DelMastro Heather M, Ruiz Jennifer A, Simaitis Laura B, Gromisch Elizabeth S, Neto Lindsay O, Cohen Evan T, Wong Edgar, Krug Robert J, Lo Albert C
Joyce D. and Andrew J. Mandell Center for Comprehensive Multiple Sclerosis Care and Neuroscience Research, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, CT, USA (HMDM, JAR, ESG, LON, ACL).
Department of Rehabilitative Medicine (HMDM, JAR, ESG, LON), Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA.
Int J MS Care. 2023 Mar-Apr;25(2):45-50. doi: 10.7224/1537-2073.2022-010. Epub 2022 Oct 3.
Backward walking (BW) interventions have improved gait and balance in persons with stroke, cerebral palsy, and Parkinson disease but have not been studied in persons with multiple sclerosis (MS). We examined the feasibility of a BW intervention and how it affected strength, balance, and gait vs forward walking (FW) in persons with MS.
Sixteen persons with MS with a Patient-Determined Disease Steps (PDDS) scale score of 3 to 5 (gait impairment-late cane) were randomized to the FW (n = 8) or BW (n = 8) group. Participants did 30 minutes of FW or BW on a treadmill 3 times per week for 8 weeks (24 visits). Enrollment, adherence rate, and safety were tracked. The Timed Up and Go test, Six-Spot Step Test, single-leg stance, and abbreviated Activities-specific Balance Confidence scale were used to measure balance. Hip and knee flexion and extension strength (isometric peak torque), gait speed, and spatiotemporal gait parameters were measured. A 2×2 factorial multivariate analysis of covariance was used to examine changes in strength, balance, and gait, with the PDDS scale score as the covariate.
Treatment adherence rate was 99.7%, with no safety concerns. After controlling for baseline differences in disability (PDDS scale score; = .041), the BW group improved dominant hip flexion strength preintervention to postintervention compared with the FW group ( = 9.03; = .010). No other significant differences were seen between groups.
This was the first study to look at BW as an intervention in persons with MS. Based on its feasibility, safety, and significant finding, BW should be studied in a larger, definitive trial in the future.
倒走（BW）干预已改善了中风、脑瘫和帕金森病患者的步态和平衡，但尚未在多发性硬化症（MS）患者中进行研究。我们研究了BW干预在MS患者中的可行性，以及它与正走（FW）相比对力量、平衡和步态的影响。
16名患者确定疾病阶段（PDDS）量表评分为3至5（步态障碍-晚期手杖辅助）的MS患者被随机分为FW组（n = 8）或BW组（n = 8）。参与者每周在跑步机上进行3次30分钟的FW或BW训练，共8周（24次就诊）。记录入组情况、依从率和安全性。使用计时起立行走测试、六点步测试、单腿站立和简化的特定活动平衡信心量表来测量平衡。测量髋部和膝部的屈伸力量（等长峰值扭矩）、步态速度和时空步态参数。采用2×2析因多变量协方差分析来检查力量、平衡和步态的变化，以PDDS量表评分作为协变量。
治疗依从率为99.7%，无安全问题。在控制了残疾程度的基线差异（PDDS量表评分；P = .041）后，与FW组相比，BW组干预前至干预后的优势髋部屈曲力量有所改善（P = 9.03；P = .010）。两组之间未观察到其他显著差异。
这是第一项将BW作为MS患者干预措施的研究。基于其可行性、安全性和显著发现，未来应在更大规模的确定性试验中对BW进行研究。
