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Effects of a multimodal intervention on gait and balance of subjects with progressive multiple sclerosis: a prospective longitudinal pilot study

Authors Bisht B, Darling WG, White EC, White KA, Shivapour ET, Zimmerman MB, Wahls TL

Received 28 November 2016

Accepted for publication 30 March 2017

Published 26 June 2017 Volume 2017:7 Pages 79—93

DOI https://doi.org/10.2147/DNND.S128872

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 3

Editor who approved publication: Prof. Dr. Thomas Müller

Video abstract presented by Terry L Wahls.

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Babita Bisht,1,2 Warren G Darling,2 Emily C White,2 Kaitlin A White,2 E Torage Shivapour,3 M Bridget Zimmerman,4 Terry L Wahls1,5

1Department of Internal Medicine, Carver College of Medicine,2Department of Health and Human Physiology, UI College of Liberal Arts and Sciences,3Department of Neurology, Carver College of Medicine, 4Department of Biostatistics, College of Public Health, University of Iowa, 5Department of Extended Care and Rehabilitation Service Line, Iowa City VA Health Care System, Iowa City, IA, USA

Purpose: To investigate the effects of a multimodal intervention including a modified Paleolithic diet, nutritional supplements, stretching, strengthening exercises with electrical stimulation of trunk and lower limb muscles, meditation and massage on walking performance and balance of subjects with progressive multiple sclerosis (MS).
Materials and methods: Twenty subjects with mean (standard deviation) age of 51.7 (6.4) years and Expanded Disability Status Scale score of 6.2 (1) participated in a 12-month study. Assessments were completed at baseline, 3, 6, 9, and 12 months.
Results: The entire cohort did not show significant changes in any of the assessments over 12 months except higher speed of walking toward the 10 feet mark during timed up and go (TUG) test at 6 months compared with baseline (mean change 7.9 cm/s [95% confidence interval {CI}]: 0.3, 15.2; p=0.041). Sub-group analysis revealed that 50% subjects (n=10) showed decrease in TUG time from baseline to at least 3 of 4 time-points post-intervention and were considered as responders (TUG-Res), the remaining 10 subjects were considered as nonresponders (TUG-NRes). Over 12 months, TUG-Res showed decreased mean TUG time by 31% (95% CI: −52%, −2%), increased median Berg Balance Scale scores (42 to 47), 30% increase in mean timed 25-foot walk speed (>20% considered clinically significant) and increased speed of walk toward 10 feet mark during TUG by 11.6 cm/s (95% CI: −3.0, 25.9) associated with increases in step lengths and decrease in step duration. TUG-NRes showed deterioration in walking ability over 12 months. Comparison of TUG-Res and TUG-NRes showed no significant differences in adherence to intervention but better stride duration and longer step length at baseline for TUG-Res than for TUG-NRes (p<0.05).
Conclusion: A multimodal lifestyle intervention may improve walking performance and balance in subjects with progressive MS who have mild-to-moderate gait impairment, whereas subjects with severe gait impairments may not respond to this intervention. Future trials should assess effects of this intervention in subjects with MS during early stages of the disease.

Keywords: multiple sclerosis, Paleolithic diet, exercise, neuromuscular electrical stimulation, gait, balance
 

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Other articles by this author:

Multimodal intervention improves fatigue and quality of life in subjects with progressive multiple sclerosis: a pilot study [Corrigendum]

Bisht B, Darling WG, Shivapour ET, Lutgendorf SK, Snetselaar LG, Chenard CA, Wahls TL

Degenerative Neurological and Neuromuscular Disease 2015, 5:91-92

Published Date: 10 September 2015

Multimodal intervention improves fatigue and quality of life in subjects with progressive multiple sclerosis: a pilot study

Bisht B, Darling WG, Shivapour ET, Lutgendorf SK, Snetselaar LG, Chenard CA, Wahls TL

Degenerative Neurological and Neuromuscular Disease 2015, 5:19-35

Published Date: 27 February 2015