Treadmill training with virtual reality to enhance gait and cognitive function among people with multiple sclerosis: a randomized controlled trial.
Dual task
Gait
Multiple sclerosis
Treadmill training
Virtual reality
Journal
Journal of neurology
ISSN: 1432-1459
Titre abrégé: J Neurol
Pays: Germany
ID NLM: 0423161
Informations de publication
Date de publication:
Mar 2023
Mar 2023
Historique:
received:
02
08
2022
accepted:
01
11
2022
revised:
31
10
2022
pubmed:
11
11
2022
medline:
3
3
2023
entrez:
10
11
2022
Statut:
ppublish
Résumé
Motor and cognitive impairments impact the everyday functioning of people with MS (pwMS). The present randomized controlled trial (RCT) evaluated the benefits of a combined motor-cognitive virtual reality training program on key motor and cognitive symptoms and related outcomes in pwMS. In a single-blinded, two-arm RCT, 124 pwMS were randomized into a treadmill training with virtual reality (TT + VR) group or a treadmill training alone (TT) (active-control) group. Both groups received three training sessions per week for 6 weeks. Dual-tasking gait speed and cognitive processing speed (Symbol Digit Modalities Test, SDMT, score) were the primary outcomes. Secondary outcomes included additional tests of cognitive function, mobility, and patient-reported questionnaires. These were measured before, after, and 3 months after training. Gait speed improved (p < 0.005) in both groups, similarly, by about 10 cm/s. The TT + VR group (n = 53 analyzed per-protocol) showed a clinically meaningful improvement of 4.4 points (95% CI 1.9-6.8, p = 0.001) in SDMT, compared to an improvement of only 0.8 points in the TT (n = 51 analyzed per-protocol) group (95% CI 0.9-2.5 points, p = 0.358) (group X time interaction effect p = 0.027). Furthermore, TT + VR group-specific improvements were seen in depressive symptoms (lowered by 31%, p = 0.003), attention (17%, p < 0.001), and verbal fluency (11.6% increase, p = 0.002). These findings suggest that both TT and TT + VR improve usual and dual-task gait in pwMS. Nonetheless, a multi-modal approach based on VR positively impacts multiple aspects of cognitive function and mental health, more than seen after treadmill-treading alone. Trial registered at ClinicalTrials.Gov NCT02427997.
Sections du résumé
BACKGROUND
BACKGROUND
Motor and cognitive impairments impact the everyday functioning of people with MS (pwMS). The present randomized controlled trial (RCT) evaluated the benefits of a combined motor-cognitive virtual reality training program on key motor and cognitive symptoms and related outcomes in pwMS.
METHODS
METHODS
In a single-blinded, two-arm RCT, 124 pwMS were randomized into a treadmill training with virtual reality (TT + VR) group or a treadmill training alone (TT) (active-control) group. Both groups received three training sessions per week for 6 weeks. Dual-tasking gait speed and cognitive processing speed (Symbol Digit Modalities Test, SDMT, score) were the primary outcomes. Secondary outcomes included additional tests of cognitive function, mobility, and patient-reported questionnaires. These were measured before, after, and 3 months after training.
RESULTS
RESULTS
Gait speed improved (p < 0.005) in both groups, similarly, by about 10 cm/s. The TT + VR group (n = 53 analyzed per-protocol) showed a clinically meaningful improvement of 4.4 points (95% CI 1.9-6.8, p = 0.001) in SDMT, compared to an improvement of only 0.8 points in the TT (n = 51 analyzed per-protocol) group (95% CI 0.9-2.5 points, p = 0.358) (group X time interaction effect p = 0.027). Furthermore, TT + VR group-specific improvements were seen in depressive symptoms (lowered by 31%, p = 0.003), attention (17%, p < 0.001), and verbal fluency (11.6% increase, p = 0.002).
DISCUSSION
CONCLUSIONS
These findings suggest that both TT and TT + VR improve usual and dual-task gait in pwMS. Nonetheless, a multi-modal approach based on VR positively impacts multiple aspects of cognitive function and mental health, more than seen after treadmill-treading alone. Trial registered at ClinicalTrials.Gov NCT02427997.
Identifiants
pubmed: 36357586
doi: 10.1007/s00415-022-11469-1
pii: 10.1007/s00415-022-11469-1
pmc: PMC9649393
doi:
Banques de données
ClinicalTrials.gov
['NCT02427997']
Types de publication
Randomized Controlled Trial
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1388-1401Subventions
Organisme : National Multiple Sclerosis Society
ID : RG-1507-05433
Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.
