Clinical Rehabilitation http://cre.sagepub.com/
Web-based physiotherapy for people moderately affected with Multiple Sclerosis; quantitative and qualitative data from a randomized, controlled pilot study Lorna Paul, Elaine H Coulter, Linda Miller, Angus McFadyen, Joe Dorfman and Paul George G Mattison Clin Rehabil 2014 28: 924 originally published online 1 April 2014 DOI: 10.1177/0269215514527995 The online version of this article can be found at: http://cre.sagepub.com/content/28/9/924
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527995
research-article2014
CRE0010.1177/0269215514527995Clinical RehabilitationPaul et al.
CLINICAL REHABILITATION
Article
Web-based physiotherapy for people moderately affected with Multiple Sclerosis; quantitative and qualitative data from a randomized, controlled pilot study
Clinical Rehabilitation 2014, Vol. 28(9) 924–935 © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0269215514527995 cre.sagepub.com
Lorna Paul1, Elaine H Coulter1, Linda Miller2, Angus McFadyen3, Joe Dorfman4 and Paul George G Mattison2
Abstract Objective: To explore the effectiveness and participant experience of web-based physiotherapy for people moderately affected with Multiple Sclerosis (MS) and to provide data to establish the sample size required for a fully powered, definitive randomized controlled study. Design: A randomized controlled pilot study. Setting: Rehabilitation centre and participants’ homes. Subjects: Thirty community dwelling adults moderately affected by MS (Expanded Disability Status Scale 5-6.5). Interventions: Twelve weeks of individualised web-based physiotherapy completed twice per week or usual care (control). Online exercise diaries were monitored; participants were telephoned weekly by the physiotherapist and exercise programmes altered remotely by the physiotherapist as required. Main measures: The following outcomes were completed at baseline and after 12 weeks; 25 Foot Walk, Berg Balance Scale, Timed Up and Go, Multiple Sclerosis Impact Scale, Leeds MS Quality of Life Scale, MS-Related Symptom Checklist and Hospital Anxiety and Depression Scale. The intervention group also completed a website evaluation questionnaire and interviews. Results: Participants reported that website was easy to use, convenient, and motivating and would be happy to use in the future. There was no statistically significant difference in the primary outcome measure, the timed 25ft walk in the intervention group (P=0.170), or other secondary outcome measures, except the Multiple Sclerosis Impact Scale (P=0.048). Effect sizes were generally small to moderate. Conclusion: People with MS were very positive about web-based physiotherapy. The results suggested that 80 participants, 40 in each group, would be sufficient for a fully powered, definitive randomized controlled trial. 1School
of Medicine, University of Glasgow, Scotland, UK Sclerosis Service NHS Ayrshire and Arran, Scotland,
2Multiple
UK 3AKM-STATS, 4Video3
Statistical Consultant, Glasgow, Scotland, UK Technologies, Falkirk, Scotland, UK
Corresponding author: Lorna Paul, School of Medicine, University of Glasgow, 59 Oakfield Avenue, Glasgow, G12 8LL, UK. Email: [email protected]
Downloaded from cre.sagepub.com at UNIV WASHINGTON LIBRARIES on August 27, 2014
925
Paul et al. Keywords Multiple sclerosis, MS, web-based, exercise, patient experience, telerehabilitation Received: 5 October 2013; accepted: 22 February 2014
Introduction Telerehabilitation defined as ‘The use of information and communication technology to deliver rehabilitation services over a distance’1 may provide a means to make rehabilitation both accessible and more efficient for people with long term rehabilitation needs, such as those with Multiple Sclerosis (MS). Telerehabilitation, specifically web-based telerehabilitation, has many advantages over conventional, face-to-face rehabilitation. It is useful for people who work, who live in rural locations, who are housebound, who have transport problems or for whom the effort/stress of getting to the therapy location outweighs the benefits gained.2 Telerehabilitation is reported as being as effective in improving clinical outcome as conventional rehabilitation1 and also provides a means to support self-management through personalised, targeted rehabilitation programmes and personal autonomy.2 Web-based interventions are becoming a more feasible option due to the increasing number of people with access to the internet and skills to use it.3 Surveys in Canada and the UK have found approximately 75%4 and 92%5 respectively of people with MS use the internet on a regular basis. Thus web-based physiotherapy has the potential to be an alternative model of rehabilitation for people with MS. Very few studies have specifically investigated the effectiveness of telerehabilitation for people with MS.6,7 Motl and colleagues, who evaluated an internet intervention for increasing physical activity in people mildly affected by MS, demonstrated some promising initial results but the intervention was specifically aimed at increasing physical activity.8–10 Only two studies have investigated telerehabilitation as a method of delivering physical rehabilitation for people with MS. Huijgen et al. (2008) evaluated the feasibility of a web-camera and teleconferencing programme to improve arm and hand function in people with MS, stroke and
traumatic brain injury.11 The programme was found to be as effective as usual care with high patient and therapist satisfaction. Finkelstein et al. (2008) evaluated the effects of a 12 week customised, exercise programme prescribed by a physiotherapist.12 The results showed improvements in functional outcome with measures such as quality of life remaining unaltered. However, this study was undertaken on a small sample and with no control group. The aims of the present study were to explore the participant experience and effectiveness of physiotherapy led, web-based rehabilitation for people moderately affected with MS and to provide sufficient data to establish the sample size required for a fully powered, definitive randomized controlled study.
