Home rehabilitation equal to – but not better than – clinic-based in MS
Trial in 'Deep South' compares in-clinic vs. at-home exercise programs
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A study compared the benefits of an in-clinic versus at-home exercise program. (Image from iStock)
- A clinical trial in three U.S. Southern states found home-based rehab has comparable outcomes to clinic-based exercise programs.
- Researchers had expected telerehabilitation, thought to be more convenient, would have greater benefits.
- Still, home exercise programs offer a practical alternative, expanding access for those facing logistical barriers to clinic visits.
While U.S. researchers believed a home-based telerehabilitation program — thought to be more convenient and accessible for patients — would prove more effective than a clinic-based one in improving walking endurance in people with multiple sclerosis (MS), data from a large clinical trial in “the Deep South” found no major differences in outcomes between the two approaches.
According to the research team, the two exercise programs “produced comparable improvements in patient-reported outcomes.” If anything, the team noted that clinic-based rehabilitation generally produced greater gains in balance than the home-based program. Still, those differences were not considered clinically significant, meaning they wouldn’t be expected to meaningfully influence patient outcomes in a real-world setting.
The researchers had sought to compare the two program types in a trial involving more than 700 people with MS in what they dubbed the Deep South — three “predominantly rural” U.S. states with “limited access to specialized rehabilitation services.” The study spanned about three months, with results tracked for one year.
The team concluded that, while so-called telerehabilitation is a feasible alternative that can help expand access to exercise for people who can’t easily reach a clinic, more work is needed to improve the results of such programs.
“The hypothesis that [home-based rehab] would be superior to [a clinic-based program] was not supported,” the researchers wrote, adding that “optimization of intervention protocols and strategies to enhance engagement may be needed to achieve clinically meaningful outcomes.”
The study, “Effectiveness of In-Clinic Rehabilitation vs. Home-Based Telerehabilitation for Adults with MS in the Deep South: The TEAMS Cluster Randomized Trial,” was published in the journal Archives of Physical Medicine and Rehabilitation.
MS is caused by inflammation in the brain and spinal cord that damages the myelin sheath, a protective layer around nerve fibers that helps them communicate more efficiently. This leads to symptoms such as movement problems, fatigue, pain, and cognitive and emotional changes.
Regular exercise is recommended for people with MS to help manage symptoms, improve both physical function and quality of life, and support daily activities. “In particular, yoga and Pilates improve depression, walking speed, physical activity, and [quality of life],” the researchers wrote.
Exercise ‘underutilitized’ in MS, despite known benefits
However, many people with MS do not get enough physical activity, according to the team.
“Despite [the known] benefits, exercise remains underutilized, with approximately 80% of individuals with [one MS type] failing to meet recommended physical activity guidelines,” the researchers wrote.
The team says this is due in part to limited access to personalized exercise and rehabilitation programs, especially in regions of the U.S. with fewer specialized centers. According to the researchers, home-based exercise programs can make it easier for people to participate by reducing transportation, financial, and other logistical barriers.
Previous studies have suggested that home-based rehabilitation programs are feasible and can help ease MS symptoms. Still, evidence directly comparing home-based and clinic-based rehabilitation has been limited.
To know more, the researchers launched the Tele-Exercise and Multiple Sclerosis (TEAMS) study (NCT03117881), which compared two versions of an evidence-based complementary alternative medicine (CAM) exercise program for people with MS. The program combined functional exercise, yoga, and Pilates, delivered either with a therapist in a clinical setting — dubbed DirectCAM — or at home using exercise videos preloaded onto a tablet, called TeleCAM.
Participants completed 20 exercise sessions over 12 weeks, or about three months, and were encouraged to continue the program at home for up to one year. The researchers assessed quality of life, fatigue, physical activity, walking ability, balance, and functional mobility using patient questionnaires and performance-based functional tests.
The study enrolled 759 participants across clinics in Alabama, Mississippi, and Tennessee, with 382 assigned to DirectCAM and 377 to TeleCAM. The participants had a mean age of 50, and most were women (about 89%) and white individuals (about 73%). About 75% lived in urban areas. Most had relapsing-remitting MS (about 82%).
‘Lack of human interaction’ may limit home rehab
Overall, both rehab programs were generally well tolerated, the data showed. The few adverse events that were considered related to the exercise regimen — two in the DirectCAM group and one in the TeleCAM group — were mild or moderate in severity.
Functional assessments showed that DirectCAM led to significantly greater improvements in balance than TeleCAM at three, six, and twelve months; however, these differences were not considered clinically meaningful, the researchers noted.
DirectCAM was also associated with significantly greater gains in walking endurance at three and six months, but these differences were again not considered clinically meaningful.
No statistically significant differences were observed between the two groups in patient-reported outcome measures. While participants in the DirectCAM group tended to experience greater reductions in pain and improvements in mental and emotional health after three months, these differences were neither statistically nor clinically significant.
Looking at changes within each group, DirectCAM produced clinically meaningful improvements in balance and walking endurance at all time points compared with participants’ performance before the trial. TeleCAM also improved walking endurance to a clinically meaningful degree at six months and one year, the researchers noted.
Other improvements in measures of fatigue and functional mobility were statistically significant in some analyses but did not necessarily reach thresholds considered clinically meaningful.
Overall, both programs were associated with improvements in some measures of physical function, suggesting that home-based telerehabilitation may offer a practical alternative to clinic-based exercise, particularly for MS patients who face barriers to accessing in-clinic programs.
“No statistically significant between-group differences were observed for patient-reported outcomes at [three, six] or 12 months,” the team wrote.
The researchers had initially expected the home-based program to prove more effective than clinic-based therapy because it was more convenient and accessible. The team noted, however, that the “lack of human interaction and potential mismatched level of exercise in TeleCAM” may have reduced its benefits.
According to the researchers, future studies should explore whether combining home- and clinic-based sessions could improve rehabilitation effectiveness.
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