Références
Ann N Y Acad Sci. 2022 Feb;1508(1):155-171
pubmed: 34689347
Cyberpsychol Behav. 2005 Jun;8(3):187-211; discussion 212-9
pubmed: 15971970
J Am Med Dir Assoc. 2021 May;22(5):995-1002
pubmed: 33812843
J Clin Neurosci. 2019 Jul;65:106-111
pubmed: 30898488
J Clin Med. 2019 Dec 10;8(12):
pubmed: 31835502
Mult Scler. 2012 Mar;18(3):364-71
pubmed: 21952098
Mult Scler. 2013 Nov;19(13):1784-91
pubmed: 23587605
Physiotherapy. 2019 Jun;105(2):174-186
pubmed: 30876717
Neurol Clin Pract. 2020 Jun;10(3):190-198
pubmed: 32642320
Neurology. 2003 Jan 14;60(1):31-6
pubmed: 12525714
Qual Life Res. 1995 Jun;4(3):187-206
pubmed: 7613530
Neurology. 2021 Nov 16;97(20):e2020-e2031
pubmed: 34556562
Clin Rehabil. 2017 Feb;31(2):278-284
pubmed: 26951347
Lancet Neurol. 2008 Dec;7(12):1139-51
pubmed: 19007738
J Gerontol A Biol Sci Med Sci. 2011 Feb;66(2):234-40
pubmed: 21106702
Mult Scler. 2013 Dec;19(14):1913-22
pubmed: 23633067
Neurorehabil Neural Repair. 2014 Sep;28(7):621-31
pubmed: 24503204
Mult Scler Relat Disord. 2021 Nov;56:103230
pubmed: 34500177
Contemp Clin Trials. 2020 Oct;97:106122
pubmed: 32858229
Mult Scler. 2017 Apr;23(5):721-733
pubmed: 28206827
Mult Scler. 2016 Jan;22(1):94-103
pubmed: 25921035
Mult Scler Relat Disord. 2016 Nov;10:116-122
pubmed: 27919477
PLoS One. 2020 Jun 1;15(6):e0234200
pubmed: 32479543
Mult Scler. 2022 Feb;28(2):289-299
pubmed: 34100297
Disabil Rehabil. 2017 Jul;39(15):1557-1563
pubmed: 27808596
Gait Posture. 2017 Jan;51:25-35
pubmed: 27693958
Arch Phys Med Rehabil. 2017 Jun;98(6):1229-1240
pubmed: 27543046
Arch Neurol. 1995 Feb;52(2):168-72
pubmed: 7848126
J Cent Nerv Syst Dis. 2018 Nov 27;10:1179573518813541
pubmed: 30515028
Expert Rev Neurother. 2017 Mar;17(3):251-261
pubmed: 27548008
Lancet. 2016 Sep 17;388(10050):1170-82
pubmed: 27524393
J Biomech. 2004 Jan;37(1):121-6
pubmed: 14672575
Mult Scler. 2012 Jun;18(6):891-8
pubmed: 22190573
J Geriatr Phys Ther. 2018 Jan/Mar;41(1):49-61
pubmed: 27362526
J Neurol. 2020 Jul;267(7):1912-1921
pubmed: 32166481
Gait Posture. 2020 Sep;81:172-182
pubmed: 32750612
Arch Clin Neuropsychol. 2004 Mar;19(2):203-14
pubmed: 15010086
Eur Rev Aging Phys Act. 2019 May 03;16:6
pubmed: 31073340
Iran Red Crescent Med J. 2013 Jun;15(6):449-54
pubmed: 24349740
Biomed Res Int. 2015;2015:720856
pubmed: 25839039
Arch Phys Med Rehabil. 2021 Feb;102(2):290-299
pubmed: 33161005
Mult Scler. 2022 May;28(6):859-861
pubmed: 35293819
Cochrane Database Syst Rev. 2016 Dec 21;12:CD010760
pubmed: 28000926
Neurology. 2018 Feb 6;90(6):278-288
pubmed: 29343470
J Gen Intern Med. 2001 Sep;16(9):606-13
pubmed: 11556941
Mult Scler. 2009 Jul;15(7):779-88
pubmed: 19542262
J Neurol Sci. 2013 Dec 15;335(1-2):160-3
pubmed: 24090757
Am J Geriatr Psychiatry. 2015 Apr;23(4):335-359
pubmed: 24998488
J Eval Clin Pract. 2014 Aug;20(4):295-300
pubmed: 24798823