Abdominal functional electrical stimulation for bowel management in multiple sclerosis.

Aim: Functional constipation is common in multiple sclerosis (MS) and first line treatments are frequently ineffective. The current study explored the use of abdominal functional electrical stimulation (ABFES) for treating constipation in MS. Patients/methods: 20 people with MS and constipation (ROME IV criteria). The patient assessment of constipation-related quality of life questionnaire was administered at baseline and after 6 weeks of ABFES treatment alongside semi-structured interviews. Results: All patient assessment of constipation-related quality of life subscales were significant: satisfaction (p = 0.003), psychosocial discomfort (p = 0.008), physical discomfort (p = 0.001) and worries and concerns (p = 0.003). A long-term therapeutic effect, reduction in laxative use and improved sexual functioning were also reported. Conclusion: ABFES provides a potential alternative treatment intervention for people with MS and constipation.

Five-Year Follow-up of a Longitudinal Cohort Study of the Effectiveness of Functional Electrical Stimulation for People with Multiple Sclerosis.

BACKGROUND: Few studies have examined the long-term consequences of using peroneal nerve functional electrical stimulation (FES) for people with multiple sclerosis (MS). This study examines orthotic effects on a longitudinal cohort and explores additional benefits of FES on self-reported measures such as joint pain. METHODS: One hundred forty-five people with foot drop and MS were included (mean age, 52 [range, 28-74] years). Orthotic effects, unassisted walking speed, and clinically important differences (ie, ≥0.05 and ≥0.10 m/s) were derived from walking speed over 10 m. Visual analogue scales examined joint pain, walking effort, trips, confidence, and quality of life. Measures were taken on day 1, after 6 months, and at 2, 3, 4, and 5 years. RESULTS: A significant difference was found overall for walking with FES compared with walking without FES for the 5-year period (P < .001). Despite a significant decline in overall unassisted walking speed at baseline (0.58 m/s) compared with 5 years later (0.46 m/s) (P < .001), participants achieved an orthotic effect with (0.52 m/s) versus without (0.46 m/s) FES after 5 years (P < .001). A significant decrease in joint pain was found after 6 months compared with day 1 (P = .004), which was maintained after 5 years (P < .001). CONCLUSIONS: Despite progression of MS, long-term users of FES still benefit from an orthotic effect after using FES for 5 years. The study highlights the need for further work to assess the perceived benefits of FES regarding the experience of joint pain.

A clinically meaningful training effect in walking speed using functional electrical stimulation for motor-incomplete spinal cord injury.

CONTEXT/OBJECTIVE: The study aimed to investigate the presence of a training effect for rehabilitation of walking function in motor-incomplete spinal cord injury (SCI) through daily use of functional electrical stimulation (FES). SETTING: A specialist FES outpatient centre. PARTICIPANTS: Thirty-five participants (mean age 53, SD 15, range 18-80; mean years since diagnosis 9, range 5 months - 39 years) with drop foot and motor-incomplete SCI (T12 or higher, ASIA Impairment Scale C and D) able to ambulate 10 metres with the use of a walking stick or frame. INTERVENTIONS: FES of the peroneal nerve, glutei and hamstrings as clinically indicated over six months in the community. OUTCOME MEASURES: The data was analysed for a training effect (difference between unassisted ten metre walking speed at baseline and after six months) and orthotic effects (difference between walking speed with and without FES) initially on day one and after six months. The data was further analysed for a minimum clinically important difference (MCID) (>0.06 m/s). RESULTS: A clinically meaningful, significant change was observed for initial orthotic effect (0.13m/s, CI: 0.04-0.17, P = 0.013), total orthotic effect (0.11m/s, CI: 0.04-0.18, P = 0.017) and training effect (0.09m/s, CI: 0.02-0.16, P = 0.025). CONCLUSION: The results suggest that daily independent use of FES may produce clinically meaningful changes in walking speed which are significant for motor-incomplete SCI. Further research exploring the mechanism for the presence of a training effect may be beneficial in targeting therapies for future rehabilitation.

The Efficacy of Functional Electrical Stimulation of the Abdominal Muscles in the Treatment of Chronic Constipation in Patients with Multiple Sclerosis: A Pilot Study.

Chronic constipation in patients with multiple sclerosis (MS) is common and the current methods of treatment are ineffective in some patients. Anecdotal observations suggest that functional electrical stimulation (FES) of the abdominal muscles may be effective in the management of constipation in these patients. Patients and Methods. In this exploratory investigation we studied the effects of FES on the whole gut transit time (WGTT) and the colonic transit time (CTT). In addition, we evaluated the treatment effect on the patients' constipation-related quality of life and on the use of laxatives and the use of manual bowel evacuation. FES was given for 30 minutes twice a day for a period of six weeks. Four female patients were studied. Results. The WGTT and CTT and constipation-related quality of life improved in all patients. The patients' use of laxatives was reduced. No adverse effects of FES treatment were reported. Conclusion. The findings of this pilot study suggest that FES applied to the abdominal muscles may be an effective treatment modality for severe chronic constipation in patients with MS.

The perceptions of people with multiple sclerosis about the NHS provision of physiotherapy services.

PURPOSE: In 2008, the Royal College of Physicians (RCP) and MS Trust conducted a second audit of NHS services for people with MS (PwMS). Using the free text comments obtained from the RCP and MS Trust audit, this study aimed to perform content analysis on the views of PwMS about MS services, focussing on physiotherapy provision. METHOD: A total of 757 PwMS included a free text comment on MS services and an additional 41 commented separately about physiotherapy services. The data were analysed using content analysis, which identified three main themes, positive, negative and neutral and subsequent categories and sub-categories. Intra- and inter-rater reliability were assessed and the data were manipulated to address the research aim. RESULTS: This study found that the majority of the free text comments on MS services were negative (55%). Physiotherapy provision was rated the most negative of NHS services (38%), with the primary complaints being lack of information about services and excessive waiting times for appointments. CONCLUSION: This study has revealed that NHS physiotherapy provision is not meeting the needs of PwMS.

A study analysing inconsistent responses from people with multiple sclerosis in a recent national audit.

PURPOSE: An audit of NHS services for people with multiple sclerosis (PwMS) revealed inconsistency in individuals' responses to different types of questions. The main aim of this subsequent study was to analyse systematically the qualitative data gathered as part of the audit and use the findings to investigate the disparity between the global expressions of satisfaction and the negative, and at times heart wrenching, free text comments made. METHOD: This study analysed questionnaires completed by 557 PwMS, 336 of which had made free text comments. This qualitative data was analysed using content analysis by grouping content into positive and negative comments and then into more detailed categories and sub-categories. Inter-coder and intra-coder reliabilities were confirmed and the data manipulated to address the aim of the study. RESULTS: The study found that PwMS who gave conflicting reports of satisfaction with services were more likely to give negative comments regarding the provision of service rather than the quality of service. CONCLUSION: This study has revealed that simple, single questions on satisfaction with services do not offer a valid measure of patient experience. It has shown that there is a place for qualitative research in the area of patient satisfaction.