ClinicSpeak: hand training trial

We should shift our focus away from the legs to the hands in progressive MS. #ClinicSpeak #MSBlog #MSResearch

"The following study is remarkable in two ways; firstly, you can do a rater-blinded randomised trials of a physical therapy and secondly, it focuses on hand function and not walking. Upper limb function is the elephant in the room. We are also focused on lower limb function and mobility that we forget how important hand function is for maintaining quality of life. MS is many disease rolled into one and when someone with MS tells you they are losing hand function (buttons, writing, eating, drinking, laces, self-catheterisation, transferring, etc.) you begin to realise how this impacts on their quality of life. I personally think that in progressive MS trials we should shift our focus away from the lower limb function as a primary outcome and focus on hand and upper limb function. I am sure if we do this we will have a better chance of showing that there is a role for DMTs in progressive MS. For those of you who are noticing a fall-off in upper limb and hand function you should let your neurologist or nurse specialist know about it so that you can be referred for the most appropriate therapy."

Epub: Kamm et al. Home-based training to improve manual dexterity in patients with multiple sclerosis: A randomized controlled trial. Mult Scler. 2015 Jan 26. pii: 1352458514565959. 

BACKGROUND: Impaired manual dexterity is frequent and disabling in MSers, affecting activities of daily living (ADL) and quality of life.

OBJECTIVE: We aimed to evaluate the effectiveness of a standardized, home-based training program to improve manual dexterity and dexterity-related ADL in MSers.

METHODS: This was a randomized, rater-blinded controlled trial. Thirty-nine MSers acknowledging impaired manual dexterity and having a pathological Coin Rotation Task (CRT), Nine Hole Peg Test (9HPT) or both were randomized 1:1 into two standardized training programs, the dexterity training program and the theraband training program. MSers trained five days per week in both programs over a period of 4 weeks. Primary outcome measures performed at baseline and after 4 weeks were the CRT, 9HPT and a dexterous-related ADL questionnaire. Secondary outcome measures were the Chedoke Arm and Hand Activity Inventory (CAHAI-8) and the JAMAR test.

RESULTS: The dexterity training program resulted in significant improvements in almost all outcome measures at study end compared with baseline. The theraband training program resulted in mostly non-significant improvements.

CONCLUSION: The home-based dexterity training program significantly improved manual dexterity and dexterity-related ADL in moderately disabled MS patients. Trial Registration NCT01507636.

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