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Individualized Physiotherapy and Activity Coaching in Multiple Sclerosis (IPAC-MS): Results of a Randomized
Sarah J Donkers1, Charity Evans2, Michael C Levin3
1School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, SK.
Objective:
To evaluate if a novel intervention involving individualized behavior change strategies delivered by physiotherapists has an effect on physical activity levels in people with multiple sclerosis (MS) who were previously inactive compared with usual care.
Design:
Prospective, assessor-blinded, parallel-group, randomized controlled trial.
Setting:
Community settings across Saskatchewan, Canada.
Participants:
Individuals diagnosed with MS, >18 years of age, and able to walk with or without aids were invited to participate from an MS Saskatchewan database.
Intervention:
The intervention group received individualized physical activity behavioral coaching for 12 months compared with a usual care control group. There were 3 consistent features of the intervention: behavior change techniques, recommendations for physical activity, and ongoing physiotherapist support. However, these components were tailored to each participant.
Main Outcome Measures:
The primary outcome was change in physical activity levels at 12 months on the Godin Leisure Time Exercise Questionnaire. Secondary measures included MS symptoms (Multiple Sclerosis Impact Scale-29), confidence with managing MS (Multiple Sclerosis Self-Efficacy Scale), and exercise self-efficacy (Exercise Self-Efficacy Scale).
Results:
A total of 120 participants (mean age 53 years, 78% female, average disease duration 14.7 years) were enrolled and 117 completed primary outcome. At month 12, the mean (95% confidence interval) difference between intervention and control group for Godin Leisure Time Exercise Questionnaire was 15.9 (12.5-28.4). This improvement occurred regardless of age, gender, if on an MS drug, time since relapse, or comorbidity history. In the intervention group, 33.9% were sufficiently active for substantial health benefits compared with 6.9% in the control group at month 12 (P<.001). At baseline, these proportions were 3.4% and 4.9% respectively. Improvement occurred on the Multiple Sclerosis Self-Efficacy Scale and Exercise Self-Efficacy Scale at 12 months in favor of the intervention group.
Conclusion:
Physical activity levels and exercise self-efficacy improved clinically and significantly with neurophysiotherapist led individualized coaching.
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