Methods Ethical approval was received from the West of Scotland Research Ethics Service (ref: 12/ WS/0147) and participants were recruited from the Multiple Sclerosis Service, at the Douglas Grant Rehabilitation Centre, Irvine, Scotland. To be included in the study participants were required to have a confirmed diagnosis of MS, an Expanded Disability Status Score of between 5 and 6.5,13 stable drug therapy for 30 days, no relapses in the previous three months, no significant co-morbidities such as coexisting cardiac or pulmonary condition and have access to the internet via personal or tablet computer. Letters were sent to 138 patients from the Multiple Sclerosis Service database, thought to be suitable for the study, inviting them to participate. Of those 37 people expressed an interest in taking part. Seven people were excluded as they did not meet the inclusion and exclusion criteria (Figure 1). Therefore, 30 people were recruited into the study and all participants provided written informed consent.
Downloaded from cre.sagepub.com at UNIV WASHINGTON LIBRARIES on August 27, 2014
926
Clinical Rehabilitation 28(9)
Invited to participate (n=138) ♦ Expressed interest in taking part (n=37) Excluded (n=7); change in medication (n=3), recent relapse (n=1), EDSS
Web-based physiotherapy for people moderately affected with Multiple Sclerosis; quantitative and qualitative data from a randomized, controlled pilot study Lorna Paul, Elaine H Coulter, Linda Miller, Angus McFadyen, Joe Dorfman and Paul George G Mattison Clin Rehabil 2014 28: 924 originally published online 1 April 2014 DOI: 10.1177/0269215514527995 The online version of this article can be found at: http://cre.sagepub.com/content/28/9/924
Published by: http://www.sagepublications.com
Additional services and information for Clinical Rehabilitation can be found at: Email Alerts: http://cre.sagepub.com/cgi/alerts Subscriptions: http://cre.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav
>> Version of Record - Aug 20, 2014 OnlineFirst Version of Record - Apr 1, 2014 What is This?
Downloaded from cre.sagepub.com at UNIV WASHINGTON LIBRARIES on August 27, 2014
527995
research-article2014
CRE0010.1177/0269215514527995Clinical RehabilitationPaul et al.
CLINICAL REHABILITATION
Article
Web-based physiotherapy for people moderately affected with Multiple Sclerosis; quantitative and qualitative data from a randomized, controlled pilot study
Clinical Rehabilitation 2014, Vol. 28(9) 924–935 © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0269215514527995 cre.sagepub.com
Lorna Paul1, Elaine H Coulter1, Linda Miller2, Angus McFadyen3, Joe Dorfman4 and Paul George G Mattison2
Abstract Objective: To explore the effectiveness and participant experience of web-based physiotherapy for people moderately affected with Multiple Sclerosis (MS) and to provide data to establish the sample size required for a fully powered, definitive randomized controlled study. Design: A randomized controlled pilot study. Setting: Rehabilitation centre and participants’ homes. Subjects: Thirty community dwelling adults moderately affected by MS (Expanded Disability Status Scale 5-6.5). Interventions: Twelve weeks of individualised web-based physiotherapy completed twice per week or usual care (control). Online exercise diaries were monitored; participants were telephoned weekly by the physiotherapist and exercise programmes altered remotely by the physiotherapist as required. Main measures: The following outcomes were completed at baseline and after 12 weeks; 25 Foot Walk, Berg Balance Scale, Timed Up and Go, Multiple Sclerosis Impact Scale, Leeds MS Quality of Life Scale, MS-Related Symptom Checklist and Hospital Anxiety and Depression Scale. The intervention group also completed a website evaluation questionnaire and interviews. Results: Participants reported that website was easy to use, convenient, and motivating and would be happy to use in the future. There was no statistically significant difference in the primary outcome measure, the timed 25ft walk in the intervention group (P=0.170), or other secondary outcome measures, except the Multiple Sclerosis Impact Scale (P=0.048). Effect sizes were generally small to moderate. Conclusion: People with MS were very positive about web-based physiotherapy. The results suggested that 80 participants, 40 in each group, would be sufficient for a fully powered, definitive randomized controlled trial. 1School
of Medicine, University of Glasgow, Scotland, UK Sclerosis Service NHS Ayrshire and Arran, Scotland,
