1% in the mild and moderate MS subgroups, respectively. The EDSS score showed the strongest relationship to the 2MWT and the 6MWT in the total MS group (r=−0.76, p<0.0001), to the MSWS-12 score in the mild MS group (r=0.56, p<0.0001), and to the 2MWT in the moderate MS group (r=−0.50, p<0.0001).
In pwMS (EDSS scores 1–6.5), walking speed is on average reduced by ~40% when compared to predicted values in healthy controls, and impairments are already present at early disease stages, suggesting early initiation of rehabilitation. The 2MWT and 6MWT show the strongest relationship to EDSS, but the MSWS-12 identify impairments more gradually at low EDSS scores.
•Persons with MS walk 40% slower than expected based on predicted reference values.•Walking impairments are present early in MS, and early rehabilitation is necessary.•Long walking tests (6MWT, 2MWT) show the best correlation with EDSS score.•The MSWS-12 identify impairments in persons with mild MS more gradually.
The 6-minute walk test (6MWT) is often used to assess walking distance in multiple sclerosis (MS), but can be both time consuming for the investigator and exhausting for people with MS (pwMS). The ...present report compared the 6MWT scores of 40 ambulatory pwMS with their scores on the shorter 2-minute walk test (2MWT). The 2MWT estimated the 6MWT results with a mean relative error of 5% (R2 = 0.96; p < 0.01). As the last 4-minute period of the 6MWT seems redundant, the 2MWT may be considered as a practical replacement for the 6MWT in routine clinical assessment.
Background
Performing cognitive–motor dual tasks (DTs) may result in reduced walking speed and cognitive performance. The effect in persons with progressive multiple sclerosis (pwPMS) having ...cognitive dysfunction is unknown.
Objective
To profile DT-performance during walking in cognitively impaired pwPMS and examine DT-performance by disability level.
Methods
Secondary analyses were conducted on baseline data from the CogEx-study. Participants, enrolled with Symbol Digit Modalities Test 1.282 standard deviations below normative value, performed a cognitive single task (ST, alternating alphabet), motor ST (walking) and DT (both). Outcomes were number of correct answers on the alternating alphabet task, walking speed, and DT-cost (DTC: decline in performance relative to the ST). Outcomes were compared between EDSS subgroups (≤ 4, 4.5–5.5, ≥ 6). Spearman correlations were conducted between the DTC
motor
with clinical measures. Adjusted significance level was 0.01.
Results
Overall, participants (n = 307) walked slower and had fewer correct answers on the DT versus ST (both
p
< 0.001), with a DTC
motor
of 15.8% and DTC
cognitive
of 2.7%. All three subgroups walked slower during the DT versus ST, with DTC
motor
different from zero (
p
’s < 0.001). Only the EDSS ≥ 6 group had fewer correct answers on the DT versus ST (
p
< 0.001), but the DTC
cognitive
did not differ from zero for any of the groups (
p
≥ 0.039).
Conclusion
Dual tasking substantially affects walking performance in cognitively impaired pwPMS, to a similar degree for EDSS subgroups.
•Multidisciplinary physical rehabilitation is an effective method for impovement gait and balance disturbances in patients with MS.•Among various baseline characteristics disease duration, EDSS score ...and the age of patients are significant predictors of improvement.•Rehabilitation outcomes measures should be based on the level of disability of patients.•Applied MCIDs require standardization for a more relieble evaluation of rehabilitation methods.
The relationship between fatigue impact and walking capacity and perceived ability in patients with multiple sclerosis (MS) is inconclusive in the existing literature. A better understanding might ...guide new treatment avenues for fatigue and/or walking capacity in patients with MS.
To investigate the relationship between the subjective impact of fatigue and objective walking capacity as well as subjective walking ability in MS patients.
