Supported Treadmill Training for Progressive Multiple Sclerosis
This study is a pilot trial to evaluate the effects of supported treadmill walking in patients with primary progressive multiple sclerosis (MS) on functional and psychosocial outcomes. Patients will exercise three times per week over the course of 6 months and will be evaluated at baseline, 12 weeks and 24 weeks into the program. Follow-up testing will also be conducted 12 weeks after participants have stopped exercising to determined the lasting effects of the intervention.
The investigators hypothesize that supported treadmill walking will be effective at improving physical physical function and psychosocial outcomes in patients with primary progressive MS.
|Study Design:||Endpoint Classification: Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
|Official Title:||Body-weight Supported Treadmill Training in Primary Progressive Multiple Sclerosis: A Pilot Trial|
- Change from baseline in Multiple Sclerosis Functional Composite (MSFC) at 12, 24 and 36 weeks [ Time Frame: Repeat assessments: baseline, 12 weeks, 24 weeks and 36 weeks (12 weeks post-exercise follow-up) ] [ Designated as safety issue: No ]The MSFC assesses functional ability with three scales: the 25ft walk (leg strength and ambulation), the 9-hole peg test (arm strength and coordination) and the Paced Auditory Serial Addition Test (PASAT; cognition). Scores on all three measures are combined to produce a composite Z-score.
- Change from baseline in Expanded Disability Status Scale (EDSS) at 12, 24 and 36 weeks [ Time Frame: Repeat assessments: baseline, 12 weeks, 24 weeks and 36 weeks (12 weeks post-exercise follow-up) ] [ Designated as safety issue: No ]The EDSS provides a measure of physical and neurological function specifically in MS patients and is scored from 0-10. This will be assessed by a train neurologist.
- Change from baseline in Modified Fatigue Impact Scale (MFIS) at 12, 24 and 36 weeks [ Time Frame: Repeat assessments: baseline, 12 weeks, 24 weeks and 36 weeks (12 weeks post-exercise follow-up) ] [ Designated as safety issue: No ]The MFIS is a 21-item self-report questionnaire that evaluates fatigue overall fatigue, as well as within three categories: physical (pMFIS); cognitive (cMFIS); and psychosocial (psMFIS), over the previous 4 weeks. Scores range from 0-4 on each item with a maximum total score of 84, where higher scores indicate greater fatigue levels.
- Change from baseline in Multiple Sclerosis Quality of Life-54 questionnaire at 12, 24 and 36 weeks [ Time Frame: Repeat assessments: baseline, 12 weeks, 24 weeks and 36 weeks (12 weeks post-exercise follow-up) ] [ Designated as safety issue: No ]The MSQOL-54 is an MS-specific measure of quality of life that consists of 54 items divided into 12 multi-item scales, 2 single-item scales, and 2 composite scores (physical and mental health).
- Change from baseline in brain-derived neurotrophic factor (BDNF) at 12, 24 and 36 weeks [ Time Frame: Repeat assessments: baseline, 12 weeks, 24 weeks and 36 weeks (12 weeks post-exercise follow-up) ] [ Designated as safety issue: No ]
- Change from baseline in magnetic resonance imaging (MRI) outcomes at 24 weeks [ Time Frame: Repeat assessments: baseline and 24 weeks ] [ Designated as safety issue: No ]Both standard and unconventional MRI techniques will be used to evaluate the effects of exercise on brain health.
|Study Start Date:||April 2008|
|Study Completion Date:||June 2009|
|Primary Completion Date:||June 2009 (Final data collection date for primary outcome measure)|
|Experimental: Body-weight supported treadmill training||
Other: Body-weight supported treadmill training
Patients will undergo training using the Woodway Loco-system which consists of a treadmill with an overhead pulley system connected to a support harness. BWSTT allows patients with limited mobility to safely walk upright on a treadmill with a portion of their body weight counter balanced. Three trainers will be required to assist with the BWSTT program. Two trainers will be positioned at the lower limbs to manually guide the participant through a proper gait motion and provided lower limb control. A third trainer will stand behind the participant to provide trunk support and assist with weight shifting.
The use of exercise as an adjunct to other disease modifying treatments in MS has found increasing support over the past decade. There is ample evidence that exercise therapy can improve physical measures of disability in MS, in addition to being safe and well-tolerated. However, there is a paucity of data on whether exercise is equally effective for those with primary progressive MS as it is in relapsing remitting MS. In addition, studies of exercise therapy have traditionally excluded MS patients with severe disability. There are also currently no treatments for primary progressive MS, so finding a safe disease-modifying therapy is of the utmost importance. The investigators are therefore conducting a pilot trial to evaluate the effects of exercise in the form of supported treadmill walking for patients with primary progressive MS with severe functional impairments.
Six patients with primary progressive MS with high disability level will be recruited to participate in this study. Participants will exercise using body-weight supported treadmill training (BWSTT; Woodway Loco-system) which allows a portion of an individual's body-weight to be counterbalanced by an overhead pulley system. This system allows patients with limited mobility to walk upright on the treadmill with therapist assistance. Therapists trained in using the BWSTT system will guide the patients' legs through a proper gait motion and assist with lower limb control. Participants will complete 72 training sessions (30min/session, 3x/week) over the course of 24 weeks. Participants will be evaluated at baseline, 12 weeks (half-way through the training program) and 24 weeks (end of intervention). A follow-up assessment will also be performed 12 after participants have completed the training program (36 weeks). Outcome measures are described below.
|McMaster University (Centre for Health Promotion and Rehabilitation)/Hamilton Health Sciences|
|Hamilton, Ontario, Canada, L8S 4K1|
|Principal Investigator:||Michel Rathbone, MD, PhD||McMaster University|
|Principal Investigator:||Audrey Hicks, PhD||McMaster University|