Telerehabilitation in MS: Gait, Balance, and Patient-Reported Outcomes

Background: Functional improvement of established physical deficits in MS can be achieved through rehabilitation to include physical therapy (PT). Access to specialized rehabilitation services is limited due to a variety of factors (availability, geography, mobility, transportation and finances). 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 (T-PT) in MS and to evaluate its efficacy when compared to conventional physical therapy.

Methods: This was a single-center, prospective, randomized, 3-arm, evaluator blinded, 8-week study. Thirty individuals participated (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: 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 measurements of gait, balance and patient reported outcomes (PROs). Selected outcomes were performed with a computerized system (Neurocom SmartBalance). 

Results: Functional gait assessment improved in all groups (group 1 p=0.0002, group 2 p=0.0006, group 3 p=0.009) and were no different between T-PT and the 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. PROs  showed improvement from baseline in the Modified fatigue impact scale (MFIS) for groups 2 (p=0.05) and 3 (p=0.01) and SF36m for groups 2 (p=0.04) and 3 (p=0.01). Groups 2 and 3 were comparatively equivalent in SF36m p=0.06, balance confidence p=0.47, MFIS p=0.37, and self-efficacy p=0.79. Group 3 was better than groups 1 and 2 in the SF36p. 

Conclusions:

T-PT is a convenient and practical method to perform PT in MS individuals and is equivalent to conventional in-person PT as measured by PROs of fatigue, confidence and self-efficacy, and objective measures of gait and balance. T-PT should be researched further and used more extensively as a mean to improve functional independence and quality of life in MS patients.