A cross-sectional multicenter study design was applied. Ambulatory MS patients (n = 189, age: 47.6 ± 10.5 years; gender: 115/74 women/men; Expanded Disability Status Scale (EDSS): 4.1 ± 1.8 range: 0–6.5) were tested at 11 sites. Objective tests of walking capacity included short walking tests (Timed 25-Foot Walk (T25FW), 10-Metre Walk Test (10mWT) at usual and fastest speed and the timed up and go (TUG)), and long walking tests (2- and 6-Minute Walk Tests (MWT). Subjective walking ability was tested applying the Multiple Sclerosis Walking Scale-12 (MSWS-12). Fatigue impact was measured by the self-reported modified fatigue impact scale (MFIS) consisting of a total score (MFIStotal) and three subscales (MFISphysical, MFIScognitive and MFISpsychosocial). Uni- and multivariate regression analysis were performed to evaluate the relation between walking and fatigue impact.
MFIStotal was negatively related with long (6MWT, r = −0.14, p = 0.05) and short composite (TUG, r = −0.22, p = 0.003) walking measures. MFISphysical showed a significant albeit weak relationship to walking speed in all walking capacity tests (r = −0.22 to −0.33, p < .0001), which persisted in the multivariate linear regression analysis. Subjective walking ability (MSWS-12) was related to MFIStotal (r = 0.49, p < 0.0001), as well as to all other subscales of MFIS (r = 0.24–0.63, p < 0.001), showing stronger relationships than objective measures of walking.
The physical impact of fatigue is weakly related to objective walking capacity, while general, physical, cognitive and psychosocial fatigue impact are weakly to moderately related to subjective walking ability, when analysed in a large heterogeneous sample of MS patients.
•Despite being equally prevalent symptoms in MS the relation between gait impairments and fatigue is unclear.•General fatigue impact is not related to most walking outcomes in MS.•The physical impact of fatigue is weak to moderately related to both objective and subjective walking capacity in MS.
•Experiences of rehabilitation technology using mixed methods have been rarely explored in people with multiple sclerosis.•Robot-mediated upper limb therapy resulted in positive experiences on upper ...limb impairments for people with multiple sclerosis.•Expectations of participants were rather low at baseline but increased with observed functional benefits.•Long-term rehabilitation programs involving rehabilitation technology should be considered for people with multiple sclerosis.
Robot-mediated training is increasingly considered as a rehabilitation intervention targeting upper limb disability. However, experiences of such an intervention have been rarely explored in the multiple sclerosis population. This mixed methods study sought to explore the impact of an eight week upper limb robotic intervention on experiences of people with multiple sclerosis.
Eleven participants (Median EDSS- score: 6.5) with moderate to severe upper limb impairment, performed eight week robot- mediated training of the most affected arm. The training involved a virtual learning platform called I-TRAVLE with duration of 30 min per training session, twice to three times per week. Two subjective questionnaires with items from the Intrinsic Motivation Inventory (IMI) and Credibility and Expectancy Questionnaire (CEQ) were collected bi-weekly during the intervention. Approximately one month after completing the training, three focus groups were conducted. Main themes were identified using thematic analysis.
Results from the IMI and CEQ indicated high patient satisfaction and expectation that the intervention will be beneficial for them. Two main themes were identified: (1) Effect of the intervention on impairment and activity in that participants felt that there was a positive impact of the training on strength, endurance and during activities of daily living and that it met their expectations; (2) Experiences based on system usage from the system in that participants expressed feelings of motivation and self-improvement. The participants also perceived the training as enjoyable and concluded that the use of games instigated a competitive spirit between the participants.
Robot-mediated training could have a motivating effect and induce a general positive experience while reducing disabilities of people with multiple sclerosis.
•Relations between DT walking performance and clinical characteristics were analysed.•Relations depend on type of motor and cognitive task used in the dual task.•Better mobility in MS is related to ...higher DT walking speed.•Faster information processing speed related to lower DTC.
