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ADSTEP: preliminary investigation of a multicomponent walking aid program in people with multiple sclerosis
Martini DN, Zeeboer E, Hildebrand A, Fling BW, Hugos CL, Cameron MH
Archives of Physical Medicine and Rehabilitation 2018 Oct;99(10):2050-2058
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*

OBJECTIVE: To evaluate the impact of the Assistive Device Selection, Training and Education Program (ADSTEP) on falls and walking and sitting activity in people with multiple sclerosis (PwMS). DESIGN: Randomized controlled trial. SETTING: Veterans Affairs Medical Center. PARTICIPANTS: Forty PwMS using a walking aid at baseline who had fallen in the previous year. INTERVENTIONS: Participants were randomly assigned to ADSTEP or control. ADSTEP had six weekly, 40-minute, one-on-one sessions with a physical therapist, starting with walking aid selection and fitting, followed by task-oriented progressive gait training. Control was usual medical care with the option of ADSTEP after the study. MAIN OUTCOME MEASURES: The following were assessed at baseline, intervention completion, and three months later: falls, Timed Up and Go, Timed 25-Foot Walk, Two-Minute Walk, Four Square Step Test, International Physical Activity Questionnaire, Quebec User Evaluation of Satisfaction with Assistive Technologies, Multiple Sclerosis Walking Scale-12, Activities-specific Balance Confidence scale, and Multiple Sclerosis Impact Scale-29. Effect on these outcomes was estimated by a two-by-two repeated measures general linear model. RESULTS: Fewer ADSTEP than control participants fell (Chi2 = 3.96, p < 0.05. NNT 3.3). Time spent sitting changed significantly differently with ADSTEP than with control from baseline to intervention completion (F = 11.16, p = 0.002. ADSTEP reduced 87.00 +/- 194.89 minutes/day; control increased 103.50 +/- 142.21 minutes/day; d = 0.88) and to three-month follow-up (F = 9.25, p = 0.004. ADSTEP reduced 75.79 +/- 171.57 minutes/day; control increased 84.50 +/- 149.23 minutes/day; d = 0.79). ADSTEP yielded a moderate effect on time spent walking compared to control at three-month follow-up (p > 0.05. ADSTEP 117.53 +/- 148.40 minutes/day; control 46.43 +/- 58.55 minutes/day; d = 0.63). CONCLUSIONS: ADSTEP prevents falls, reduces sitting, and may increase walking in PwMS.

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