Augmenting a Progressive Resistance Training Programme with Neuromuscular Electrical

Stimulation in People with Multiple Sclerosis - Effects on Quality of Life and Spasticity

Authors: Mr. Lonan Hughes1, Prof. Alan Donnelly

2, Mr. Gary Rainsford

3 and Dr. Susan Coote

1.

Institution: 1Physiotherapy Dept, University of Limerick, Limerick, Ireland. lonan.hughes@ul.ie

and susan.coote@ul.ie; 2Physical Education and Sports Science Dept., University of Limerick,

Limerick, Ireland. alan.donnelly@ul.ie; 3Biomedical Research Neurotech Ltd., Galway, Ireland.

GRainsford@bmr.ie.

Introduction: Decreased quality of life (QoL) and spasticity

are prevalent problems for people with

Multiple Sclerosis (PwMS). Progressive

resistance training (PRT) has been shown to

improve QoL in PwMS1. The benefits of

neuromuscular electrical stimulation (NMES)

for reducing spasticity in PwMS are unclear.

Aims: To determine differences in treatment effect

for PwMS on QoL and lower limb spasticity,

between PRT and the same with NMES.

Methods: A single blind randomised design was

employed. PwMS (n=37) that used a walking

aid were allocated to a 12 week home-based

lower limb PRT programme or the same with

the Kneehab ® device (Biomedical Research,

Ltd., neurotech ®, Galway, Ireland), designed

for the quadriceps. Participants’ QoL (MSIS-

29v2) and lower limb spasticity (effect on

function – Visual Analogue Scale) were

evaluated pre-, mid- (6 weeks) and post-

intervention. Between group differences were

analysed with medians and Mann-Whitney U

tests.

Results: Twenty-five completed the programme (PRT

n=10; Kneehab n=15). Reasons for drop-out

were relapse (n=3), fatigue (n=2), other health

problems (n=3), non-compliance (n=2) and

muscle spasm induced by the device (n=2).

There were no statistically significant

differences between groups at baseline.

The Kneehab group’s change from 0 to 6

weeks in QoL on the Physical Subscale and

spasticity was significantly greater than the

PRT (Table 1). On the QoL Psychological

Subscale, Kneehab participants’ improvement

was close to significantly greater than PRT

participants. The total number of repetitions

completed by the Kneehab group was greater.

Table 1. Group Outcomes 0-6 Weeks

QoL Subscales: 0-100; Spasticity:

millimetres.

Discussion and Conclusions: Improvements in Physical QoL at 6 weeks, in

the Kneehab group were similar to a previous

study1. The association between QoL and

physical activity in PwMS3 may explain this,

as Kneehab participants completed more

exercise. Spasticity improvements in the

Kneehab group exceeded the clinically

important difference of 30% for a spasticity

numerical rating scale3. The clinical

implications are that adding an NMES device

to a PRT programme improves QoL and

reduces spasticity. Further studies using larger

samples are needed to confirm these results.

References: 1. Taylor, N., et al., Progressive resistance

exercise for people with multiple sclerosis.

Disability & Rehabilitation, 2006. 28(18):

p. 1119-1126.

2. Motl, R. W., and McAuley, E., Pathways

between physical activity and quality of

life in adults with multiple sclerosis.

Health Psychology, 2009. 28(6): p. 682-

689.

3. Farrar, J. T., et al., Validity, reliability,

and clinical importance of change in a 0-

10 numeric rating scale measure of

spasticity: a post hoc analysis of a

randomized, double-blind, placebo-

controlled trial. Clinical

Therapeutics,2008. 30(5): p. 974-985.

Outcomes PRT Kneehab p-value

QoL Physical

Subscale

42.5 to

35.8

50 to 40 0.034*

QoL

Psychological

Subscale

20.4 to

20.4

25.9 to

11.1

0.058

Spasticity 35.2 to

54.6

39.6 to

3.5

0.019*

Repetitions 1564 1885 0.154