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ADSTEP: Preliminary Investigation of a Multicomponent Walking Aid Program in People With Multiple Sclerosis

      Abstract

      Objective

      To evaluate the effect of the Assistive Device Selection, Training and Education Program (ADSTEP) on falls and walking and sitting activity in people with multiple sclerosis (PwMS).

      Design

      Randomized controlled trial.

      Setting

      Veterans affairs medical center.

      Participants

      PwMS (N=40) using a walking aid at baseline who had fallen in the previous year.

      Interventions

      Participants were randomly assigned to ADSTEP or control. ADSTEP had 6 weekly, 40-minute, 1-on-1 sessions with a physical therapist, starting with walking aid selection and fitting, followed by task-oriented progressive gait training. Control was usual medical care with the option of ADSTEP after the study.

      Main Outcome Measures

      The following were assessed at baseline, intervention completion, and 3 months later: falls, timed Up and Go, timed 25-foot walk, 2-minute walk, Four Square Step Test, International Physical Activity Questionnaire, Quebec User Evaluation of Satisfaction with Assistive Technologies, Multiple Sclerosis Walking Scale-12, Activities-Specific Balance Confidence Scale, and Multiple Sclerosis Impact Scale-29. Effect on these outcomes was estimated by a 2-by-2 repeated measures general linear model.

      Results

      Fewer ADSTEP than control participants fell (χ2=3.96, P<.05. number needed to treat =3.3). Time spent sitting changed significantly differently with ADSTEP than with control from baseline to intervention completion (F=11.16, P=.002. ADSTEP: reduced 87.00±194.89min/d; control: increased 103.50±142.21min/d; d=0.88) and to 3-month follow-up (F=9.25, P=.004. ADSTEP: reduced 75.79±171.57min/d; control: increased 84.50±149.23min/d; d=0.79). ADSTEP yielded a moderate effect on time spent walking compared to control at 3-month follow-up (P>.05. ADSTEP 117.53±148.40min/d; control 46.43±58.55min/d; d=0.63).

      Conclusions

      ADSTEP prevents falls, reduces sitting, and may increase walking in PwMS.

      Keywords

      List of abbreviations:

      2MWT (2-minute walk test), ABC (Activities-Specific Balance Confidence Scale), ADSTEP (Assistive Device Selection, Training and Education Program), FSST (Four Square Step Test), IPAQsf (International Physical Activity Questionnaire, short form), MRI (magnetic resonance imaging), MS (multiple sclerosis), MSIS-29 (Multiple Sclerosis Impact Scale-29), MSWS-12 (Multiple Sclerosis Walking Scale-12), NNT (number needed to treat), PRO (patient-reported outcome), PwMS (people with multiple sclerosis), QUEST (Quebec User Evaluation of Satisfaction With Assistive Technologies), T25W (timed 25-foot walk), TUG (timed Up and Go)
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