Dataset Information

Immediate and Sustained Effects of Interventions for Changing Physical Activity in People with Multiple Sclerosis: Meta-analysis of Randomized Controlled Trials.

ABSTRACT:

Objectives

To examine the immediate and sustained effects of interventions for changing physical activity behavior in people with multiple sclerosis (MS), and to explore factors that might moderate intervention effects on physical activity behavior (eg, intervention type and duration, type of physical activity measurement, intensity of theory integration [degree of theory used in study design], and study quality).

Data sources

Systematic searches were conducted in 4 databases, including MEDLINE, CINAHL, PsychINFO, and Google Scholar, in October 2017 and October 2018. Updated searches were conducted in September 2019 with 2 additional databases (Embase and Scopus) and enhanced search terms.

Study selection

Studies were included that (1) incorporated a randomized controlled trial design of interventions that targeted change in physical activity behavior in adults with MS, namely, exercise training and behavioral intervention (alone and combined); (2) included self-reported and/or device-measured physical activity as an outcome; and (3) contained pre- and post-intervention assessments.

Data extraction

Data were extracted for immediate (pre- to post-intervention) and sustained (pre-intervention to follow-up) physical activity outcomes and study characteristics. Weighted mean effect sizes were expressed as standardized mean differences (SMD). Heterogeneity between each categorical moderator was compared using Q between statistics.

Data synthesis

The mean SMD was 0.56 for immediate changes (n=24) and 0.53 for sustained changes (n=7) of physical activity outcomes. Self-reported physical activity measures yielded larger effects (SMD, 0.64; n=22) than those of device-measured physical activity (0.26; n=7). There appeared to be larger immediate effects of behavioral interventions (SMD, 0.71; n=9) than exercise training (SMD, 0.53; n=7) and combined interventions (0.37; n=8).

Conclusions

Current evidence demonstrates that interventions are efficacious for increasing and potentially sustaining physical activity behavior in adults with MS. The effects appear to be optimized based on the delivery of behavioral interventions alone, and these interventions may be capable of supporting long-term behavior change.

SUBMITTER: Kim Y

PROVIDER: S-EPMC9159367 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Immediate and Sustained Effects of Interventions for Changing Physical Activity in People with Multiple Sclerosis: Meta-analysis of Randomized Controlled Trials.

Kim Yumi Y Mehta Tapan T Lai Byron B Motl Robert W RW

Archives of physical medicine and rehabilitation 20200425 8

<h4>Objectives</h4>To examine the immediate and sustained effects of interventions for changing physical activity behavior in people with multiple sclerosis (MS), and to explore factors that might moderate intervention effects on physical activity behavior (eg, intervention type and duration, type of physical activity measurement, intensity of theory integration [degree of theory used in study design], and study quality).<h4>Data sources</h4>Systematic searches were conducted in 4 databases, inc ...[more]

PMID: 32343973

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Project description:IntroductionAlthough physical activity may reduce disease burden, fatigue and disability, and improve quality of life among people with multiple sclerosis (MS), many people with MS are physically inactive and spend significant time in sedentary behaviour. Behaviour change interventions may assist people with MS to increase physical activity and reduce sedentary behaviour. However, few studies have investigated their effectiveness using objective measures of physical activity, particularly in the long term. Further, interventions that have proven effective in the short term may not be feasible in clinical practice because of the large amount of support provided. The iStep-MS trial aims to determine the safety, feasibility and acceptability of a behaviour change intervention to increase physical activity and reduce sedentary behaviour among people with MS.Methods and analysisSixty people with MS will be randomised (1:1 ratio) to receive a 12-week intervention or usual care only. The intervention consists of four physical activity consultations with a physiotherapist supported by a handbook and pedometer. Outcomes assessed at baseline, 12 weeks and 9 months are physical activity (ActiGraph wGT3X-BT accelerometer), sedentary behaviour (activPAL3µ), self-reported activity and sitting time, walking capability, fatigue, self-efficacy, participation, quality of life and health service use. The safety of the intervention will be determined by assessing change in pain and fatigue and the incidence of adverse events during the follow-up period. A parallel process evaluation will assess the feasibility and acceptability of the intervention through assessment of fidelity to the programme and semistructured interviews exploring participants' and therapists' experiences of the intervention. The feasibility of conducting an economic evaluation will be determined by collecting data on quality of life and resource use.Ethics and disseminationResearch ethics committee approval has been granted from Brunel University London. Results of the trial will be submitted for publication in journals and distributed to people with MS and physiotherapists.Trial registration numberISRCTN15343862 (doi 10.1186/ISRCTN15343862). Protocol version: 1.0; Pre-results.

