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

Sarah Donkers, Darren Nickel, Lorna Paul, Shane R. Wiegers, Katherine B. Knox

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Abstract

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.
Original languageEnglish
JournalInternational Journal of MS Care
Early online dateJan 2020
DOIs
Publication statusE-pub ahead of print - Jan 2020

Fingerprint

Multiple Sclerosis
Exercise
Wheelchairs
Physical Therapists
Hand Strength
Internet
Anxiety
Safety
Research
4-amino-4'-hydroxylaminodiphenylsulfone

Keywords

  • multiple sclerosis
  • exercise
  • adherence
  • physiotherapy
  • telerehabilitation

Cite this

Donkers, Sarah ; Nickel, Darren ; Paul, Lorna ; Wiegers, Shane R. ; Knox, Katherine B. / Adherence to physiotherapy-guided web-based exercise for persons living with moderate-to-severe multiple sclerosis: a randomized-controlled pilot study. In: International Journal of MS Care. 2020.
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abstract = "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.",
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author = "Sarah Donkers and Darren Nickel and Lorna Paul and Wiegers, {Shane R.} and Knox, {Katherine B.}",
note = "Acceptance in SAN AAM: made open, with rights statement in line with previous acceptances to jnl. 6/12/19 DC - ET/DC to update rights statement upon publication Only year available for earliest pub date - added current month as available in January. 12/01/2020 TM",
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Adherence to physiotherapy-guided web-based exercise for persons living with moderate-to-severe multiple sclerosis: a randomized-controlled pilot study. / Donkers, Sarah; Nickel, Darren; Paul, Lorna; Wiegers, Shane R.; Knox, Katherine B.

In: International Journal of MS Care, 01.2020.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Adherence to physiotherapy-guided web-based exercise for persons living with moderate-to-severe multiple sclerosis: a randomized-controlled pilot study

AU - Donkers, Sarah

AU - Nickel, Darren

AU - Paul, Lorna

AU - Wiegers, Shane R.

AU - Knox, Katherine B.

N1 - Acceptance in SAN AAM: made open, with rights statement in line with previous acceptances to jnl. 6/12/19 DC - ET/DC to update rights statement upon publication Only year available for earliest pub date - added current month as available in January. 12/01/2020 TM

PY - 2020/1

Y1 - 2020/1

N2 - 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.

AB - 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.

KW - multiple sclerosis

KW - exercise

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KW - physiotherapy

KW - telerehabilitation

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DO - 10.7224/1537-2073.2019-048

M3 - Article

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