ADSTEP: Preliminary Investigation of a Multicomponent Walking Aid Program in People With Multiple Sclerosis

Abstract

Objective: To evaluate the effect of the Assistive Device Selection, Training and Education Program (ADSTEP) on falls and walking and sitting activity in people with multiple sclerosis (PwMS).

Design: Randomized controlled trial.

Setting: Veterans affairs medical center.

Participants: PwMS (N=40) using a walking aid at baseline who had fallen in the previous year.

Interventions: Participants were randomly assigned to ADSTEP or control. ADSTEP had 6 weekly, 40-minute, 1-on-1 sessions with a physical therapist, starting with walking aid selection and fitting, followed by task-oriented progressive gait training. Control was usual medical care with the option of ADSTEP after the study.

Main outcome measures: The following were assessed at baseline, intervention completion, and 3 months later: falls, timed Up and Go, timed 25-foot walk, 2-minute walk, Four Square Step Test, International Physical Activity Questionnaire, Quebec User Evaluation of Satisfaction with Assistive Technologies, Multiple Sclerosis Walking Scale-12, Activities-Specific Balance Confidence Scale, and Multiple Sclerosis Impact Scale-29. Effect on these outcomes was estimated by a 2-by-2 repeated measures general linear model.

Results: Fewer ADSTEP than control participants fell (χ²=3.96, P<.05. number needed to treat =3.3). Time spent sitting changed significantly differently with ADSTEP than with control from baseline to intervention completion (F=11.16, P=.002. ADSTEP: reduced 87.00±194.89min/d; control: increased 103.50±142.21min/d; d=0.88) and to 3-month follow-up (F=9.25, P=.004. ADSTEP: reduced 75.79±171.57min/d; control: increased 84.50±149.23min/d; d=0.79). ADSTEP yielded a moderate effect on time spent walking compared to control at 3-month follow-up (P>.05. ADSTEP 117.53±148.40min/d; control 46.43±58.55min/d; d=0.63).

Conclusions: ADSTEP prevents falls, reduces sitting, and may increase walking in PwMS.

Trial registration: ClinicalTrials.gov NCT02408718.

Keywords: Accidental falls; Multiple sclerosis; Physical activity; Randomized controlled trial; Rehabilitation; Walking.

Fig 1

CONSORT diagram for the clinical investigation. *Inclusion criteria not met: no use of assistive device for walking (n=4), no falls in the past year (n=4), unconfirmed diagnosis of MS (n=1), received gait training within the last 3 years (n=1), making a change to medications (n=1), contraindications to MRI (n=6).

Fig 2

Average amount of (A) time spent sitting and (B) time spent walking per day at baseline, intervention completion, and 3 months later, based on IPAQsf responses. Error bars represent standard deviation.