Coote 2015.
| Methods |
Design: random assignment to progressive resistance training (PRT) or progressive resistance training augmented by neuromuscular electrical stimulation (NMES) Setting: MS Society, Ireland Categorization: PRT = muscle power, NMES = muscle power |
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| Participants |
n = 37; PRT = 18, NMES = 19 Inclusion criteria: definite MS, use of walking aid most of the time, and could walk at least 10 metres unaided Exclusion criteria: contraindications to electrical stimulation, had participated in an exercise programme < 1 month, relapse or steroid treatment < 3 months Type MS: RRMS, PPMS, SPMS, benign, unknown Disease duration (yr) ± SD: PRT = 12.2 ± 4, NMES = 11.8 ± 5.5 Mean age (yr) ± SD: PRT = 51.8 ± 12.1, NMES = 51.8 ± 12.6 % Female (n/n group): PRT = 6/10, NMES = 11/15 Mean EDSS ± SD: ? |
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| Interventions |
PRT: 12 weeks, 2x per week for weeks 1‐6, 3x per week for week 7‐12. The programme consisted of 6 lower limb exercises performed in the home environment. Participants progressed from 1 set of 12 repetitions to 3 sets of 12 repetitions. Once 3 sets of 12 repetitions could be completed, free‐weights in the hands, around the ankle, or in a backpack were added in increments of 0.5 or 1 kg as advised during weekly telephone calls. Rest period of 2‐3 minutes between sets were advised NMES: participants in the NMES group followed the same PRT programme while wearing The Kneehab®. The Kneehab® is a synthetic garment that consists of 4 electrodes strategically placed to activate the quadriceps muscle through a novel Multipath® system. It is placed on the thigh and attached using Velcro fastenings. The pre‐set programme parameters used were a frequency of 50 Hz, on/off time 5/10 seconds, ramp up/down of 1/0.5 seconds. Participants were encouraged to use the highest tolerable intensity |
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| Outcomes | MFIS, muscle strength and endurance, VAS lower limb spasticity, TUG, MSWS‐12, BBS, MSIS29v2 | |
| Notes |
Drop‐outs PRT: 3 relapse, 2 musculoskeletal injury, 2 MS‐related fatigue, 1 non‐compliance NMES: 2 muscle spasm with device use, 1 non‐compliance, 1 medical problem Measurements Baseline, 12 weeks |
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| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | 60 randomizations were generated by repeatedly drawing cards from a pool of 3 PRT and 3 NMES cards |
| Allocation concealment (selection bias) | Low risk | 'The sequence of allocation was concealed from all study personnel' |
| Blinding of participants and personnel (performance bias) All outcomes | High risk | Due to the nature of the intervention, neither participants nor personnel could be blinded |
| Blinding of outcome assessment (detection bias) All outcomes | High risk | Fatigue was self reported and therefore outcome assessment was not blinded |
| Incomplete outcome data (attrition bias) All outcomes | High risk | Overall drop‐out rate was 32%, with indications for differences in reasons |
| Selective reporting (reporting bias) | Low risk | No selective reporting identified |
| Other bias | Low risk | No other bias identified |