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Randomized Controlled Trial
. 2022 Nov;36(10-11):678-688.
doi: 10.1177/15459683221124126. Epub 2022 Sep 13.

Rehabilitation to Improve Gaze and Postural Stability in People With Multiple Sclerosis: A Randomized Clinical Trial

Brian J Loyd  1 , Annie Fangman  2 , Daniel S Peterson  3 , Eduard Gappmaier  2 , Anne Thackeray  2 , Michael C Schubert  4 , Leland E Dibble  2
Affiliations
Randomized Controlled Trial

Rehabilitation to Improve Gaze and Postural Stability in People With Multiple Sclerosis: A Randomized Clinical Trial

Brian J Loyd et al. Neurorehabil Neural Repair. 2022 Nov.

Abstract

Background: People with multiple sclerosis (PwMS) frequently experience dizziness and imbalance that may be caused by central vestibular system dysfunction. Vestibular rehabilitation may offer an approach for improving dysfunction in these people.

Objective: To test the efficacy of a gaze and postural stability (GPS) retraining intervention compared to a strength and endurance (SAE) intervention in PwMS.

Methods: About 41 PwMS, with complaints of dizziness or history of falls, were randomized to either the GPS or SAE groups. Following randomization participants completed 6-weeks of 3×/week progressive training, delivered one-on-one by a provider. Following intervention, testing was performed at the primary (6-weeks) and secondary time point (10-weeks). A restricted maximum likelihood estimation mixed effects model was used to examine changes in the primary outcome of the Dizziness Handicap Inventory (DHI) between the 2 groups at the primary and secondary time point. Similar models were used to explore secondary outcomes between groups at both timepoints.

Results: Thirty-five people completed the study (17 GPS; 18 SAE). The change in the DHI at the primary time point was not statistically different between the GPS and SAE groups (mean difference = 2.33 [95% CI -9.18, 12.85]). However, both groups demonstrated significant improvement from baseline to 6-weeks (GPS -8.73; SAE -7.31). Similar results were observed for secondary outcomes and at the secondary timepoint.

Conclusions: In this sample of PwMS with complaints of dizziness or imbalance, 6-weeks of GPS training did not result in significantly greater improvements in dizziness handicap or balance compared to 6-weeks of SAE training.

Keywords: dizziness; gaze stability; multiple sclerosis; postural stability; rehabilitation; vestibular.

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Conflict of interest statement

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Consort diagram demonstrating the screening, enrollment, randomization, and study completion for both of the study groups. Abbreviations: MS, multiple sclerosis; GPS, gaze and postural stability; SAE, strength and endurance.
Figure 2.
Figure 2.
Box and whisker plot displaying the median, IQR, and minimum and maximum scores on the Dizziness Handicap Inventory (DHI) at baseline, 6-week, and 10-week timepoints for both the strength and endurance and gaze and postural stability groups.
Figure 3.
Figure 3.
Box and whisker plot displaying the median, IQR, and minimum and maximum scores on the Activities-specific Balance Confidence (ABC) scale at baseline, 6-week, and 10-week timepoints for both the strength and endurance and gaze and postural stability groups.
Figure 4.
Figure 4.
Box and whisker plot displaying the median, IQR, and minimum and maximum scores on the Functional Gait Assessment (FGA) at baseline, 6-week, and 10-week timepoints for both the strength and endurance and gaze and postural stability groups.
Figure 5.
Figure 5.
Box and whisker plot displaying the median, IQR, and minimum and maximum scores on the computerized dynamic visual acuity (cDVA) test at baseline, 6-week, and 10-week timepoints for both the strength and endurance and gaze and postural stability groups.
Figure 6.
Figure 6.
Displaying the individual Dizziness Handicap Inventory (DHI) scores from baseline to the 6- and 10-week timepoints for the strength and endurance and gaze and postural stability groups.
See this image and copyright information in PMC

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