Effects of pulsed electromagnetic field therapy on fatigue, walking performance, depression, and quality of life in adults with multiple sclerosis: a randomized placebo-controlled trial.

BACKGROUND: Multiple sclerosis has a great disability burden. Management of the disease is complex, and patients often seek new conservative approaches. OBJECTIVE: To investigate the effect of low-frequency pulsed electromagnetic field (PEMF) therapy, compared to placebo, on the level of fatigue, walking performance, symptoms of depression, and quality of life (QOL) in patients with relapsing-remitting multiple sclerosis (RRMS). METHODS: Forty-four adults with RRMS and minimal to significant disability were randomly assigned to a 4-week protocol using a PEMF or a placebo whole-body mat. The PEMF group were initially treated with 15Hz frequency, gradually increased to 30Hz (intensity between 25-35µT). The primary outcome was fatigue, assessed with the Fatigue Severity Scale (FSS) and the Modified Fatigue Impact Scale (MFIS). Secondary measures included walking function (GAITRite system and Timed 25-Foot Walk test), the Beck Depression Inventory-II, and the Multiple Sclerosis International Quality of Life Questionnaire. Data were collected at baseline, after intervention, and at 3-months post-intervention (follow-up). RESULTS: There were no differences between groups for changes in fatigue symptoms from baseline to end of intervention (mean and 95% confidence interval FSS: -0.6, 95%CI: -1.3, 0.1; MFIS: -5.4, 95% CI: -15.1, 4.4) or at follow-up (FSS: -0.6, 95% CI: -1.4, 0.2; MFIS: -2.1, 95% CI: -10.9, 6.8). Similarly, both groups did not differ for any of the secondary outcomes at post-intervention or follow-up. CONCLUSIONS: Low-frequency PEMF therapy is no more effective than placebo to produce changes in fatigue, gait performance, severity of depression, and QOL in people with RRMS and minimal to significant disability.

Effect of Training Exercises Incorporating Mechanical Devices on Fatigue and Gait Pattern in Persons with Relapsing-Remitting Multiple Sclerosis.

Purpose: The aim of this study was to evaluate the effects of regular exercise incorporating mechanical devices on fatigue, gait pattern, mood, and quality of life in persons with relapsing-remitting multiple sclerosis (RRMS). Method: A total of 55 individuals with RRMS with an Expanded Disability Status Scale (EDSS) score of 0-4.5 and a Fatigue Severity Scale (FSS) score of 4.0 or more were randomly assigned to one of two exercise groups or a control group (n=18). Exercise programmes used aerobic, body weight, coordination, and balance exercises with either whole-body vibration (WBV; n=19; drop-outs, n=3) or the Balance Trainer system (n=18; drop-outs, n=4). Outcome measures included the FSS, Modified Fatigue Impact Scale (MFIS), Beck Depression Inventory (BDI-II), and Multiple Sclerosis International Quality of Life (MusiQoL). Spatiotemporal gait parameters were assessed using the GAITRite electronic walkway. Pre- and post-intervention assessments were performed by a blinded assessor. Intra- and inter-group analysis was performed, using the paired-samples t-test, by calculating the effect size with Cohen's d analysis and one-way analysis of variance, respectively. Results: Significant improvements in fatigue and mood were identified for both intervention groups (p<0.05). Gait parameters also improved significantly in the WBV group: velocity and step length increased (12.8% and 6.5%, respectively; p<0.005), and step time, stance time, double support time, and step length asymmetry decreased (-5.3%, -1.4%, -5.9%, and -43.7%, respectively; p<0.005). Conclusions: The results of this study support the hypothesis that combined training programmes help to reduce fatigue and improve mood in persons with mild to moderate RRMS. WBV combined with a standard exercise programme significantly improves spatiotemporal gait parameters.

