Adherence to physiotherapy-guided web-based exercise for persons living with moderate-to-severe multiple sclerosis: a randomized-controlled pilot study

Background: Options to support adherence with physical activity in moderate-to-severe MS are needed. The primary aim was to evaluate adherence to a web-based, individualized exercise program in moderate-to-severe MS. Secondary aims were to explore changes in MSIS-29, HADS, grip strength, T25FWT, and TUG.
Methods: Inclusion criteria were diagnosis of MS, internet access, residing within 300km of Saskatoon, and exercising less than twice weekly. Participants were randomized (2:1) to a physiotherapist-guided web-based home exercise program or physiotherapist-prescribed written home exercise program. The primary outcome was adherence (number of exercise sessions over 26 weeks). Secondary outcomes were described in terms of means and effect sizes.
Results: There were 48 participants: mean age 54.3y (SD 11.9), disease duration 19.5y (SD 11.0) and mean Patient-Determined Disease Steps 4.4 (SD 1.6). There was no significant difference in adherence between groups: web group (mean 38.9, SD 28.1); comparator group (mean 34.6, SD 40.8; U=198.5, p=.208, Hedges’ g 0.13). Nearly 50% of participants (23/48) exercised ≥ twice per week for at least 13 of the 26 weeks. Adherence was highest in the web-based subgroup of wheelchair users. Medium effect sizes were found for HADS - anxiety subscale and in ambulatory participants for TUG. There were no adverse events.
Conclusions: There was no difference in exercise adherence between the web-based and active comparator groups. There was no worsening on secondary outcomes or adverse events, supporting the safety of web-based physiotherapy. More research is needed to determine if wheelchair users might be most likely to benefit from web-based physiotherapy.