2Multiple
UK 3AKM-STATS, 4Video3
Statistical Consultant, Glasgow, Scotland, UK Technologies, Falkirk, Scotland, UK
Corresponding author: Lorna Paul, School of Medicine, University of Glasgow, 59 Oakfield Avenue, Glasgow, G12 8LL, UK. Email: [email protected]
Downloaded from cre.sagepub.com at UNIV WASHINGTON LIBRARIES on August 27, 2014
925
Paul et al. Keywords Multiple sclerosis, MS, web-based, exercise, patient experience, telerehabilitation Received: 5 October 2013; accepted: 22 February 2014
Introduction Telerehabilitation defined as ‘The use of information and communication technology to deliver rehabilitation services over a distance’1 may provide a means to make rehabilitation both accessible and more efficient for people with long term rehabilitation needs, such as those with Multiple Sclerosis (MS). Telerehabilitation, specifically web-based telerehabilitation, has many advantages over conventional, face-to-face rehabilitation. It is useful for people who work, who live in rural locations, who are housebound, who have transport problems or for whom the effort/stress of getting to the therapy location outweighs the benefits gained.2 Telerehabilitation is reported as being as effective in improving clinical outcome as conventional rehabilitation1 and also provides a means to support self-management through personalised, targeted rehabilitation programmes and personal autonomy.2 Web-based interventions are becoming a more feasible option due to the increasing number of people with access to the internet and skills to use it.3 Surveys in Canada and the UK have found approximately 75%4 and 92%5 respectively of people with MS use the internet on a regular basis. Thus web-based physiotherapy has the potential to be an alternative model of rehabilitation for people with MS. Very few studies have specifically investigated the effectiveness of telerehabilitation for people with MS.6,7 Motl and colleagues, who evaluated an internet intervention for increasing physical activity in people mildly affected by MS, demonstrated some promising initial results but the intervention was specifically aimed at increasing physical activity.8–10 Only two studies have investigated telerehabilitation as a method of delivering physical rehabilitation for people with MS. Huijgen et al. (2008) evaluated the feasibility of a web-camera and teleconferencing programme to improve arm and hand function in people with MS, stroke and
traumatic brain injury.11 The programme was found to be as effective as usual care with high patient and therapist satisfaction. Finkelstein et al. (2008) evaluated the effects of a 12 week customised, exercise programme prescribed by a physiotherapist.12 The results showed improvements in functional outcome with measures such as quality of life remaining unaltered. However, this study was undertaken on a small sample and with no control group. The aims of the present study were to explore the participant experience and effectiveness of physiotherapy led, web-based rehabilitation for people moderately affected with MS and to provide sufficient data to establish the sample size required for a fully powered, definitive randomized controlled study.
Methods Ethical approval was received from the West of Scotland Research Ethics Service (ref: 12/ WS/0147) and participants were recruited from the Multiple Sclerosis Service, at the Douglas Grant Rehabilitation Centre, Irvine, Scotland. To be included in the study participants were required to have a confirmed diagnosis of MS, an Expanded Disability Status Score of between 5 and 6.5,13 stable drug therapy for 30 days, no relapses in the previous three months, no significant co-morbidities such as coexisting cardiac or pulmonary condition and have access to the internet via personal or tablet computer. Letters were sent to 138 patients from the Multiple Sclerosis Service database, thought to be suitable for the study, inviting them to participate. Of those 37 people expressed an interest in taking part. Seven people were excluded as they did not meet the inclusion and exclusion criteria (Figure 1). Therefore, 30 people were recruited into the study and all participants provided written informed consent.
Downloaded from cre.sagepub.com at UNIV WASHINGTON LIBRARIES on August 27, 2014
926
Clinical Rehabilitation 28(9)
Invited to participate (n=138) ♦ Expressed interest in taking part (n=37) Excluded (n=7); change in medication (n=3), recent relapse (n=1), EDSS
