Circuito task-oriented ad alta intensità supportato da teleriabilitazione: efficacia e fattibilità in soggetti con sclerosis multipla e disabilità lieve-moderata del cammino.

Scritto da

Andrea Baroni

in

High-intensity task-oriented circuit training empowered with telerehabilitation: effectiveness and feasibility in people with multiple sclerosis and mild-to-moderate walking impairment.

Autori

Baroni Andrea (Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy)

Perachiotti Gabriele (Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy)

Carpineto Andrea (Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy)

Presti Carmelo Pio (School of Physiotherapy, University of Ferrara, Ferrara, Italy)

Straudi Sofia (Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy)

Background and aims

Mobility and balance disorders are frequent in people with Multiple Sclerosis (PwMS) (1) and are present from the earliest stages of the disease. Physical exercise plays a crucial role in improving motor function and reducing fatigue in PwMS, particularly when performed at high intensity (2). Task-oriented circuit training (TOCT) allows to combine the features of exercise training with motor control skills (3). This study aims to evaluate feasibility and effects of a high intensity (TOCT) in PwMS and mild-to-moderate gait impairment, followed by a three-month asynchronous telerehabilitation intervention.

Methods

We planned to recruit 18 PwMS with EDSS  6. All subjects received 10 one-hour TOCT sessions where they performed 2 rounds of five exercise stations targeting specific motor skills: walking (speed and adaptability), supine-to-stand, stepping, stair climbing. Stations were graded across 10 difficulty levels to permit progression of exercise. Perceived exertion, technical challenge and stability were assessed after each station. At the end of the in-hospital rehabilitation, each subject received three months of asynchronous telerehabilitation. Mobility, balance, walking function, fatigue and patient-reported outcome measures (PROMs) were evaluated before (T0) and after (T1) in-hospital treatment, after telerehabilitation intervention (T2) and at three-month follow-up. Acceptability of the intervention was evaluated at T1.

Results

Fifteen PwMS completed the in-hospital protocol (6 male, median age 51y, median EDSS 4.5). During each session, every subject performed a median of: 257 meters at the highest possible speed in the walking speed station; 67 meters in the walking adaptability station; 18 repetitions in supine-to-stand station; 165 repetitions in the stepping station; 54 steps in the stair climbing station. All subjects significantly improved in mobility (Timed Up and Go Test -0.71s, p<0.05), walking speed (Timed 25-Foot Walk test -0.36s, p<0.05), walking endurance (6-Minute Walk Test +52m, p<0.05), dynamic balance (Dynamic Gait Index +4pts, p<0.05). No significant changes were observed in fatigue and PROMs. Nine subjects completed the telerehabilitation treatment and retained improvement at T2. Retention was observed for 6 subjects at T3. Despite high exertion and balance challenge levels, the intervention was rated acceptable (5/5), safe (5/5) and appropriate (5/5). No adverse events were observed.

Conclusion

Our preliminary results showed that a high intensity TOCT seems to be effective for improving mobility, balance and walking function in PwMS and mild-to-moderate gait impairment. Our protocol was safe and well accepted. A higher number of subjects may confirm our findings.

REFERENCES

  1. Parsaei M, Amanollahi M, TaghaviZanjani F, Khanmohammadi S, Jameie M, Naser Moghadasi A. Effects of non-pharmacological interventions on gait and balance of persons with Multiple Sclerosis: A narrative review. Mult Scler Relat Disord. 2024;82:105415. doi:10.1016/j.msard.2023.105415
  2. Callesen J, Cattaneo D, Brincks J, Kjeldgaard Jørgensen ML, Dalgas U. How do resistance training and balance and motor control training affect gait performance and fatigue impact in people with multiple sclerosis? A randomized controlled multi-center study. Mult Scler. 2020;26(11):1420-1432. doi:10.1177/1352458519865740
  3. Cardini R, Corrini C, Bertoni R, Anastasi D, Cattaneo D, Gervasoni E. Exploring the effectiveness of circuit training rehabilitation on balance, gait, and fatigue in multiple sclerosis: a systematic review and meta-analysis. Physiotherapy. 2024;125:101413. doi:10.1016/j.physio.2024.101413

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