Group-Based Individualized Comprehensive Core Stability Intervention Improves Balance in Persons With Multiple Sclerosis: A Randomized Controlled Trial

Abstract

Background Balance and trunk control are often impaired in individuals with multiple sclerosis (MS). Interventions addressing these issues are needed. Objective The objective of this study was to compare the immediate and long-term effects of a 6-week individualized, group-based, comprehensive core stability intervention (GroupCoreDIST) with those of standard care on balance and trunk control in individuals with MS. Design This study was a prospective, assessor-masked randomized controlled trial. Setting The GroupCoreDIST-intervention was conducted by 6 physical therapists in 6 municipalities in Norway. Standard care included the usual care for individuals with MS in the same municipalities. Assessments at all time-points took place at a Norwegian hospital. Participants Eighty people with Expanded Disability Status scores of 1 to 6.5 participated in this trial. Intervention Randomized, concealed allocation was used to assign the participants to the GroupCoreDIST intervention (n = 40) or to standard care (n = 40). The GroupCoreDIST intervention was conducted with groups of 3 participants (1 group had 4 participants), for 60 minutes 3 times per week. Measurements Assessments were undertaken at baseline and at weeks 7, 18, and 30. Outcomes were measured with the Trunk Impairment Scale–Norwegian Version, Mini Balance Evaluation Systems Test, and Patient Global Impression of Change–Balance. Repeated-measures mixed models were used for statistical analysis. Results One individual missed all postintervention tests, leaving 79 participants in the intention-to-treat analysis. GroupCoreDIST produced significant between-group effects on the mean difference in the following scores at 7, 18, and 30 weeks: for Trunk Impairment Scale–Norwegian Version, 2.63 points (95% CI = 1.89 to 3.38), 1.57 points (95% CI = 0.81 to 2.33), and 0.95 point (95% CI = 0.19 to 1.71), respectively; for Mini Balance Evaluation Systems Test, 1.91 points (95% CI = 1.07 to 2.76), 1.28 points (95% CI = 0.42 to 2.15), and 0.91 point (95% CI = 0.04 to 1.77), respectively; and for Patient Global Impression of Change–Balance, 1.21 points (95% CI = 1.66 to 0.77), 1.02 points (95% CI = 1.48 to 0.57), and 0.91 point (95% CI = 1.36 to 0.46), respectively. Limitations Groups were not matched for volume of physical therapy. Conclusions Six weeks of GroupCoreDIST improved balance and trunk control in the short and long terms compared with standard care in individuals who were ambulant and had MS and is an effective contribution to physical therapy.