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Efficacy of an internet-based program to promote physical activity and exercise after inpatient rehabilitation in persons with multiple sclerosis: a randomized, single-blind, controlled study
Flachenecker P, Bures AK, Gawlik A, Weiland AC, Kuld S, Gusowski K, Streber R, Pfeifer K, Tallner A
International Journal of Environmental Research & Public Health 2020 Jun;17(12):4544
clinical trial
5/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: No; 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: Multimodal rehabilitation improves fatigue and mobility in persons with multiple sclerosis (PwMS). Effects are transient and may be conserved by internet-based physical activity promotion programs. OBJECTIVE: Evaluate the effects of internet-based physical activity and exercise promotion on fatigue, quality of life, and gait in PwMS after inpatient rehabilitation. METHODS: PwMS (Expanded Disability Status Scale (EDSS) <= 6.0, fatigue: Wurzburg Fatigue Inventory for Multiple Sclerosis (WEIMuS) >= 32) were randomized into an intervention group (IG) or a control group (CG). After rehabilitation, IG received 3 months of internet-based physical activity promotion, while CG received no intervention. PRIMARY OUTCOME: self-reported fatigue (WEIMuS). SECONDARY OUTCOMES: quality of life (Multiple Sclerosis Impact Scale 29, MSIS-29), gait (2 min/10 m walking test, Tinetti score). MEASUREMENTS: beginning (T0) and end (T1) of inpatient rehabilitation, 3 (T2) and 6 (T3) months afterwards. RESULTS: 64 of 84 PwMS were analyzed (IG = 34, CG = 30). After rehabilitation, fatigue decreased in both groups. At T2 and T3, fatigue increased again in CG but was improved in IG (p < 0.001). MSIS-29 improved in both groups at T1 but remained improved at T2 and T3 only in IG. Gait improvements were more pronounced in IG at T2. CONCLUSIONS: The study provides Class II evidence that the effects of rehabilitation on fatigue, quality of life, and gait can be maintained for 3 to 6 months with an internet-based physical activity and exercise promotion program.

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