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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: June 26, 2018
Footnotes
This work was supported by a Small Projects in Rehabilitation award no. 5I21RX001918-02 from the United States Department of Veterans Affairs Rehabilitation Research and Development Service. The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States government.
Clinical Trial Registration No.: NCT02408718.
Disclosures: none.
Identification
Copyright
Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
