App Helps With Long-term Spasticity Management After Rehab
Multiple sclerosis (MS) patients who experience reductions in spasticity after a four-week course of inpatient rehabilitation can sustain those improvements in the long term using an app-based self-training program, according to data from a clinical trial.
The app also led to better adherence to the self-training program than its paper-based alternative, which supports its usefulness for spasticity self-management in MS patients after inpatient treatment.
“We found evidence that an individualized app-based self-training program is superior to a paper-based self training program in managing spasticity after [inpatient rehabilitation] in a large cohort of [MS patients],” the researchers wrote.
The study, “Successful long-term management of spasticity in people with multiple sclerosis using a software application: Results from a randomized-controlled, multicenter study,” was published in the European Journal of Neurology.
The recommended first-line treatment for MS spasticity is rehabilitation guided by a physical therapist, which should be followed by daily at-home training to ensure the long-term success of this approach. However, many patients are unlikely to train on their own, according to the researchers.
Previously, the team showed that 30 minutes of daily personalized exercises delivered via short videos on an app had a positive impact on spasticity and a high adherence to the training program.
Now, the research team evaluated the app in a larger clinical study of 115 adult MS patients who had moderate-to-severe spasticity in their legs and were still able to walk.
Patients were enrolled across seven rehabilitation centers in Austria between 2017 and 2021. Their median age was 50 years, 67.8% were female, and their median Expanded Disability Status Scale (EDSS) was 5, indicating significant disability. The majority of patients (55%) had a progressive form of MS.
First, all participants underwent four weeks of multidisciplinary inpatient rehabilitation (MIR), consisting of 38 individual sessions of physical, occupational, or speech therapy targeting each patient’s rehabilitation goals. In these sessions, patients were familiarized with spasticity exercises they could perform at home.
All patients also participated in at least 38 group sessions during the inpatient rehabilitation part.
After this part, self-reported spasticity was determined using the 11-point Numeric Rating Scale for Spasticity (NRSs), with higher scores indicating more severe spasticity.
Overall, the inpatient rehabilitation program was associated with significant improvements in NRSs scores, with an average 2 point reduction observed after therapy. Similar improvements also were observed using other spasticity scales, and associated improvements in limb strength and mobility were observed across several clinical tests.
The 94 patients (82%) who experienced at least a 20% NRSs improvement after this rehabilitation part then were assigned randomly to participate in self-training with either the “MS-spasticity App” or a paper-based program for 12 weeks.
Self-training using the app was associated with sustained improvements in spasticity, with an average reduction of 0.3 points in their NRSs scores from their post-MIR measurements. In contrast, patients in the paper-based training group had a 0.3 point increase in their scores, indicating increased spasticity.
Furthermore, those who used the app were more adherent to the training program compared with the paper-based group. In total, 95% of those using the app completed their self-training program, compared with 72% of those using a paper booklet.
According to the researchers, features of the app, including variation of daily activities, daily reminders, and motivating messages, could have contributed to the increased completion rate observed among app users.
They also noted that all app users had been given some preliminary introduction to these at-home exercises during inpatient training. The app is not designed to be downloaded and used without professional supervision, they emphasized.
In summary, “the ‘MS-spasticity App’ seems to be an innovative tool for rehabilitation in long-term management of moderate to severe MS-spasticity,” the researchers wrote.
“As an easily accessible technology, the ‘MS-spasticity App’ can enhance and support individual responsibility for regular exercising in [MS patients],” they concluded.