Motor-cognitive Performance in People With Multiple Sclerosis

NCT ID: NCT06312046

Last Updated: 2025-07-10

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

90 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-02-26

Study Completion Date

2027-08-31

Brief Summary

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Having a neurological disease such as multiple sclerosis (MS) leads to difficulties in balance and gait with or without concurrent performance of cognitive tasks, hindering activity performance and influencing the possibilities for an independent lifestyle.

The investigators have adapted a previously developed balance training program to a highly challenging program specifically directed to MS (HiBalance-MS). This program was recently tested and found feasible in a pilot study. The investigators will now perform a randomized controlled trial in people with MS, in order to determine the effects of the program. The hypothesis is that progressively challenging balance exercise programs that are specific to the balance control domains affected by MS will be effective to improve balance control, walking, motor-cognitive performance, activity performance and health related quality of life.

Detailed Description

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Everyday living means being in complex environments and performing complex activities which usually consist of and require a combination of motor and cognitive skills. Having a neurological disease such as multiple sclerosis (MS) compromises the motor-cognitive performance. This leads to difficulties in balance and gait with or without concurrent performance of cognitive tasks, hindering activity performance and influencing the possibilities for an independent lifestyle.

The investigators have, in a co-design process with stakeholders, adapted a HiBalance program, originally developed by the Franzén research group for people with Parkinson's disease and combining motor-cognitive exercises in a progressively more difficult manner (HiBalance-PD), to a program specifically developed to MS (HiBalance-MS). The developed HiBalance-MS program was recently tested and found feasible in a pilot study (results published 2023). The investigators will now perform a randomized controlled trial in people with MS, in order to determine the effects of a highly challenging balance training program (HiBalance-MS) on physical and cognitive functioning, and activity performance, in this group. The results will have immediate application and clinical relevance. With improved balance control people with MS will also gain other health benefits related to an active lifestyle and a better everyday life.

The hypothesis that motor-cognitive performance is reduced and impact activity performance in people with MS. They also hypothesize that progressively challenging balance exercise programs that are specific to the balance control domains affected by MS will be effective to improve balance control, walking, motor-cognitive performance, activity performance and health related quality of life.

Participants will be recruited through Karolinska University Hospital, through physiotherapists and physicians specialized in neurology in Stockholm and via advertisement in newspapers and the patient organization NEURO Sweden. According to earlier power calculations for detecting effects in balance and gait measures after this particular intervention, the investigators anticipate 40 to 50 participants in each group to detect significant changes.

The HiBalance-MS program is based on scientifically well-established principles of exercise training and postural control. It will be conducted as a progressive individually adjusted group training to challenge the specific balance deficit of every participant. Four main sub-systems underlying balance control (stability limits, anticipatory postural adjustments, sensory integration and motor agility) are used to target specific balance impairments. To ensure highly challenging exercises, each task is individually adjusted. Daily variation in capacity will be rated before each training session and participants will at the end of each session rate the challenging level. The training will be performed in the clinic (Karolinska University hospital) for an hour, twice a week for 10 weeks, as a group intervention (6 to 8 participants) facilitated by two physiotherapists/trainers.

Conditions

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Multiple Sclerosis Postural Balance

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Randomized controlled trial
Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Investigators Outcome Assessors
Investigator and Outcome assessor will not participate in the provided training program. Care provider will not perform the analyses.

Study Groups

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Balance training intervention group

The program HiBalance-MS is based on scientifically well-established principles of exercise training and postural control. It will be conducted as a progressive individually adjusted group training to challenge the specific balance deficit of every participant. To ensure highly challenging exercises, each task is individually adjusted, e.g., by altering the base of support, increasing speed, restricting vision and varying grade of multitasking. Daily variation in capacity will be rated before each training session and participants will at the end of each session rate the challenging level. The training will be performed in the clinic, at Karolinska University Hospital, for an hour, twice a week for 10 weeks, as a group intervention including 6 to 8 participants and facilitated by two physiotherapists/trainers.

Group Type EXPERIMENTAL

HiBalance-MS

Intervention Type OTHER

See arm description for intervention group.

No intervention control group

Participants in the control group are encouraged to maintain their normal physical activities and are not restricted from participation in ongoing rehabilitation programs.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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HiBalance-MS

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Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* an MS diagnosis according to McDonald criteria;
* an overall MS-disability score from 2.0 to 5.5 according to the Expanded Disability Status Scale;
* ability to walk 100 m without aid;
* a maximum score of 24 in the Mini-BESTest (i.e., \< 25 points)
* 18 to 65 years of age

Exclusion Criteria

* cognitive impairment as indicated by a score \<21 in the Montreal Cognitive Assessment;
* presence of other conditions that would substantially influence balance;
* an MS relapse or change of disease-modifying treatment within the past 8 weeks
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Karolinska University Hospital

OTHER

Sponsor Role collaborator

Karolinska Institutet

OTHER

Sponsor Role lead

Responsible Party

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Sverker Johansson

Associate professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Sverker Johansson, Ph.D

Role: PRINCIPAL_INVESTIGATOR

Karolinska Institutet, org.nr 202100-2973

Locations

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Karolinska Institutet

Stockholm, Stockholm County, Sweden

Site Status RECRUITING

Countries

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Sweden

Central Contacts

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Compliance Office Karolinska Institutet

Role: CONTACT

+46852480000

Erika Franzén, Ph.D

Role: CONTACT

+46852480000

Facility Contacts

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Sverker Johansson, Ph.D

Role: primary

+46702861260

Andreas Wallin, Ph.D

Role: backup

+46735137604

Related Links

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https://pubmed-ncbi-nlm-nih-gov.proxy.kib.ki.se/36922859/

Publication: A highly challenging balance training intervention for people with multiple sclerosis: a feasibility trial

Other Identifiers

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2018 374-31

Identifier Type: -

Identifier Source: org_study_id

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