Multiple Sclerosis
Conditions
Keywords
Clinical Pilates, Physiotherapy, Balance, Postural Control, Rehabilitation, Functional Mobility
Brief summary
This randomized controlled trial evaluated the effects of an 8-week Clinical Pilates program on balance and physical function in individuals with multiple sclerosis (MS). Participants were randomly allocated to one of three groups: Clinical Pilates, conventional exercise-based physiotherapy, or a control group receiving postural guidance without a structured rehabilitation program. The two intervention groups completed 16 supervised exercise sessions over 8 weeks. Outcomes included static and dynamic balance, functional mobility, lower-limb motor function, fatigue, and exercise-related motivation. Assessments were conducted at baseline, after 4 and 8 weeks, and at a one-month follow-up.
Interventions
BEHAVIORALClinical Pilates-Based Rehabilitation
Participants received an 8-week Clinical Pilates-based rehabilitation program comprising 16 sessions, delivered twice weekly with a minimum interval of 48 hours between sessions. Each session lasted approximately 60 minutes and included mobility and breathing exercises, strengthening, balance and coordination exercises, trunk control, core activation, body awareness, and stretching. Exercises were performed in standing, sitting, supine, prone, and side-lying positions. Exercise intensity and complexity were progressively adjusted according to individual ability.
BEHAVIORALConventional Exercise-Based Physiotherapy
Participants received an 8-week conventional exercise-based physiotherapy program comprising 16 sessions, delivered twice weekly with a minimum interval of 48 hours between sessions. Each session lasted approximately 60 minutes and included progressive strengthening, postural control, sensory integration, balance, and functional training. Exercises progressed from stable to more demanding balance and functional activities, with difficulty individually adjusted according to each participant's abilities and performance.
Sponsors
University of Patras
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Investigator)
Masking description
The principal investigator remained blinded to participants' group allocation during data analysis. Participant data were coded and analyzed without access to identifying information or knowledge of group assignment.
Intervention model description
Participants were randomly assigned in a 1:1:1 ratio to one of three parallel groups: Clinical Pilates, conventional exercise-based physiotherapy, or control.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adults with a diagnosis of multiple sclerosis * Ability to maintain an upright standing position * Mini-Mental State Examination (MMSE) score \>24
Exclusion criteria
* Presence of neurological disorders other than multiple sclerosis * Lower-limb and/or spinal surgery within the previous year * History of heart failure * Uncontrolled hypertension
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Center of Pressure Sway Area | Baseline, Week 4, Week 8, and 1-month follow-up | Center of pressure (CoP) sway area was assessed using a Bertec force platform during six standing conditions: feet together with eyes open, feet together with eyes closed, single-leg stance on the right and left leg, and tandem stance with the right and left foot leading. CoP sway area was used as a measure of static postural control, with lower values indicating less postural sway. |
| Change in Mini-BESTest Score | Baseline, Week 4, Week 8, and 1-month follow-up | Dynamic balance was assessed using the Mini-Balance Evaluation Systems Test (Mini-BESTest), a 14-item clinical measure assessing anticipatory postural adjustments, reactive postural control, sensory orientation, and dynamic gait. The total score ranges from 0 to 28 points, with higher scores indicating better balance performance. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Center of Pressure Displacement | Baseline, Week 4, Week 8, and 1-month follow-up | Center of pressure (CoP) displacement in the mediolateral (ML) and anteroposterior (AP) directions was assessed using a Bertec force platform during six standing conditions: feet together with eyes open, feet together with eyes closed, single-leg stance on the right and left leg, and tandem stance with the right and left foot leading. Lower displacement values indicate less postural sway. |
| Change in Functional Gait Assessment (FGA) Score | Baseline, Week 4, Week 8, and 1-month follow-up | Dynamic balance during walking was assessed using the Functional Gait Assessment (FGA). The FGA consists of 10 items assessing the ability to modify gait while performing different walking tasks. Each item is scored from 0 to 3, giving a total score ranging from 0 to 30. Higher scores indicate better functional gait and dynamic balance. |
| Change in Short Physical Performance Battery (SPPB) Score | Baseline, Week 4, Week 8, and 1-month follow-up | Lower-limb physical performance was assessed using the Short Physical Performance Battery (SPPB), which includes standing balance, usual gait speed, and repeated chair-stand tests. Each component is scored from 0 to 4, giving a total score ranging from 0 to 12. Higher scores indicate better lower-limb physical performance. |
| Change in Fugl-Meyer Assessment-Lower Extremity (FMA-LE) Domain Scores | Baseline, Week 4, Week 8, and 1-month follow-up | Lower-limb sensorimotor function was assessed using the Fugl-Meyer Assessment-Lower Extremity (FMA-LE). The following domains were analyzed separately: lower-extremity motor function (E-F; score range: 0-34), sensation (H; score range: 0-12), passive joint motion (I; score range: 0-20), and joint pain (J; score range: 0-20). Higher scores indicate better motor and sensory function, greater passive joint mobility, and less joint pain, respectively. |
| Change in Fatigue Severity Scale (FSS) Score | Baseline, Week 4, Week 8, and 1-month follow-up | Fatigue was assessed using the Fatigue Severity Scale (FSS), a 9-item questionnaire evaluating the severity and impact of fatigue on daily functioning. Each item is rated from 1 to 7, with higher scores indicating greater fatigue severity. |
| Intrinsic Motivation Inventory (IMI) Scores | 2nd, 5th and 8th week | Exercise-related motivation was assessed using the 22-item version of the Intrinsic Motivation Inventory (IMI), comprising four subscales: interest/enjoyment, perceived competence, perceived choice, and pressure/tension. Items are rated on a 7-point scale from 1 (not at all true) to 7 (very true), with negatively worded items reverse-scored. Subscale scores are calculated by averaging the corresponding item scores and therefore range from 1 to 7. Higher scores indicate greater levels of the construct represented by each subscale (i.e., greater interest/enjoyment, perceived competence, perceived choice, or pressure/tension). The IMI was administered only to participants in the two intervention groups. |
Countries
Greece
Outcome results
None listed