Objective: To use a pilot study to compare two physiotherapy approaches to improve walking in patients with gait disturbance due to multiple sclerosis (MS).
Design: Patients were assessed and then randomly assigned to one of two groups using a block randomization technique. They were treated by the research physiotherapist for a minimum of 15 treatments over a 5–7-week period and then reassessed by an independent therapist one week after treatment.
Setting: Both assessment and treatment were undertaken at a specialist rehabilitation centre.
Subjects: Outpatients with clinically stable MS (chronic progressive or relapsing-remitting types) who were referred for physiotherapy to improve their mobility.
Intervention: Comparison was between a facilitation (impairment-based) approach and a task-oriented (disability-focused) approach.
Outcome: Mobility was assessed using four measures: the 10-metre timed walk, the Rivermead Mobility Index, stride length and the Rivermead Visual Gait Assessment. Balance was assessed using the Berg Balance Test.
Results: Twenty-three patients were entered, and 10 in each group completed the study. The groups were similar on all measured items both before and after treatment. There was no significant difference in improvement between the two approaches. Following treatment, patients in both groups showed a significant overall improvement (p <0.05) in both impairment and disability measures.
Conclusions: No significant differences in effectiveness between the two methods were demonstrated. Both a task-oriented approach and a facilitation approach to the treatment of MS outpatients were associated with improved mobility.
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References
1.
Bauer HJ, Hanefeld FA. Multiple sclerosis. Its impact from childhood to old age. London: W.B. Saunders, 1993.
2.
Swingler RJ, Compston DA. The morbidity of multiple sclerosis. Q J Med1992; 83: 325–337.
3.
Freeman JA, Langdon DW, Hobart JC, Thompson AJ. The impact of inpatients rehabilitation on progressive multiple sclerosis. Ann Neurol1997; 42: 236–244.
4.
Fuller KJ, Dawson K, Wiles CM. Physiotherapy in chronic multiple sclerosis: a controlled trial. Clin Rehabil1996; 10: 195–204.
5.
Kidd D, Howard RS, Losseff NA, Thompson AJ. The benefit of inpatient neurorehabilitation in multiple sclerosis. Clin Rehabil1995; 74: 612–620.
6.
Jones L, Lewis Y, Harrison J, Wiles CM. The effectiveness of occupational therapy and physiotherapy in multiple sclerosis patients with ataxia of the upper limb and trunk. Clin Rehabil1996; 10: 277–282.
7.
De Souza LH, Worthington JA. The effect of long-term physiotherapy on disability in multiple sclerosis patients. In: Rose FC, Jones R eds. Multiple sclerosis: immunological, diagnostic and therapeutic aspects. London: John Libbey, 1987: 1655–1664.
8.
Horak FB. Assumptions underlying motor control for neurologic rehabilitation. In: Lister MJ ed. II Step: contemporary management of motor control problems. Washington, DC: Foundation for Physical Therapy, 1991: 11–28.
9.
Bobath B. Adult hemiplegia: evaluation and treatment. Oxford: Butterworth Heinemann, 1990.
10.
Johnstone M. Restoration of motor function in the stroke patient: a physiotherapy approach. Edinburgh: Churchill Livingstone, 1987.
11.
Knott M, Voss D. Proprioceptive neuromuscular facilitation. New York: Harper & Row, 1968.
12.
Gentile AM. Skill acquisition: action, movement and neuromuscular process. In: Carr JH and Shepherd RB eds. Movement science: foundations for physical therapy in rehabilitation. Rockville, MD: Aspen, 1987: 93–154.
13.
Carr JH, Shepherd RB. A motor relearning programme for stroke, second edition. Rockville, MD: Aspen, 1987.
14.
Ashburn A. Physiotherapy in the rehabilitation of stroke: a review. Clin Rehabil1993; 7: 337–345.
15.
Richards CL, Malouin F, Wood-Dauphinee S, Williams JI, Bouchard JP, Brunet D. Task-specific physical therapy for optimisation of gait recovery in acute stroke patients. Arch Phys Med Rehabil1993; 74: 612–620.
16.
Armitage P, Berry G. Statistical methods in medical research, second edition. Oxford: Blackwell Scientific, 1987: 522-522.
17.
Collen FM, Wade DTBradshaw CM. Mobility after stroke: reliability of measures of impairment and disability. Int Disabil Studies1990; 12: 6–9.
18.
Collen FM, Wade DT, Robb GF, Bradshaw CM. The Rivermead Mobility Index: a further development of the Rivermead Motor Assessment. Int Disabil Studies1991; 13: 50–54.
19.
Robinson JL, Schmidt GL. Quantitative gait evaluation in the clinic. Phys Ther1981; 61: 351–353.
20.
Lord SE, Halligan PW, Wade DT. Visual gait analysis: the development of a clinical assessment and scale. Clin Rehabil1998; 12: 107–119.
21.
Berg K, Wood-Dauphinee SW, Williams JI, Maki B. Measuring balance in the elderly: validation of an instrument. Can J Public Health1992; 83: 7–11.
22.
Ashworth B. Preliminary trial of carisoprodol in multiple sclerosis. Practitioner1964; 192: 540–542.
23.
Vaney C, Blaurock H, Gattlen PT, Meisels C. Assessing mobility in multiple sclerosis using the Rivermead Mobility Index and gait speed. Clin Rehabil1996; 10: 216–226.
