Local dynamic stability as a responsive index for the evaluation of rehabilitation effect on fall risk in patients with multiple sclerosis: a longitudinal study.

BACKGROUND: Gait and balance problems are common in patients with multiple sclerosis, leading to high risk for falls. Local Dynamic Stability (LDS), a non-linear gait stability index, has been advocated as an early indicator of risk for falls. With this longitudinal study over three weeks, we aimed to assess the responsiveness of Local Dynamic Stability to a rehabilitation program and to compare it to other measures. METHODS: Eighteen patients (mean 54 years, median EDSS score: 5) participated. They were admitted to inpatient rehabilitation and received a three weeks individually tailored program. They performed a 3-minute walking test at the beginning and at the end of the stay, as well as pain, wellbeing, fatigue, and balance assessment. The Local Dynamic Stability was computed from the acceleration signals measured with a 3D-accelerometer. RESULTS: At the end of the rehabilitation process, patients reported reduced pain (Effect Size: -0.7), fatigue (ES:-0.6), and increased wellbeing (ES: 1.1). A small positive effect on static balance was observed (ES: 0.3). LDS was improved (ES: 0.6), and the effect was higher than walking speed improvement (ES: 0.4). CONCLUSIONS: The Local Dynamic Stability seemed responsive to assess rehabilitation effects in patients with multiple sclerosis. It could constitute a valuable gait quality index, which could evaluate potential effects of rehabilitation on fall risk. TRIAL REGISTRATION: Current Controlled Trials ISRCTN69803702.

Robotic-assisted step training (lokomat) not superior to equal intensity of over-ground rehabilitation in patients with multiple sclerosis.

BACKGROUND: Robot-assisted gait training (RAGT) has been suggested as an intervention to improve walking capacity in patients with multiple sclerosis (MS). OBJECTIVE: This study aimed to evaluate whether RAGT (Lokomat) is superior to over-ground walking training in terms of quality of life, activity level, and gait. METHODS: A total of 67 patients with MS with the Expanded Disability Status Scale (EDSS) 3.0 to 6.5 were randomized to walking or RAGT, in addition to multimodal rehabilitation. Primary outcomes were walking speed, activity level (estimated metabolic equivalent, metabolic equivalents [METs], using an accelerometer), and quality of life (Well-Being Visual Analogue Scale (VAS) and EQ-5D European VAS. RESULTS: In all, 49 patients finished the interventions. Mean age was 56 years (range 36-74 years), mean EDSS was 5.8 (3.0-6.5), and the preferred walking speed at baseline was 0.56 m/s (0.06-1.43 m/s). Before rehabilitation, participants spent on average 68 min/d at an MET ≥ 3. The walking group improved gait speed nonsignificantly more than the RAGT; the upper bound of the confidence interval (CI) did not exclude a clinically relevant benefit (defined as a difference of 0.05 m/s) in favor of the walking group; the lower bound of the CI did exclude a clinically important benefit in favor of the Lokomat. Quality of life improved in both groups, with a nonsignificant between-group difference in favor of the walking group. Both groups had reduced their activity by 8 weeks after the rehabilitation. CONCLUSION: It is unlikely that RAGT is better than over-ground walking training in patients with an EDSS between 3.0 and 6.5.