Background: In persons with Multiple Sclerosis (pwMS) performing a simultaneous cognitive task while walking often results in slower gait. Clinical characteristics associated with reduced dual task (DT) performance are not yet entirely clear. This multi-centre study aimed to determine the relationship between clinical and demographical characteristics with dual task (DT) walking performance in pwMS during multiple DT conditions.
Methods: Nine DT conditions were analysed, consisting of combinations of three types of cognitive (‘digit span’, ‘subtraction’, ‘vigilance’) and three types of walking (‘walk’, ‘walk with cup’, ‘walk over obstacles’) conditions. Primary outcomes were DT gait speed (m/s) and motor DT cost of gait speed (DTCmotor, %). Secondary outcomes were clinical tests of physical and cognitive functioning and patient-reported and demographical outcomes. Firstly, univariate analyses and, subsequently, multivariate analyses with backward modelling, were conducted for each type of walking DT condition separately. Cognitive DT conditions were included in the models as main and as interaction effect with the secondary outcomes.
Results: Analysis were performed in 81 pwMS (EDSS 3.3 ± 1.0). In the final models of DTCmotor, the significant main effects were in ‘walk’ DT-conditions the Symbol Digit Modalities Test (SDMT), in ‘cup’ conditions the SDMT and Dynamic Gait Index and in ‘obstacles’ conditions age. For DT gait speed, main effects were found for the 2-Minute Walking Test (2MWT) and the Multiple Sclerosis Walking Scale for all walking conditions. Additionally, interactions between cognitive DT-conditions and SDMT, age and 2MWT were found.
Conclusion: Clinical characteristics related to DT walking performance differed according to cognitive-motor DT-condition used. Still, in general, pwMS with a better mobility demonstrated higher DT gait speed, while a faster information processing speed was related to a lower DTCmotor.
Abstract Motor imagery (MI) is a promising practice tool in neurorehabilitation. However, in patients with multiple sclerosis (MS), impairments in MI accuracy and temporal organization were found ...during clinical assessment, which may limit the benefits of MI practice. Therefore, we investigated whether the MI quality of MS patients could be optimized by means of external cueing. Fourteen patients with MS and 14 healthy control patients physically executed and visually imagined a goal-directed upper limb task in the presence and absence of added visual and auditory cues. MI quality was assessed by means of eye-movement registration. As main results, it was found that MS patients had significant higher eye-movement times than controls during both execution and imagery, and overestimated the to-be-imagined movement amplitude when no external information was provided during imagery. External cues, however, decreased patients' MI duration and increased the spatial accuracy of their imagined movements. In sum, our results indicate that MS patients imagine movements in a better way when they are provided with external cues during MI. These findings are important for developing rehabilitation strategies based on MI in patients with MS.
Patients with progressive multiple sclerosis (MS) have been attributed greater walking disability than relapsing-remitting MS (RRMS) patients but quantitative data on walking speed and ability are ...lacking.
To investigate the impact of type of MS on severity of reduced walking ability and capacity taking into account age, sex, height and disease duration.
Cross-sectional observational multi-center study
European MS centers providing either in- or out-patient services, or both.
This study included 502 patients: 259, 162 and 81 patients showed RRMS, secondary and primary progressive MS respectively.
Walking was evaluated by T25FW, six minute walk test and MS-Walking Scale-12. Patient characteristics were compared using a one-way ANOVA, and simple and multivariate regression analysis were applied with the walking measures.
In adjusted (sex, age, weight, height and disease duration) analyses, walking impairments were more than 20% greater in progressive types of MS compared to RRMS. There were also indications of greater walking impairment in primary compared to secondary progressive MS patients.
Clinical walking impairment was larger in progressive compared to relapsing-remitting type of MS. The biological disease mechanism, being degeneration or inflammation, impacts on disability.
Health care professionals must be aware of different severity of walking impairment in progressive compared to relapsing type of MS, and need for intensive treatment. Also, studies must report rehabiltiation effects according to MS type.
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