Home-based training to improve manual dexterity in patients with multiple sclerosis: A randomized controlled trial
- 1Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland [email protected]
- 2Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland.
- 3Division of Cognitive and Restorative Neurology, Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland.
- 4Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Switzerland.
- 5HES-SO Valais-Wallis, School of Health Sciences, University of Applied Sciences and Arts Western Switzerland Valais, Sion, Switzerland.
- 6Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland/Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Switzerland.
Background: Impaired manual dexterity is frequent and disabling in patients with multiple sclerosis (MS), affecting activities of daily living (ADL) and quality of life.
Objective: We aimed to evaluate the effectiveness of a standardized, home-based training program to improve manual dexterity and dexterity-related ADL in MS patients.
Methods: This was a randomized, rater-blinded controlled trial. Thirty-nine MS patients acknowledging impaired manual dexterity and having a pathological Coin Rotation Task (CRT), Nine Hole Peg Test (9HPT) or both were randomized 1:1 into two standardized training programs, the dexterity training program and the theraband training program. Patients trained five days per week in both programs over a period of 4 weeks. Primary outcome measures performed at baseline and after 4 weeks were the CRT, 9HPT and a dexterous-related ADL questionnaire. Secondary outcome measures were the Chedoke Arm and Hand Activity Inventory (CAHAI-8) and the JAMAR test.
Results: The dexterity training program resulted in significant improvements in almost all outcome measures at study end compared with baseline. The theraband training program resulted in mostly non-significant improvements.
Conclusion: The home-based dexterity training program significantly improved manual dexterity and dexterity-related ADL in moderately disabled MS patients. Trial Registration NCT01507636.
Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system (CNS) and the most common cause of non-traumatic disability in young adults in industrialized countries (1). Several drugs are available to potentially ameliorate
the disease course. However, drugs that ameliorate existing neurologic deficits are vastly lacking. Therefore, physical and occupational therapy is an important cornerstone in the therapy of MS patients. They are however often applied in a non-standardized way in different settings and not all patients receive adequate therapy due to various circumstances including lack of time and missing infrastructure.
The aim of this study was to develop a standardized, feasible, convenient and cost-effective training program to improve manual dexterity in MS patients with impaired manual dexterity. For this purpose, a home-based dexterity training program predominantly focusing on in-hand manipulation of objects (dexterity training program) was compared to a home-based training program predominantly focusing on arm and hand strength training (theraband training program) in a rater-blinded, randomized controlled single-center study. Both groups trained five days a week for four weeks and outcome measurements such as the Coin Rotation Task, the Nine Hole Peg Test, the Chedoke Arm and Hand Activity Inventory, the JAMAR and a dexterity questionnaire were performed before and after the training.
After four weeks of training, the dexterity training program resulted in significant improvements in almost all outcome measures at study end compared to baseline whereas the the theraband training program did not.
Besides the efficacy, the home-based dexterity training program has several advantages. It allows frequent training independently of available hospital or community based programs at any time of the day. Patients with problems in transportation and time-wise inflexible patients are able to perform the program as well. Finally, it is very cheap with material costs below 10 Euros/Dollars that can be easily accessed in any hardware store.
It is therefore an applicable program that can be offered to MS patients with impaired manual dexterity exclusively or in addition to other rehabilitation programs.
- Kamm CP, Uitdehaag BM, Polman CH. Multiple sclerosis: current knowledge and future outlook. Eur Neurol. 2014;72(3-4):132-41. doi: 10.1159/000360528.