MS-intakt Bad Wildbad
MS-intakt – Internet-based physical activity promotion in persons with multiple sclerosis
Physical training is a promising non-pharmacological approach to improve fatigue in people with multiple sclerosis (pwMS). Studies to date have shown the many positive effects of exercise on physical fitness such as muscle strength, endurance and aspects of MS symptoms (e.g. ability to walk). However, the study situation regarding the effects of sport on fatigue is inconsistent. This is explained by the fact that fatigue has so far been surveyed predominantly as a secondary outcome, that the samples often did not show any fatigue and that the measuring instruments used were different.
Despite the many positive effects of physical activity on health, the majority of pwMS are predominantly inactive. In particular, only a few pwMS succeed in transferring the knowledge and skills acquired in exercise therapy to everyday life following inpatient rehabilitation. However, this is a necessary prerequisite for benefiting from the positive effects of physical activity in the long term. Internet-based interventions can be suitable in this context to promote physical activity and ensure the sustainability of inpatient rehabilitation. However, such programmes do not yet exist.
Aim of the study
This randomised controlled trial (RCT) investigated the concept of three-month internet-based intervention following in-patient MS-specific rehabilitation to improve fatigue and promote physical activity of pwMS.
The programme is aimed at adult pwMS ≥ 18 years (according to McDonald criteria of 2010), regardless of the course of the disease, who are in-patients for rehabilitation and are interested in follow-up care. Important requirements are written and voluntary participation, access to web-enabled PC and basic computer and internet skills. Participants may be persons with clinically relevant fatigue symptoms or those who require an intermittent or constant walking aid (e.g. crutches, walking stick, splint). The programme in its present form is not suitable for persons with severe physical limitations or a high degree of disability (EDSS, Expanded Disability Status Scale ≥ 7.0, i.e. limited walking ability to a maximum of 5 m).
The internet-based intervention is designed as a follow-up care measure and follows on from an MS-specific inpatient rehabilitation measure. In-patient rehabilitation lasts between three and five weeks and includes an individual, disorder-specific rehabilitation programme. As part of the clinical study in which the intervention was developed, in-patient rehabilitation took place exclusively at the Quellenhof Neurological Rehabilitation Centre in Bad Wildbad. The clinic is a “recognised MS rehabilitation centre” according to the criteria of the German Multiple Sclerosis Society, Federal Association e.V. (DMSG).
Participants were randomly allocated to the intervention group or the control group. The three-month home-based training programme is communicated via a web-based application (https://e-training.ms-intakt.de/) and can be individually adapted to the requirements and needs of the participants. The protocol focuses on combined strength and endurance training, including supplementary balance exercises. Based on the model of physical health competence and self-determination theory, the intervention aims at increasing the motivational and volitional prerequisites as well as the competences necessary for an independent and regular active lifestyle. It includes several behavioural change techniques and integrates the concept of motivational conversation.
The data from this study are currently being evaluated. The first results can be found in Downloads.
With the presented programme, an internet-based care offering with professional therapeutic support is available that can support pwMS in building a physically active lifestyle. This concept can also be adapted to other people with chronic diseases.
Project duration: 2015 – 2017
Principal investigator: Prof. Dr. Klaus Pfeifer
Project staff: René Streber, Dr. Alexander Tallner
Cooperation partners: Prof. Dr. med. Peter Flachenecker Specialist for Neurology), Chief Physician at the Quellenhof Neurological Rehabilitation Centre with Klaus Gusowski and Ann-Christin Weiland as co-workers