Abstract
Multiple Sclerosis (MS), the most common neurological condition of the working age population in the UK, presents with changes in gait. Functional electrical stimulation (FES), an assistive device, used in the management of foot drop, has been found to improve the speed and effort of walking in people with central nervous system (CNS) disorders. This doctoral programme of work aims to examine the effects of FES for foot drop in people with Multiple Sclerosis (pwMS), and the factors shaping its implementation, thus informing future FES policy and prescription. The objectives of the papers presented are to i) systematically review the evidence of the impact of FES on walking speed in pwMS, ii) evaluate and compare the orthotic effect of different FES devices and standard care (ankle foot orthoses (AFO)) on the speed and oxygen cost of walking in pwMS, iii) investigate the variable of walking speed on determining the orthotic effect of FES and iv) explore the lived experience of pwMS using FES.Six peer reviewed papers, of mixed research methodologies, applying a pragmatism paradigm, present a narrative synthesis and critical review of a programme of work which has developed over ten years. The aims and objectives are examined through three studies and a systematic review and meta-analyses.
The initial study applied an observational, before-after design and recruited twelve pwMS to investigate the orthotic effect of FES on the speed and energy cost of walking in pwMS (objective ii). This study found significant improvements in the speed (P<0. 001) and physiological cost (P=0. 017) of walking with FES compared to without in pwMS. The second study presents papers two and three, and uses a similar design, recruiting twenty pwMS. Paper two, investigates the impact of walking
speed on the orthotic effect of FES (objective iii). Significant improvements in walking speed (/:3=0. 005) of slow walkers (<0. 8m/s), however an increase in the oxygen cost of walking (P=0. 004) in fast walkers (^0.8m/s) was observed. Paper three, compares the ongoing orthotic effects of two different FES devices; the Odstock Dropped Foot Stimulator (ODFS) III (OML, Salisbury, UK) and the Walkaide (WA) (Innovative Neurotronics, Austin, USA) (objective ii). There were no differences
between the two devices with regards to their impact on the speed and energy cost of walking, however significant methodological flaws were evident. Paper four presents a systematic review and meta-analyses of nineteen studies on the effect of FES on walking speed in MS (objective i). Significant initial (T=2. 14, P=0. 016) and ongoing (T=2. 81, P=0. 003) orthotic effects of FES on walking speed in short walk tests were found, however the quality of studies reviewed were found to be moderate at best. Study three, a randomised trial comparing FES and AFO, recruited 84 treatment naive participants across Scotland. Paper five investigates the initial orthotic effect of FES and AFO (objectives ii & iii). The slow walking (0. 8m/s) group (P=0. 011). Paper six, explores the lived experience of pwMS using FES (objective iv), using an Interpretative Phenomenological Analysis (IPA) approach. Improvements in many aspects of walking, emotions, outlook and mental well-being were found. A thematic model identifying intrinsic and extrinsic factors influencing participants continued FES use is presented.
In conclusion, this programme of work has strengthened the evidence base for a positive orthotic effect of FES on walking speed in pwMS. It has confirmed the influence of baseline walking speed on this effect and provided some insight into the experiences of pwMS using FES. This work will inform clinicians in the prescription of FES and the support needed to maximise compliance with FES and enable positive outcomes for pwMS over the longer term.
| Date of Award | 2018 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Lorna Paul (Supervisor) & Paul Flowers (Supervisor) |