A group mediated cognitive behavioural intervention to improve mobility in individuals with multiple sclerosis: Effects on walking velocity and quality of life


Group mediated cognitive behavioural interventions (GMCB-IV) promote and sustain exercise for symptomatic individuals (e.g., SCI; CVD). We conducted a pilot feasibility GMCB-IV targeting balance and mobility exercise (BME) for inactive persons with multiple sclerosis (MS). Our prospective design utilized 8 weeks of intensive training and a 4 week follow-up. The intensive phase consisted of twice-weekly 60 minute BME sessions coupled with one 30 minute group cognitive-behavioural training session. Primary outcomes of self-efficacy and function changed significantly over time and were retained during follow-up (Sessford et al 2013, 2014). The present report concerns the secondary outcomes of walking velocity and MS-specific health-related quality of life (HRQoL: Hamburg). Twenty-nine individuals with EDSS scores between 1.5 and 6 participated. Functional mobility measures were from the In Chianti toolkit (i.e., 7m walk overcoming 2 obstacles (7m2), 7m walk picking up 3 objects (7m3), and 7m usual and brisk pace walks) and were assessed using the GAITRite walkway analysis system. The HRQol measure provides an overall score and 5 subscale scores (fatigue, upper body function, lower body function, social, and mood). Measures were taken at baseline and at the 12 week follow-up. Paired t-tests compared pre-post means on secondary outcomes. Walking velocity improved for all tasks (p < .01; effect range:  d = -.57 [7m2] to d = -1.00 [7m usual]) except 7m3HRQoL also improved for overall score, fatigue, and upper body function subscales (i.e., p < .05; effect range: d = .40 [overall] to .49 [upper]). Participants demonstrated improved walking velocity on functional mobility task indicants of dynamic gait and correspondent HRQoL. Taken together, primary and secondary outcome results suggest feasibility of a mobility training GMCB-IV for people with MS.  Efficacy of this pilot is similar to GMCB-IV studies in chronic disease and physically disabled samples (Brawley, Flora, Locke, Gierc, 2012).

Acknowledgments: Cameco Multiple Sclerosis Neuroscience Research Centre