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The effect of balance training on postural control in people with multiple sclerosis using the CAREN virtual reality system: a pilot randomized controlled trial
Kalron A, Fonkatz I, Frid L, Baransi H, Achiron A
Journal of NeuroEngineering & Rehabilitation 2016 Mar 1;13(13):Epub
clinical trial
7/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; 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: Multiple sclerosis (MS) is a multi-focal progressive disorder of the central nervous system often resulting in diverse clinical manifestations. Imbalance appears in most people with multiple sclerosis (PwMS). A popular balance training tool is virtual reality (VR) with several advantages including increased compliance and user satisfaction. Therefore, the aim of this pilot RCT (Trial registration number, date ISRCTN14425615, 21/01/2016) was to examine the efficacy of a 6-week VR balance training program using the computer assisted rehabilitation environment (CAREN) system (Motek Medical BV, Amsterdam, Netherlands) on balance measures in PwMS. Results were compared with those of a conventional balance exercise group. Secondary aims included the impact of this program on the fear of falling. METHODS: Thirty-two PwMS were equally randomized into the VR intervention group or the control group. Each group received balance training sessions for 6 consecutive weeks, two sessions per week, 30 min sessions. Clinical balance tests and instrumented posturography outcome measures were collected upon initiation of the intervention programs and at termination. RESULTS: Final analysis included 30 patients (19 females, 11 males; mean age (SD) 45.2 (11.6) years; mean EDSS (SD) 4.1 (1.3), mean disease duration (SD) 11.0 (8.9) years). Both groups showed a main effect of time on the center of pressure (CoP) path length with eyes open (F = 5.278, p = 0.024), sway rate with eyes open (F = 5.852, p = 0.035), Functional Reach Test (F = 20.841, p = 0.001), Four Square Step Test (F = 9.011, p = 0.031) and the Fear of Falls self-reported questionnaire (F = 17.815, p = 0.023). In addition, significant differences in favor of the VR program were observed for the group x time interactions of the Functional Reach Test (F = 10.173, p = 0.009) and fear of falling (F = 6.710, p = 0.021). CONCLUSIONS: We demonstrated that balance training based on the CAREN device is an effective method of balance training for PwMS.

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