Individualized Physiotherapy and Activity Coaching for Multiple Sclerosis

Overview

Multiple Sclerosis (MS) is a chronic neurological disease that places a high burden on patients, families and society. Physical activity in MS is associated with improved fitness, symptoms, and function, fewer relapses, and fewer brain lesions on MRI. Saskatchewan has one of the highest rates of MS worldwide, and a recent survey estimated approximately 80% of persons living with MS are not sufficiently active for health benefits. Individuals living with MS recognize the importance of physical activity, but often indicate a lack support, including limited access to professionals knowledgeable about both MS and physical activity. There is a need to identify effective interventions for improving activity levels safely and appropriately. Behaviour change strategies target specific behaviours involved in increasing and maintaining physical activity. The primary objective of this project is to determine if individualized behaviour change strategies delivered by neurophysiotherapists increases physical activity in MS. Participants will be randomly assigned into two groups. The intervention group will receive individualized behaviour change strategies delivered through the support of neurophysiotherapists for 12 months. The wait-list control group will receive usual care for 12 months, and then be offered the intervention for a 6-month period at the end of the study period. The long-term goal of this research is to help decrease the burden of MS by identifying new opportunities for increasing physical activity.

Full Title of Study: “Individualized Physiotherapy and Activity Coaching for Multiple Sclerosis (IPAC-MS): A Randomised Controlled Trial”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Supportive Care
    • Masking: Double (Investigator, Outcomes Assessor)
  • Study Primary Completion Date: July 2021

Interventions

  • Behavioral: Individualized behavioural physical activity intervention
    • • The intervention involves a tailored physiotherapy (PT) intake that will serve as the foundation for the individualized approach. Participants’ individual attributes and physical activity needs, including a general PT assessment will occur initially. Over the next 12 months, participants will receive individualized PT coaching and a physical activity plan plus access to educational literature that outlines methods and benefits of exercise. An estimated 15 hours of PT contact hours per participant is anticipated and the specifics of each encounter will be documented.

Arms, Groups and Cohorts

  • Experimental: Behavioural Physical Activity (PA) intervention
  • No Intervention: Wait list control

Clinical Trial Outcome Measures

Primary Measures

  • Godin Leisure Time Exercise Questionnaire (GLTEQ) Score
    • Time Frame: baseline to 12 months
    • change in physical activity level. The GLTEQ is a 4-item self-administered questionnaire with the first three questions seeking information on the number of times one engages in mild, moderate and strenuous activity in bouts of at least 15 min duration in a typical week. Total leisure activity score is then calculated based on number of bouts at each intensity multiplied by 3, 5, and 9 metabolic equivalents and summed. A higher score means more physically active.

Secondary Measures

  • Multiple Sclerosis Impact Scale version 2 (MSIS-29 v2)
    • Time Frame: baseline to 12 months
    • change in patient-reported disease-related symptoms measured using MSIS-29 v2 scale. MSIS-29 assess the impact of MS on health related quality of life in terms of physical and psychological well-being. The MSIS-29 v2 is a 29 item self-administered questionnaire. 20 items are associated with a physical scale and 9 items with a psychological scale. Items ask about the impact of MS on day-to-day life in the past two weeks. All items have 4 response options: 1 “not at all” to 4″extremely”. Min score=29, max =116 with a higher value indicating more severely impacted
  • Multiple Sclerosis Self Efficacy Scale (MSSE)
    • Time Frame: baseline to 12 months
    • change in patient-reported level of confidence regarding components of disease management. The MSSE has 18 items represented by two subscales of Function (9 items) and Control (9 items). Participants rate their confidence from 10-100 where 10 has an anchor of very uncertain, 50 moderately certain, and 100 very certain. A higher score meaning more confident/higher self-efficacy.
  • Interviews and Exit surveys
    • Time Frame: after intervention (at 12 month point for intervention group and 18 month for wait-list control) group
    • experience of participants and interventionists
  • Intervention Description
    • Time Frame: after intervention (at 12 month point for intervention group and 18 month for wait-list control group)
    • a description of interventionist contact time with participant and frequency, method and types of services provided

Participating in This Clinical Trial

Inclusion Criteria

  • clinically definite MS (diagnosed by a neurologist)
  • patient determined disease steps (PDDS) less than or equal to 6 (i.e. not wheel-chair bound)
  • GLTEQ<24 (not active enough for health benefits)

Exclusion Criteria

  • medical instability (PAR-Q moderate-high risk of exercise-related harm)
  • persons unable to provide consent
  • persons under the age of 18 years old

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • University of Saskatchewan
  • Collaborator
    • Saskatchewan Health Research Foundation (SHRF)
  • Provider of Information About this Clinical Study
    • Principal Investigator: Sarah Donkers, Assistant Professor – University of Saskatchewan

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