Novotna Klara, Janatova Marketa, Hana Karel, Svestkova Olga, Preiningerova Lizrova Jana, Kubala Havrdova Eva
Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
MS Rehab z.s., Prague, Czech Republic.
Mult Scler Int. 2019 Dec 23;2019:2854130. doi: 10.1155/2019/2854130. eCollection 2019.
Impaired balance is common in people with multiple sclerosis (MS) and can be present even in those with a mild disability level. With increasing disability, gait, and balance impairment progress, and lead to increased risk of falls. In some recent studies, interactive commercial video games were used for improving balance, but their limitation is their lack of individual training parameter settings needed for rehabilitation purposes. The aim of this study was to evaluate the feasibility and effect of balance exercise in the home setting using the rehabilitation Homebalance® system.
A single-centre, controlled, single blind study with allocation to intervention group or to control group was utilised. Participants were assessed at baseline, after four weeks of home-based balance training, and follow-up after four weeks. The primary outcomes were the Berg Balance Test (BBT). The secondary outcome measures included the Mini-BESTest, Timed Up, and Go Test (part of Mini-BESTest), and spatio-temporal gait parameter evaluation using the GAITRite instrument. The patient reported outcomes (PRO) included the 12-Item MS Walking Scale, Activities-specific Balance Confidence Scale, and the Falls Efficacy Scale.
A total of 39 people with Multiple Sclerosis (10 men) were enrolled into the study. The mean age of participants was 40.69 ± 10.2 years, with a mean disease duration 14.76 ± 9.1 years and mean disability level 3.8 ± 1.9 EDSS (EDSS range 1.5-7). Statistically significant improvements within the home exercise group were present for the BBT and the Mini-BESTest. This improvement was more significant in the subgroup with moderate and higher disability (EDSS 4.5-7). All other gait parameters and PRO did not show any improvement. Follow-up assessment after four weeks showed that the reached improvement persisted for a short time period after finishing the regular training regimen.
In comparison with no intervention, a short-term programme of home-based balance training using Homebalance® improved balance but not gait performance in a group of people with MS. It seems that home-based balance training tailored according to individual needs by a physiotherapist may be a future approach to consider for telerehabilitation of people with MS.
平衡功能受损在多发性硬化症（MS）患者中很常见，即使在残疾程度较轻的患者中也可能存在。随着残疾程度的增加，步态和平衡功能障碍会逐渐加重，并导致跌倒风险增加。在最近的一些研究中，交互式商业视频游戏被用于改善平衡功能，但其局限性在于缺乏康复所需的个性化训练参数设置。本研究的目的是评估使用康复家用平衡系统（Homebalance®）在家庭环境中进行平衡训练的可行性和效果。
采用单中心、对照、单盲研究，将参与者分为干预组或对照组。在基线、进行四周家庭平衡训练后以及四周随访时对参与者进行评估。主要结局指标是伯格平衡量表（BBT）。次要结局指标包括简短Berg平衡量表（Mini-BESTest）、起立行走测试（Timed Up and Go Test，Mini-BESTest的一部分）以及使用GAITRite仪器进行的时空步态参数评估。患者报告结局（PRO）包括12项MS步行量表、特定活动平衡信心量表和跌倒效能感量表。
共有39例多发性硬化症患者（10名男性）纳入研究。参与者的平均年龄为40.69±10.2岁；平均病程为14.76±9.1年；平均残疾程度为3.8±1.9扩展残疾状态量表（EDSS）（EDSS范围为1.5 - 7）。家庭训练组的BBT和Mini-BESTest在统计学上有显著改善。这种改善在中度及以上残疾亚组（EDSS 4.5 - 7）中更为显著。所有其他步态参数和PRO均未显示出任何改善。四周后的随访评估表明，在完成常规训练方案后，所达到的改善在短时间内持续存在。
与不进行干预相比，使用Homebalance®进行的短期家庭平衡训练方案改善了一组MS患者的平衡功能，但未改善步态表现。由物理治疗师根据个体需求定制的家庭平衡训练似乎可能是MS患者远程康复未来可考虑的一种方法。