Project description:BackgroundReduced physical activity is a worldwide challenge in individuals with multiple sclerosis (MS). The aim of this systematic review and meta-analysis was to identify devise-measured effects of physical activity, exercise and physiotherapy-interventions on step count and intensity level of physical activity in individuals with MS.MethodsA systematic search of the databases of PubMed (including Medline), Scopus, CINHAL and Web of Science was carried out to retrieve studies published in the English language from the inception to the first of May 2023. All trials concerning the effectiveness of different types of exercise on step count and intensity level in people with MS were included. The quality of the included studies and their risk of bias were critically appraised using The modified consolidated standards of reporting trials and the Cochrane Risk of Bias tool, respectively. The pooled standardized mean difference (SMD) and 95% CI of the step-count outcome and moderate to vigorous intensity level before versus after treatment were estimated in both Intervention and Control groups using the random effect model. The Harbord test were used to account for heterogeneity between studies and assess publication bias, respectively. Further sensitivity analysis helped with the verification of the reliability and stability of our review results.ResultsA total of 8 randomized clinical trials (involving 919 individuals with MS) were included. The participants (including 715 (77.8%) female and 204 (22.2%) male) had been randomly assigned to the Intervention (n = 493) or Control group (n = 426). The pooled mean (95% CI) age and BMI of participants were 49.4 years (95% CI: 47.4, 51.4 years) and 27.7 kg/m2 (95% CI: 26.4, 29 kg/m2), respectively. In terms of the comparison within the Intervention and the Control groups before and after the intervention, the results of the meta-analysis indicate that the pooled standardized mean difference (SMD) for step-count in the Intervention group was 0.56 (95% CI: -0.42, 1.54), while in the Control group it was 0.12 (95% CI: -0.05, 0.28). Furthermore, there was no significant difference in the pooled SMD of step-count in the physical activity Intervention group compared to the Controls after the intervention (pooled standard mean difference = 0.19, 95% CI: -0.36,0.74). Subgroup analysis on moderate to vigorous intensity level of physical activity revealed no significant effect of the physical activity intervention in the Intervention group compared to the Control group after the intervention, or within groups before and after the intervention. Results of meta regression showed that age, BMI, duration of disease and Expanded Disability Status Scale (EDSS) score were not the potential sources of heterogeneity (all p > 0.05). Data on the potential harms of the interventions were limited.ConclusionThe results of this meta-analysis showed no significant differences in step count and moderate to vigorous physical activity level among individuals with MS, both within and between groups receiving physical activity interventions. More studies that objectively measure physical activity are needed.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42022343621.

Project description:BackgroundThis systematic review evaluated the effectiveness of physical and procedural interventions for reducing pain and related outcomes during vaccination.Design/methodsDatabases were searched using a broad search strategy to identify relevant randomized and quasi-randomized controlled trials. Data were extracted according to procedure phase (preprocedure, acute, recovery, and combinations of these) and pooled using established methods.ResultsA total of 31 studies were included. Acute infant distress was diminished during intramuscular injection without aspiration (n=313): standardized mean difference (SMD) -0.82 (95% confidence interval [CI]: -1.18, -0.46). Injecting the most painful vaccine last during vaccinations reduced acute infant distress (n=196): SMD -0.69 (95% CI: -0.98, -0.4). Simultaneous injections reduced acute infant distress compared with sequential injections (n=172): SMD -0.56 (95% CI: -0.87, -0.25). There was no benefit of simultaneous injections in children. Less infant distress during the acute and recovery phases combined occurred with vastus lateralis (vs. deltoid) injections (n=185): SMD -0.70 (95% CI: -1.00, -0.41). Skin-to-skin contact in neonates (n=736) reduced acute distress: SMD -0.65 (95% CI: -1.05, -0.25). Holding infants reduced acute distress after removal of the data from 1 methodologically diverse study (n=107): SMD -1.25 (95% CI: -2.05, -0.46). Holding after vaccination (n=417) reduced infant distress during the acute and recovery phases combined: SMD -0.65 (95% CI: -1.08, -0.22). Self-reported fear was reduced for children positioned upright (n=107): SMD -0.39 (95% CI: -0.77, -0.01). Non-nutritive sucking (n=186) reduced acute distress in infants: SMD -1.88 (95% CI: -2.57, -1.18). Manual tactile stimulation did not reduce pain across the lifespan. An external vibrating device and cold reduced pain in children (n=145): SMD -1.23 (95% CI: -1.58, -0.87). There was no benefit of warming the vaccine in adults. Muscle tension was beneficial in selected indices of fainting in adolescents and adults.ConclusionsInterventions with evidence of benefit in select populations include: no aspiration, injecting most painful vaccine last, simultaneous injections, vastus lateralis injection, positioning interventions, non-nutritive sucking, external vibrating device with cold, and muscle tension.

Dataset Information

Immediate and Sustained Effects of Interventions for Changing Physical Activity in People with Multiple Sclerosis: Meta-analysis of Randomized Controlled Trials.

Objectives

Data sources

Study selection

Data extraction

Data synthesis

Conclusions

Publications

Immediate and Sustained Effects of Interventions for Changing Physical Activity in People with Multiple Sclerosis: Meta-analysis of Randomized Controlled Trials.

Similar Datasets

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