Under & Over: A randomised controlled study to develop an upper limb rehabilitation tool for people with Multiple Sclerosis

Alison Thomson; Andrea Stennett; Canan Metin; Jonathan Bestwick; Gavin Giovannoni; Ruth Dobson

doi:10.1016/j.msard.2024.105529

Under & Over: A randomised controlled study to develop an upper limb rehabilitation tool for people with Multiple Sclerosis

Mult Scler Relat Disord. 2024 May:85:105529. doi: 10.1016/j.msard.2024.105529. Epub 2024 Mar 1.

Authors

Alison Thomson¹, Andrea Stennett², Canan Metin², Jonathan Bestwick², Gavin Giovannoni³, Ruth Dobson²

Affiliations

¹ Wolfson Institute of Population Health, Queen Mary University of London, London, UK. Electronic address: a.thomson@qmul.ac.uk.
² Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
³ Blizard Institute, Queen Mary University of London, London, UK.

PMID: 38447394
DOI: 10.1016/j.msard.2024.105529

Abstract

Background: Impairment of upper limb function is common in Multiple Sclerosis (MS). Rehabilitation remains a key strategy to manage symptoms and improve quality of life. The Under & Over study assessed the effectiveness of a rehabilitation programme in people with advanced MS.

Objective: To determine if repeated use of Under & Over can improve upper limb function for people with MS.

Methods: One hundred and six (N = 106) people with MS participated in this 3-month study. The primary outcome measure was the cardboard 9-hole peg test (c9HPT), with secondary outcomes including the EuroQol-5Dimensions, 5-Level Questionnaire (EQ5D-5 L) questionnaire. There were three arms: Arm 1a, the 'Daily Group', engaged with the Under & Over tool daily for 30 min. Arm 1b, the 'Free Use Group', used the same tool without time constraints, with the added feature of a community sharing platform. Arm 2, the 'Delayed Start Group', initially completed the c9HPT for three months before switching to the 'Free Use' programme.

Results: 43/106 (41 %) of those randomised completed the primary end point. No significant difference between c9HPT at baseline and 3 months was seen in Arm 1a or 1b. Participants in Arm 2 who had been completing the c9HPT 5 days a week for 3 months showed a training effect in the dominant hand (mean speed at baseline 0.0455 (s^-1), mean at 3 months 0.0341, difference 0.011; 95 % CI 0.0080 to 0.0148, p < 0.001). No significant difference was seen in c9HPT time following 3 months of active use of the Under & Over tool. The study faced significant limitations, notably in participant adherence, with fewer than half (43/106 (41 %)) completing the final assessment.

Conclusions: This study demonstrates how a small, engaged, and motivated group were able to complete a remote rehabilitation programme. Future remote intervention studies could benefit from incorporating adaptive engagement strategies, such as personalised reminders and participant-tailored activity adjustments, to enhance adherence and capture a broader spectrum of patient experiences.

Keywords: Multiple sclerosis; Rehabilitation; Upper limb.

Publication types

Randomized Controlled Trial

MeSH terms

Adult
Female
Humans
Male
Middle Aged
Multiple Sclerosis* / physiopathology
Multiple Sclerosis* / rehabilitation
Outcome Assessment, Health Care
Quality of Life
Upper Extremity* / physiopathology