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Augmenting a Progressive Resistance Training Programme with Neuromuscular Electrical Stimulation in People with Multiple Sclerosis - Effects on Quality of Life and Spasticity
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Augmenting a Progressive Resistance Training Programme with Neuromuscular Electrical
Stimulation in People with Multiple Sclerosis - Effects on Quality of Life and Spasticity
Authors: Mr. Lonan Hughes1, Prof. Alan Donnelly
2, Mr. Gary Rainsford
3 and Dr. Susan Coote
1.
Institution: 1Physiotherapy Dept, University of Limerick, Limerick, Ireland. [email protected]
and [email protected]; 2Physical Education and Sports Science Dept., University of Limerick,
Limerick, Ireland. [email protected]; 3Biomedical Research Neurotech Ltd., Galway, Ireland.
Introduction: Decreased quality of life (QoL) and spasticity
are prevalent problems for people with
Multiple Sclerosis (PwMS). Progressive
resistance training (PRT) has been shown to
improve QoL in PwMS1. The benefits of
neuromuscular electrical stimulation (NMES)
for reducing spasticity in PwMS are unclear.
Aims: To determine differences in treatment effect
for PwMS on QoL and lower limb spasticity,
between PRT and the same with NMES.
Methods: A single blind randomised design was
employed. PwMS (n=37) that used a walking
aid were allocated to a 12 week home-based
lower limb PRT programme or the same with
the Kneehab ® device (Biomedical Research,
Ltd., neurotech ®, Galway, Ireland), designed
for the quadriceps. Participants’ QoL (MSIS-
29v2) and lower limb spasticity (effect on
function – Visual Analogue Scale) were
evaluated pre-, mid- (6 weeks) and post-
intervention. Between group differences were
analysed with medians and Mann-Whitney U
tests.
Results: Twenty-five completed the programme (PRT
n=10; Kneehab n=15). Reasons for drop-out
were relapse (n=3), fatigue (n=2), other health
problems (n=3), non-compliance (n=2) and
muscle spasm induced by the device (n=2).
There were no statistically significant
differences between groups at baseline.
The Kneehab group’s change from 0 to 6
weeks in QoL on the Physical Subscale and
spasticity was significantly greater than the
PRT (Table 1). On the QoL Psychological
Subscale, Kneehab participants’ improvement
was close to significantly greater than PRT
participants. The total number of repetitions
completed by the Kneehab group was greater.
Table 1. Group Outcomes 0-6 Weeks
QoL Subscales: 0-100; Spasticity:
millimetres.
Discussion and Conclusions: Improvements in Physical QoL at 6 weeks, in
the Kneehab group were similar to a previous
study1. The association between QoL and
physical activity in PwMS3 may explain this,
as Kneehab participants completed more
exercise. Spasticity improvements in the
Kneehab group exceeded the clinically
important difference of 30% for a spasticity
numerical rating scale3. The clinical
implications are that adding an NMES device
to a PRT programme improves QoL and
reduces spasticity. Further studies using larger
samples are needed to confirm these results.
References: 1. Taylor, N., et al., Progressive resistance
exercise for people with multiple sclerosis.
Disability & Rehabilitation, 2006. 28(18):
p. 1119-1126.
2. Motl, R. W., and McAuley, E., Pathways
between physical activity and quality of
life in adults with multiple sclerosis.
Health Psychology, 2009. 28(6): p. 682-
689.
3. Farrar, J. T., et al., Validity, reliability,
and clinical importance of change in a 0-
10 numeric rating scale measure of
spasticity: a post hoc analysis of a
randomized, double-blind, placebo-
controlled trial. Clinical
Therapeutics,2008. 30(5): p. 974-985.
Outcomes PRT Kneehab p-value
QoL Physical
Subscale
42.5 to
35.8
50 to 40 0.034*
QoL
Psychological
Subscale
20.4 to
20.4
25.9 to
11.1
0.058
Spasticity 35.2 to
54.6
39.6 to
3.5
0.019*
Repetitions 1564 1885 0.154