Actual and Imagined Music-Cued Gait Training in People with Multiple Sclerosis: A Double-Blind Randomized Parallel Multicenter Trial

Abstract

Background: Actual and imagined cued gait trainings have not been compared in people with multiple sclerosis (MS).

Objective: To analyze the effects of cued motor imagery (CMI), cued gait training (CGT), and combined CMI and cued gait training (CMI-CGT) on motor, cognitive, and emotional functioning, and health-related quality of life in people with MS.

Methods: In this double-blind randomized parallel-group multicenter trial, people with MS were randomized (1:1:1) to CMI, CMI-CGT, or CGT for 30 minutes, 4×/week for 4 weeks. Patients practiced at home, using recorded instructions, and supported by ≥6 phone calls. Data were collected at weeks 0, 4, and 13. Co-primary outcomes were walking speed and distance, analyzed by intention-to-treat. Secondary outcomes were global cognitive impairment, anxiety, depression, suicidality, fatigue, HRQoL, motor imagery ability, music-induced motivation, pleasure and arousal, self-efficacy, and cognitive function. Adverse events and falls were continuously monitored.

Results: Of 1559 screened patients, 132 were randomized: 44 to CMI, 44 to CMI-CGT, and 44 to CGT. None of the interventions demonstrated superiority in influencing walking speed or distance, with negligible effects on walking speed (η² = 0.019) and distance (η² = 0.005) observed in the between-group comparison. Improvements in walking speed and walking distance over time corresponded to large effects for CMI, CMI-CGT, and CGT (η² = 0.348 and η² = 0.454 respectively). No severe study-related adverse events were reported.

Conclusions: CMI-GT did not lead to improved walking speed and distance compared with CMI and CGT alone in people with MS. Lack of a true control group represents a study limitation.

Trial registration: German Clinical Trials Register, DRKS00023978.

Keywords: fatigue; motor imagery; multiple sclerosis; music; physiotherapy; walking.

Figure 1.

CONSORT flow diagram depicting participant recruitment, randomization, and attrition. Abbreviations: CGT, cued gait training; CMI, cued motor imagery; CMI-CGT, cued motor imagery combined with cued gait training; DMT, disease-modifying treatment; EDSS, Expanded Disability Status Scale; MS, multiple sclerosis.

Figure 2.

Change in primary outcomes from baseline: Change in walking speed (A) and walking distance (B) from baseline to 4-weeks post-intervention and 13-week follow-up as assessed by the Timed 25-Foot Walk (T25FW) and 2-Minute Walk Test (2MWT), respectively. Squares represent means, while error bars denote standard deviations. Dotted lines illustrate the grand mean from all groups at baseline. Lower values on the T25FW and higher values on the 2MWT indicate improvement. Abbreviations: CGT, cued gait training; CMI, cued motor imagery; CMI-GT, cued motor imagery combined with cued gait training.