Standing Frame Exercises Aid Lower Limbs of Progressive MS Patients, UK Study Says

Standing Frame Exercises Aid Lower Limbs of Progressive MS Patients, UK Study Says

People whose advanced progressive multiple sclerosis (MS) limits their mobility can strengthen their lower limbs and improve life quality by engaging in regular standing exercises in their homes, a U.K. study into physiotherapy programs for this patient group reports.

The study, “Assessment of a home-based standing frame programme in people with progressive multiple sclerosis (SUMS): a pragmatic, multi-centre, randomised, controlled trial and cost-effectiveness analysis,” was published in the journal Lancet Neurology.

Evidence suggests that physical activity can improve mobility and lessen the likelihood of further health problems for people with severe MS. But mobility programs can be difficult for patients to access because they tend to be resource-intensive, and require professional supervision in a hospital or outpatient setting and expensive equipment not suited for home use.

Standing devices, such as wooden frames that support patients in a standing position, offer a lower cost, at-home alternative.

Research has shown that people with spinal cord injury who have used standing devices are at a lower risk of complications linked to prolonged immobility, and express a better sense of well-being.

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In the study (ISRCTN69614598; called SUMS for standing up in people with MS), a team led by researchers at the University of Plymouth, recruited 122 progressive MS patients (both primary progressive and secondary progressive) with severely limited mobility, and Expanded Disability Status Scale (EDSS) scores of between 6.5 and 8.0. All were randomly assigned to either usual care (61 patients), or usual care plus standing device treatment (remaining 61).

Standing frames were delivered to patients’ homes. The program consisted of two home-based physiotherapy sessions (of 60 minutes each), then participants were asked to stand for 30 minutes, three times a week, for a period of 20 weeks. This group was also offered instructions on how to incorporate upper limb exercises into the program. Their progress was followed with telephone calls from experienced physical therapists (of about 15 minutes each).

Participants were analyzed at baseline, and at 20 and 36 weeks after the study’s start. Motor abilities were assessed by the Amended Motor Club Assessment (AMCA) score that evaluates key functional activities in the lower limbs and trunk, such as rolling over in bed, standing up from a sitting position, and sitting and standing balance.

At 20 and 36 weeks, secondary outcomes were also assessed by measuring physical impairments, including the length of hip flexors, hamstrings and ankle plantar flexors, knee extensor strength, spasm frequency, bowel and bladder control, sitting balance, and quality of life.

Results showed that, compared to usual care alone, a standing frame program significantly improved motor function in the lower limbs and trunk of these MS patients, as seen in an AMCA score improvement of 4.7 points at 36 weeks. This implies that mobility improvements lasted for 16 weeks beyond treatment.

An AMCA increase of 4.7, however, is not considered clinically meaningful; for such a determination, a 9-point AMCA score difference is needed. 

The intervention was also shown to improve patients’ hip and ankle joint range, and life quality.

No serious program-related adverse events were reported. Primary side effects here were short-term muscle pain — 486 of 1188 events (541%) reported in the standing frame group, compared to 160 of 736 (22%) such events in the usual care group. This result was not unexpected, given that participants were long-time users of walking aids, and many had considerable muscle weakness.

An economic analysis suggested that the standing frame intervention would be cost-effective compared to usual care.

“The standing frame program significantly increased motor function in people with severe progressive multiple sclerosis, although not to the degree that was considered a priori as clinically meaningful. We suggest that the program is feasible as a home-based, self-managed intervention that could be routinely implemented in clinical practice in the U.K.,” the researchers wrote.

They added that routine use of standing devices is a convenient way to help improve lower limb function and enhance the quality of life for MS patients. Study participants who agreed to use their supplied frame at least once a week were allowed to keep the devices; 70% of these patients made such requests, the researchers said.

In a news release about this study, the National MS Society noted that “the cost of standing frames can vary greatly in the United States, and these may not be covered by insurance companies for MS. People with MS who are interested in this intervention can consult with a physical or occupational therapist for guidance.”

10 comments

    • Steve Bryson says:

      Dear Frances Robson, as noted by the National MS Society in the article, when considering using this type of therapeutic devices, always consult your healthcare team or occupational therapist for guidance. They most likely can also help you get access to these standing frames.

    • Joan M Possiel says:

      Look online for a device called “Easy Stand” that should link you to a medical supply dealer. That’s how I purchased one for my husband after he used the device in physical therapy, Unfortunately, it was not covered by insurance and it is expensive.

  1. Pauline Phelps says:

    I was offered the use of a standing frame but I just didn’t have enough room to stand one in any of my rooms.

    • Steve Bryson says:

      Dear Maureen, the actual exercises performed were not disclosed by the research team in their published research paper. This is what they say: “The person with multiple sclerosis and their standing assistant (typically their spouse) engaged in two face-to-face, home-based, 60-min physiotherapy sessions, aimed at setting up, implementing, and progressing the standing programme according to ability, supplemented by online advice and DVDs.”

      https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(19)30190-5/fulltext

  2. Sandra Aguilar says:

    I applied for a standing frame from my local OT at the ms rehab centre but as I can stand, was told that the criteria to be given one is, is that you can’t stand up, so I couldn’t have one. I was told if I buy one privately, that they cost £7000.00. My EDSS score is 6.5-7.

  3. CaroMom says:

    I recommend trying one several times at a PT/neuro rehab center. I did that before we bought one for home use. We bought mine off of eBay.

  4. Phil Longford says:

    I use one every week, at the Samson MS Centre. Very good. Gets muscles working, that have not been used for quite a while, so obviously feels a bit strange, at first. Coupled with top half exercise (ball throwing), you do feel like you have had a workout.

  5. Karen Aneshansley says:

    I think any MS patient residing in a nursing home should have access to a standing frame. It should be part of their physical therapy routine. The weight- bearing is essential for their health.

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