Helping people with MS get a step further, keep active and maintain mobility.
By Linda Renfrew,
Consultant Physiotherapist in MS, NHS Ayrshire and Arran
Physical activity has many known and well publicised health benefits. One of the cheapest and most effective ways of keeping active is good old WALKING! But what can we do to promote physical activity and how can we help those with mobility problems to be as active as possible?
For those living with MS around 75% have mobility problems and foot drop is a common occurrence. Foot drop is a symptom in MS whereby the muscles of the lower leg no longer receive the messages from the brain and spinal cord telling them to lift the foot as the person takes a step when walking.
What does this mean? Why is it important? Well, for starters it means that the person has to compensate for foot drop and often ends up working harder to clear the foot from the ground. This sometimes causes hip and back pain, and it increases the likelihood of tripping and falling. Confidence in walking also slips and this makes it less likely that people with MS will keep physically active. The consequence of falls and inactivity also has cost and resource implications for the NHS.
Working as a physiotherapist in MS I had used some of the treatments available for foot drop; but there was limited evidence to tell me which of them were most effective for my patients. In 2014 myself and a team of experts from NHS Ayrshire & Arran, the University of Glasgow, Glasgow Caledonian University and Strathclyde University designed and got funding from the MS Society to start a study. The study which is based in the Douglas Grant Rehabilitation Centre is the first large scale randomised study to compare two treatments for foot drop: AFO (ankle foot orthosis) and FES (functional electrical stimulation).
Two years on we have 61 people with MS from across 7 health boards in Scotland who have taken part in the study. Health boards taking part include NHS Ayrshire & Arran, Dumfries & Galloway, Greater Glasgow and Clyde, Fife, Lanarkshire, Lothian and Tayside. We need to recruit a further 23 people (84 people in total) over the next 6 months so that we have results which are meaningful and which can influence how we treat foot drop in MS.
People with MS who are involved in the study come for 5 assessments over 12 months and receive either FES or AFO for their foot drop. Walking is assessed with and without the device over short and longer distances. We also use a gas analysis kit to measures how much oxygen is used during walking. This lets us see how efficient someone’s walking is. We use questionnaires to evaluate how the 2 devices affect how often someone falls, and whether their confidence in balance and walking and overall quality of life changes over the 12 months. We are measuring activity levels by using a small activity monitor taped to the thigh for 7 days. Finally we are gathering information about treatment costs and peoples experience of both devices, so that all of our questions about these 2 treatments can be answered at the end of the study.
Since the beginning of this project we have been on such a journey making sure the study which spans 7 health boards runs to plan! If you are interested in finding out more about the study or our experiences so far, then drop us an email or give us a call:
Telephone: 01294 323 057