Objectif : la présente étude visait à évaluer les effets de l'exercice régulier incluant des appareils mécaniques sur la fatigue, les types de démarche, l'humeur et la qualité de vie de personnes ayant une sclérose en plaques rémittente (SPR). Méthodologie : au total, 55 personnes ayant une SPR, un score de 0 à 4,5 sur l'échelle étendue des incapacités (EDSS) et un score de 4,0 ou plus sur l'échelle de gravité de la fatigue (FSS) ont été divisées au hasard entre deux groupes d'exercices et un groupe témoin (CT, n=18). Les programmes d'exercices faisaient appel à l'aérobie, au poids du corps, à la coordination et aux exercices d'équilibre à l'aide de la vibration globale du corps (groupe WBV, n=19; abandons, n=3) ou du système d'entraînement à l'équilibre (groupe BT, n=18; abandons, n=4). Les mesures de résultats incluaient la FSS, l'échelle modifiée des répercussions sur la fatigue (MFIS), l'inventaire de dépression de Beck (BDI-II) et la qualité de vie de la fédération internationale de sclérose en plaques (MusiQoL). Les chercheurs ont évalué les paramètres de démarche spatiotemporelle au moyen de la piste électronique GAITRite. Un évaluateur a procédé à des évaluations à l'aveugle avant et après les interventions. Les chercheurs ont effectué des analyses intragroupes et intergroupes à l'aide du test de Student pour échantillons appariés, en calculant la taille de l'effet par l'analyse d de Cohen et l'analyse de variance unidirectionnelle, respectivement. Résultats : les chercheurs ont constaté une diminution significative de la fatigue et une amélioration significative de l'humeur dans les deux groupes d'intervention (p<0,05). Les paramètres de démarche se sont également améliorés de manière considérable dans le groupe de WBV : la vélocité et la longueur des pas ont augmenté (12,8 % et 6,5 %, respectivement; p<0,005), tandis que la durée des pas, la durée d'appui, la durée du double appui et l'asymétrie de la longueur des pas ont diminué (−5,3 %, −1,4 %, −5,9 % et −43,7 %, respectivement; p<0,005). Conclusion : les résultats de la présente étude appuient l'hypothèse selon laquelle des programmes d'entraînement combinés contribuent à réduire la fatigue et à améliorer l'humeur des personnes présentant une SPR. La WBV combinée à un programme d'exercices standard améliore considérablement les paramètres de la démarche spatiotemporelle.

Validez clínica de las variables cuantitativas de la marcha en pacientes con esclerosis múltiple. Comparativa entre el test de los 25 pies y el sistema electrónico de marcha GAITRite (R) / Clinical validity of the quantitative gait variables in patients with multiple sclerosis. A comparison of the Timed 25-foot Walk Test and the GAITRite (R) Electronic Walkway system

Introducción. La esclerosis múltiple es una enfermedad inflamatoria y degenerativa en la que la alteración de la marcha aparece como uno de los primeros síntomas. Su evaluación cuantitativa se realiza con frecuencia con el test de los 25 pies -Timed 25-foot Walk Test (T25FW)-, aunque se limita a conocer la distancia, el tiempo empleado y el número de pasos. El sistema GAITRite (R) Electronic Walkway (GEW) establece también estos parámetros espaciotemporales, entre otros. Objetivo. Comparar el T25FW con el resultado del sistema GEW para establecer si hay variabilidad entre ambos. Pacientes y métodos. La muestra constaba de 85 sujetos con esclerosis múltiple y capaces de deambular, con o sin ayuda (EDSS: 1,0-6,5). Se realizaron cuatro pases por el tapiz electrónico de 8 m de longitud, del sistema GEW, que calcula distintos parámetros espaciotemporales, a la vez que otro evaluador hacía una medición con cronómetro del tiempo empleado y el número de pasos dados en una distancia de 25 pies marcada lateralmente en el mismo tapiz. La velocidad se calculó en función del tiempo empleado en recorrer los 25 pies. Se hizo una media de los cuatro pases de ambas mediciones y se correlacionó con el programa SPSS v. 18, considerando estadísticamente significativa una p < 0,001. Resultados. Ni el tiempo empleado (p = 1,000), ni la velocidad (p = 0,9995), ni la cadencia (p = 0,3296) ni el número de pasos (p = 1,000) mostraron diferencias estadísticamente significativas. Conclusiones. El sistema GEW tiene la misma validez clínica en la evaluación de la marcha en pacientes con esclerosis múltiple que el T25FW

Introduction. Multiple sclerosis is an inflammatory and degenerative disease in which gait alteration is one of the first symptoms. Its quantitative evaluation is often made by the Timed 25-foot Walk Test (T25FW), although it’s limited to know only the distance, the time employed and number of steps. Aim. To compare the T25FW with the results from the GAITRit(R) Electronic Walkway system (GEW), to know if there is some variability between them. Patients and methods. The sample consisted in 85 subjects with multiple sclerosis and able to walking, with or without aids (EDSS: 1.0-6.5). Four walkings were made along the 8 m-length carpet from GEW system, while a different evaluator measured the time employed with a chronometer, and the number of steps in a 25 feet distance marked side by side in the carpet. Velocity was calculated in function of distance and time employed. A mean from the four walkings was made and both of the measures were correlated with SPSS v. 18, considering a results of p < 0.001, statistically significant. Results. Time employed (p = 1.000), velocity (p = 0.9995), cadence (p = 0.3296) and number of steps (p = 1.000) were not statistically different. Conclusions. GEW system has the same clinical validity in gait evaluation in multiple sclerosis patients than the T25FW