A task-oriented circuit training in multiple sclerosis: a feasibility study

Straudi et al. BMC Neurology 2014, 14:124 http://www.biomedcentral.com/1471-2377/14/124 RESEARCH ARTICLE Open Access A task-oriented circuit training in multiple sclerosis: a feasibility study Sofia Straudi1,2*†, Carlotta Martinuzzi1†, Claudia Pavarelli1, Amira Sabbagh Charabati1†, Maria Grazia Benedetti3, Calogero Foti2, Michela Bonato1†, Eleonora Zancato1† and Nino Basaglia1 Abstract Background: The aim of this study was to evaluate the safety, feasibility and preliminary effects of a high-intensity rehabilitative task-oriented circuit training (TOCT) in a sample of multiple sclerosis (MS) subjects on walking competency, mobility, fatigue and health-related quality of life (HRQoL). Methods: 24 MS subjects (EDSS 4.89 ± 0.54, 17 female and 7 male, 52.58 ± 11.21 years, MS duration 15.21 ± 8.68 years) have been enrolled and randomly assigned to 2 treatment groups: (i) experimental group received 10 TOCT sessions over 2 weeks (2 hours/each session) followed by a 3 months home exercise program, whereas control group did not receive any specific rehabilitation intervention. A feasibility patient-reported questionnaire was administered after TOCT. Functional outcome measures were: walking endurance (Six Minute Walk Test), gait speed (10 Meter Walk Test), mobility (Timed Up and Go test) and balance (Dynamic Gait Index). Furthermore, self-reported questionnaire of motor fatigue (Fatigue Severity Scale), walking ability (Multiple Sclerosis Walking Scale – 12) and health-related quality of life (Multiple Sclerosis Impact Scale – 29) were included. Subjects’ assessments were delivered at baseline (T0), after TOCT (T1) and 3 months of home-based exercise program (T2). Results: After TOCT subjects reported a positive global rating on the received treatment. At 3 months, we found a 58.33% of adherence to the home-exercise program. After TOCT, walking ability and health-related quality of life were improved (p < 0.05) with minor retention after 3 months. The control group showed no significant changes in any variables. Conclusions: This two weeks high-intensity task-oriented circuit class training followed by a three months home-based exercise program seems feasible and safe in MS people with moderate mobility impairments; moreover it might improve walking abilities. Trial registration: NCT01464749 Keywords: Task oriented, Rehabilitation, Mobility, Multiple sclerosis Background Multiple sclerosis (MS) is a chronic and progressive neurologic disease that commonly affects young adults worldwide and it represents a major cause of disability over time [1,2]. In this population gait and mobility impairments could have a negative impact on personal activities not only restricted to motor domains and * Correspondence: † Equal contributors 1 Neuroscience and Rehabilitation Department, Ferrara University Hospital, Ferrara, Italy 2 Doctoral Program in Advanced Sciences and Technologies in Rehabilitation Medicine and Sports, Tor Vergata University, Rome, Italy Full list of author information is available at the end of the article participation but also to quality of life [3,4]. There are several studies showing a benefit of physical therapy on walking function, mobility [5-9] and fatigue [10-12]; for this reason recent reviews and international guidelines recommend exercise for MS population [13,14]. Nonetheless, the task-oriented circuit training (TOCT) approach hasn’t been studied enough in people with MS (PwMS) and gait and mobility disorders. TOCT is based on workstations that reproduce physical activities that the subject usually performs during daily living (i.e. walking, climbing stairs, maintain balance) with the aim of promoting motor learning and task retention. In addition, a major characteristic of this rehabilitative intervention © 2014 Straudi et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Straudi et al. BMC Neurology 2014, 14:124 http://www.biomedcentral.com/1471-2377/14/124 is the exercise intensity that, compared to a conventional physiotherapy session, is nearer to the number of repetitions needed to achieve and maintain motor learning of these movements [15]. Moreover, TOCT has been designed for small groups of subjects requiring only one physiotherapist compared with conventional rehabilitation session in which the ratio is 1:1, giving also the advantage of reducing costs of rehabilitation. Previous studies [16,17] have shown that TOCT is a good method to improve locomotor function and mobility in stroke survivors. The rationale of our study is based on growing evidences [18] that demonstrate how human adult brain is capable of significant adaptations providing that the quantity (duration and frequency) and quality (taskspecificity) of interventions are appropriate to facilitate enhanced neural reorganization and upper limb motor recovery in chronic stroke survivors [19]. Also, recent neuroimaging studies highlighted how adaptive brain plasticity [20,21] and motor learning [22] are preserved even in progressive MS subjects and rehabilitative strategies that harness cortical reorganization of motor function might be an option even in this chronically disabled subjects. Task oriented circuit training (TOCT) is an intensive task-specific intervention, for this reason we designed a pilot randomized-controlled trial: (i) to test the safety, feasibility and acceptability of a two weeks high-intensity task oriented circuit training in multiple sclerosis subjects with moderate gait impairments; (ii) to assess its preliminary effects on walking, mobility, fatigue and quality of life; (iii) to evaluate the adherence to a three months home based training program that followed TOCT; (iv) to determine TOCT effect sizes and the sample needed for a future RCT study. Methods This is a single-blind randomized controlled pilot trial. Subjects were recruited at the outpatient clinic of the Physical Medicine and Rehabilitation Department (Ferrara University Hospital). Informed written consent was obtained from eligible subjects. The research study has been reviewed and approved by the Ferrara University Hospital Ethics Committee and registered in ClinicalTrial. gov database (NCT01464749). The inclusion criteria were: males and females, age 18 to 75, diagnosis of MS (primary or secondary progressive, relapsing-remitting), without relapses in the preceding 3 months, mild to moderate gait impairments referred to Expanded Disability Status Scale (EDSS) score between 4 and 5.5. Subjects were able to walk for at least 100 meters with no constant as (...truncated)