Effect of Backward and Forward Walking on Lower Limb Strength, Balance, and Gait in Multiple Sclerosis: A Randomized Feasibility Trial

Heather M DelMastro; Jennifer A Ruiz; Laura B Simaitis; Elizabeth S Gromisch; Lindsay O Neto; Evan T Cohen; Edgar Wong; Robert J Krug; Albert C Lo

doi:10.7224/1537-2073.2022-010

Effect of Backward and Forward Walking on Lower Limb Strength, Balance, and Gait in Multiple Sclerosis: A Randomized Feasibility Trial

Int J MS Care. 2023 Mar-Apr;25(2):45-50. doi: 10.7224/1537-2073.2022-010. Epub 2022 Oct 3.

Authors

Heather M DelMastro^{1

2}, Jennifer A Ruiz^{1

2

3}, Laura B Simaitis⁴, Elizabeth S Gromisch^{1

2

3

5}, Lindsay O Neto^{1

2}, Evan T Cohen⁶, Edgar Wong³, Robert J Krug⁷, Albert C Lo¹

Affiliations

¹ Joyce D. and Andrew J. Mandell Center for Comprehensive Multiple Sclerosis Care and Neuroscience Research, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, CT, USA (HMDM, JAR, ESG, LON, ACL).
² Department of Rehabilitative Medicine (HMDM, JAR, ESG, LON), Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA.
³ Department of Medical Sciences (JAR, ESG, EW), Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA.
⁴ Department of Physical Therapy (LBS), School of Health Sciences at Quinnipiac University, North Haven, CT, USA.
⁵ Department of Neurology, University of Connecticut School of Medicine, Farmington, CT, USA (ESG).
⁶ School of Health Professions, Rutgers, The State University of New Jersey, Blackwood, NJ, USA (ETC).
⁷ Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI, USA (RJK).

Abstract

Background: Backward walking (BW) interventions have improved gait and balance in persons with stroke, cerebral palsy, and Parkinson disease but have not been studied in persons with multiple sclerosis (MS). We examined the feasibility of a BW intervention and how it affected strength, balance, and gait vs forward walking (FW) in persons with MS.

Methods: Sixteen persons with MS with a Patient-Determined Disease Steps (PDDS) scale score of 3 to 5 (gait impairment-late cane) were randomized to the FW (n = 8) or BW (n = 8) group. Participants did 30 minutes of FW or BW on a treadmill 3 times per week for 8 weeks (24 visits). Enrollment, adherence rate, and safety were tracked. The Timed Up and Go test, Six-Spot Step Test, single-leg stance, and abbreviated Activities-specific Balance Confidence scale were used to measure balance. Hip and knee flexion and extension strength (isometric peak torque), gait speed, and spatiotemporal gait parameters were measured. A 2×2 factorial multivariate analysis of covariance was used to examine changes in strength, balance, and gait, with the PDDS scale score as the covariate.

Results: Treatment adherence rate was 99.7%, with no safety concerns. After controlling for baseline differences in disability (PDDS scale score; P = .041), the BW group improved dominant hip flexion strength preintervention to postintervention compared with the FW group (F _1,13 = 9.03; P = .010). No other significant differences were seen between groups.

Conclusions: This was the first study to look at BW as an intervention in persons with MS. Based on its feasibility, safety, and significant finding, BW should be studied in a larger, definitive trial in the future.

Keywords: backwards walking; balance; gait; lower limb strength; muliple sclerosis.

Grants and funding

This work was supported by the National Multiple Sclerosis Society (G-1510-07287). Dr Gromisch is a Harry Weaver Scholar of the National Multiple Sclerosis Society.