A Complementary and Alternative Medicine (CAM) Intervention for Building a TeleHealth Platform for People with MS
People with MS living in the deep south have minimal to no access to regular and sustainable exercise rehabilitation. Tele-Exercise and Multiple Sclerosis (TEAMS) is a PCORI-funded project that is comparing the average treatment effectiveness of a blended complementary and alternative medicine (CAM) intervention consisting of neurorehabilitative exercise, yoga and Pilates between people with MS receiving the same treatment onsite (DirectCAM) versus at home (TeleCAM).The program is delivered in offline mode to compensate for internet disparity in the rural South through videos uploaded on a tablet app and distributed in outpatient therapy clinics for at-home use. Participant eligibility criteria include: 18-70 years old; PDDS score between 0 and 7; and currently not meeting U.S. guidelines for physical activity.
Objectives: Effectiveness is defined by improvement in 4 key self-reported, patient-centered health outcomes recommended by our MS stakeholder panel, and an additional 4 functional outcomes associated with changes in physical health/function.
Methods: A stakeholder group advised on video content, format and production. Content included four levels of Pilates, yoga and dual tasking exercise. Two additional levels were added to redact movements contraindicated for osteoporosis, for a total of six levels. The videos were developed with the active input at every level from a MS stakeholder advisory committee.
Results: After extensive stakeholder feedback and usability testing, six 60-minute videos have been completed using trained instructors, stakeholders, and professional videograpers. The 60-minute videos instruct participants on how to hold a yoga pose for specified breaths, and Pilates exercises for specified repetitions. Each level has a set of dual-tasking activities that challenge the participant with visual, coordination, cognition and balance tasks tailored to their PDDS score. The videos can be used in the home via a tablet app and can be played without an internet connection.
Conclusions: People with MS are currently being enrolled into the study across therapy clinics in Alabama, Mississippi and Tennessee. Implementation of the CAM intervention will continue to be studied over the next two years through the TEAMS project with the goal of determining the process of transitioning telerehabilitation from a pragmatic trial to large scale use for people with MS throughout the US.