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Group-based individualized comprehensive core stability intervention improves balance in persons with multiple sclerosis: a randomized controlled trial
Arntzen EC, Straume BK, Odeh F, Feys P, Zanaboni P, Normann B
Physical Therapy 2019 Aug;99(8):1027-1038
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Balance and trunk control are often impaired in individuals with multiple sclerosis (MS). Interventions addressing these issues are needed. OBJECTIVE: The objective of this study was to compare the immediate and long-term effects of a 6-week individualized, group-based, comprehensive core stability intervention (GroupCoreDIST) with those of standard care on balance and trunk control in individuals with MS. DESIGN: This study was a prospective, assessor-masked randomized controlled trial. SETTING: The GroupCoreDIST-intervention was conducted by 6 physical therapists in 6 municipalities in Norway. Standard care included the usual care for individuals with MS in the same municipalities. Assessments at all time-points took place at a Norwegian hospital. PARTICIPANTS: Eighty people with Expanded Disability Status scores of 1 to 6.5 participated in this trial. INTERVENTION: Randomized, concealed allocation was used to assign the participants to the GroupCoreDIST intervention (n = 40) or to standard care (n = 40). The GroupCoreDIST intervention was conducted with groups of 3 participants (1 group had 4 participants), for 60 minutes 3 times per week. MEASUREMENTS: Assessments were undertaken at baseline and at weeks 7, 18, and 30. Outcomes were measured with the Trunk Impairment Scale-Norwegian Version, Mini Balance Evaluation Systems Test, and Patient Global Impression of Change-Balance. Repeated-measures mixed models were used for statistical analysis. RESULTS: One individual missed all postintervention tests, leaving 79 participants in the intention-to-treat analysis. GroupCoreDIST produced significant between-group effects on the mean difference in the following scores at 7, 18, and 30 weeks: for Trunk Impairment Scale-Norwegian Version, 2.63 points (95% CI 1.89 to 3.38), 1.57 points (95% CI 0.81 to 2.33), and 0.95 point (95% CI 0.19 to 1.71), respectively; for Mini Balance Evaluation Systems Test, 1.91 points (95% CI 1.07 to 2.76), 1.28 points (95% CI 0.42 to 2.15), and 0.91 point (95% CI 0.04 to 1.77), respectively; and for Patient Global Impression of Change-Balance, 1.21 points (95% CI 1.66 to 0.77), 1.02 points (95% CI 1.48 to 0.57), and 0.91 point (95% CI 1.36 to 0.46), respectively. LIMITATIONS: Groups were not matched for volume of physical therapy. CONCLUSIONS: Six weeks of GroupCoreDIST improved balance and trunk control in the short and long terms compared with standard care in individuals who were ambulant and had MS and is an effective contribution to physical therapy.

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