Department of Neurology, Kliniken-Valens, Rehabilitationsklinik-Valens, Taminaplatz 1, 7317, Valens, Switzerland.
Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Via Violino 11, 6928, Manno, Switzerland.
BMC Neurol. 2021 Feb 11;21(1):65. doi: 10.1186/s12883-021-02084-0.
BACKGROUND: Persons with multiple sclerosis (PwMS) often have reduced aerobic capacity and report fatigue as the most disabling symptom impacting their health-related quality of life (HRQoL). A multidisciplinary rehabilitation approach is recommended for successful management of symptoms, although there is little supporting evidence. The aim of this study is to evaluate the effect of a multimodal therapy approach, including endurance training and patient education, during a three-week inpatient rehabilitation stay, on HRQoL in PwMS at six months follow-up. Inpatient energy management education (IEME) + high-intensity interval training (HIIT) will be compared with progressive muscle relaxation (PMR) + moderate continuous training (MCT). METHODS: This study has a two-armed single-blind randomized controlled superiority trial design. One hundred six PwMS-related fatigue (relapsing-remitting or chronic progressive phenotypes; Expanded Disability Status Scale (EDSS) ≤ 6.5) will be recruited at the Valens clinic, Switzerland, and randomized into either an experimental (EG) or a control group (CG). EG: participants will perform IEME twice and HIIT three times per week during the three-week rehabilitation stay. IEME is a group-based intervention, lasting for 6.5 h over three weeks. HIIT contains of five 1.5-min high-intensive exercise bouts on a cycle ergometer at 95-100% of peak heart rate (HR), followed by active breaks of unloaded pedalling for 2 min to achieve 60% of HR. CG: participants will perform PMR twice and MCT three times per week during the three-week rehabilitation stay, representing local usual care. PMR consists of six 1-h relaxation group sessions. MCT consists of 24-min continuous cycling at 65% of HR. The primary outcome is HRQoL (Physical and Mental Component Summaries of the Medical Outcome Study 36-item Short Form Health Survey; SF-36), measured at entry to the clinic (baseline, T), three weeks after T (T) and at four (T) and six (T) months after T. Secondary outcomes comprise cardiorespiratory fitness, inflammatory markers (measured at T and T), fatigue, mood, self-efficacy, occupational performance, physical activity (measured at T, T, T and T) and behaviour changes in energy management (measured at T and T). DISCUSSION: This study will provide detailed information on a multimodal therapy approach to further improve rehabilitation for PwMS. TRIAL REGISTRATION: This trial was prospectively registered at ClinicalTrials.gov ( NCT04356248 ; 22 April 2020).
背景:多发性硬化症(MS)患者通常有氧能力下降,并报告疲劳是影响其健康相关生活质量(HRQoL)的最致残症状。建议采用多学科康复方法来成功管理症状,尽管支持证据很少。本研究旨在评估在为期三周的住院康复期间,包括耐力训练和患者教育的多模式治疗方法,对 MS 患者 HRQoL 的影响,在六个月的随访时进行评估。住院能量管理教育(IEME)+高强度间歇训练(HIIT)将与渐进性肌肉放松(PMR)+中等连续训练(MCT)进行比较。
方法:本研究采用双臂单盲随机对照优势试验设计。106 名 MS 相关疲劳患者(复发缓解或慢性进行性表型;扩展残疾状况量表(EDSS)≤6.5)将在瑞士 Valens 诊所招募,并随机分为实验组(EG)或对照组(CG)。EG:参与者将在为期三周的康复住院期间每周进行两次 IEME 和三次 HIIT。IEME 是一种基于小组的干预措施,持续三周,每次 6.5 小时。HIIT 包括五次在自行车测功计上以 95-100%最大心率(HR)进行的 1.5 分钟高强度运动,随后进行无负荷蹬踏 2 分钟的主动休息,以达到 60%的 HR。CG:参与者将在为期三周的康复住院期间每周进行两次 PMR 和三次 MCT,代表当地常规护理。PMR 包括六次 1 小时的放松小组课程。MCT 包括以 65%HR 持续 24 分钟的连续循环。主要结局是健康相关生活质量(Medical Outcome Study 36-项简短健康调查的身体和心理成分综合摘要;SF-36),在进入诊所时(基线,T)、T 后三周(T)以及 T 后四个月(T)和六个月(T)进行测量。次要结局包括心肺功能、炎症标志物(在 T 和 T 时测量)、疲劳、情绪、自我效能、职业表现、身体活动(在 T、T、T 和 T 时测量)和能量管理行为变化(在 T 和 T 时测量)。
讨论:本研究将提供关于多模式治疗方法的详细信息,以进一步改善 MS 患者的康复。
试验注册:本试验前瞻性地在 ClinicalTrials.gov 注册(NCT04356248;2020 年 4 月 22 日)。
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