| description |
MS-taudissa kävelyn ja tasapainon vaikeudet koetaan rajoitteeksi, erityisesti arjen osallistumiseen liittyvissä toiminnoissa. Aiemmissa katsauksissa terapeuttisen harjoittelun on todettu olevan vaikuttavaa MS-tautia sairastavien kävelyn kohentamisessa. Tutkielman tarkoituksena oli selvittää järjestelmällisen kirjallisuus-katsauksen ja meta-analyysin avulla aktiivisen terapeuttisen harjoittelun vaikuttavuutta MS-tautia sairastavan kävelyyn ICF:n suorituskyvyn ja suoritustason alueilla, verrattuna ei-hoitoon, ja päivittää täten aiempaa tutkimustietoa ja tuottaa tietoa harjoittelun vaikuttavuudesta sekä suoritusten että osallistumisen tasolle.
Järjestelmällinen haku tehtiin tietokantoihin: OVID Medline, Cinahl, Embase, Cochrane Database of Systematic Reviews, PEDro, Cochrane Controlled Trials Register (CENTRAL) ja Web of Science (WOS). Sisäänottokriteereinä oli PICOS:n mukaan: MS-tautia sairastavat aikuiset, terapeutti-sen harjoittelun interventiot, ei-hoitoa saava kontrolliryhmä, lopputulos-muuttujana kävely, ja RCT-tutkimukset. Tutkimusten harhan riskiä arviointiin Cochranen Risk of bias-työkalulla. Interventio- ja kontrolliryhmien välisiä eroja tarkasteltiin meta-analyysilla Review Manager-ohjelmalla satunnaisvaikutusten mallilla, standardoitujen keskiarvojen erotuksien (SMD) ja keskiarvojen erotuksien (MD) avulla.
Haun tuloksena tutkimuksia oli 35, joissa tutkittavia 1586. Interventioiden kesto oli keskimäärin 10.54 viikkoa (SD 5.03), taudin muoto pääosin relapsoiva remittoiva MS (62.1%), ja toimintakyvyn vajetta kuvaavien EDSS-pisteiden keskiarvo oli 3.94 (SD 1.36). Tutkittavat edustivat hyvin MS-tautia sairastavia. Suorituskyvyn tasolla terapeuttisella harjoittelulla havaittiin efektikooltaan pieni, mutta merkitsevä vaikutus MS-tautia sairastavan kävelyyn, verrattuna ei-hoitoon, SMD 0.28 [0.09, 0.48], I²=46%, p-arvo 0.005 (n=974). Ala-analyysina kuuden minuutin kävelytestin keskiarvojen erotus (MD) oli 18.69 metriä [-10.37, 47.74], I²=41%, p-arvo 0.21. Kahden minuutin kävelytestin MD 13.95 metriä [7.19, 20.71], I²=0%, p-arvo<0.0001, joka oli kliinisesti merkittävä interventio-ryhmän hyväksi. Lyhyiden matkojen osalta ala-analyysi tehtiin 10 metrin kävelytestille, MD oli 0.11 m/s [0.03, 0.18], p-arvo 0.007, I²=43%, joka oli kliinisesti merkittävä interventio-ryhmän hyväksi. Myös suoritustason analyysissa havaittiin terapeuttisella harjoittelulla efektikooltaan pieni, mutta merkitsevä tulos MS-tautia sairastavan kävelyyn, verrattuna ei-hoitoon, SMD 0.29 [0.02, 0.57], I²=0%, p-arvo=0.04 (n=368), MSWS-12 kyselyllä mitattuna. Tilastollinen heterogeenisyys (I²) oli analyyseissa pientä tai kohtalaista, ja merkittävää julkaisuharhaa ei havaittu. Tutkittavien ja interventioiden osalta tutkimuksissa esiintyi kliinistä heterogeenisyyttä. Näytönasteeltaan terapeuttisen harjoittelun vaikuttavuus kävelyyn MS-tautia sairastavilla on B suorituskyvyn tasolla, ja C suoritustason tasolla. Jatkossa tutkimusten tulosmuuttujia tulisi kohdentaa yhä enemmän suoritustason alueelle, mittaamaan osallistumista. Kävelyä olisi tärkeä mitata fysioterapian aikana ja kokemuksia kävelyn vaikeuksista selvittää arjen tasolla.
Tulos on samansuuntainen aikaisempien tutkimusten kanssa, ja terapeuttinen harjoittelu on vaikuttavaa MS-tautia sairastavan kävelyn kohentamisessa suorituskykytasolla. Tutkimus antoi uutta tietoa suoritustason vaikuttavuudesta. Monipuolista terapeuttista harjoittelua voidaan suositella fysioterapiassa suoritusten ja osallistumisen tukemiseen.
People with multiple sclerosis (pwMS) find walking and balance difficulties as a major con-straint, especially regarding participation on daily activities. In previous reviews, therapeutic ex-ercise has been shown to be effective on improving walking in pwMS. The purpose of this study was to investigate the effectiveness of active therapeutic exercise on walking in pwMS, on ICF capacity and performance domains, compared to no-treatment, through systematic literature re-view and meta-analysis. The objective was to update previous research and provide information on effectiveness of therapeutic exercise, focusing on capacity and performance domains (/activities and participation).
Systematic search of literature was performed on databases: OVID Medline, Cinahl, Embase, Cochrane Data-base of Systematic Reviews, PEDro, Cochrane Controlled Trials Register (CENTRAL) and Web of Science (WOS). The inclusion criteria were according to PICOS: pwMS, therapeutic exercise interventions, no-treatment control group, walking outcomes, and RCT stud-ies. The risk of bias was assessed with Cochrane's Risk of bias tool. Differences between inter-vention and control groups were examined by meta-analysis conducted using the random effects model of Review Manager program, using standardized mean difference (SMD) and mean differ-ence (MD).
The systematic search found n=35 studies, with n=1586 subjects. The duration of intervention was 10.54 weeks (SD 5.03) on average, most pwMS had relapsing remitting MS (62.1%), and average EDSS score was 3.94 (SD 1.36). The subjects were a representative sample of pwMS. At capacity level therapeutic exercise yielded a small, but significant effect size on walking in pwMS, compared to no-treatment, SMD 0.28 [0.09, 0.48], I²=46%, p-value 0.005 (n=974). As a sub-analysis, the difference in means for the six-minute walking test was 18.69 meters [-10.37, 47.74], I² =41%, p-value 0.21, and for the two-minute walking test 13.95 meters [7.19, 20.71], I²=0 %, p-value <0.0001. For short distances, a sub-analysis was performed for 10-meter walk test, MD was 0.11 m/s [0.03, 0.18], p-value 0.007, I²=43%. At performance level, therapeutic exercise also yielded a small but significant effect size, on walking in pwMS, compared to no-treatment, SMD 0.29 [0.02, 0.57], I²= 0%, p-value=0.04 (n=368), measured by MSWS-12. The statistical heterogeneity (I²) was moderate or low, and no significant publication bias was found. Clinical heterogeneity was observed in the studies. The level of evidence (näytönaste) of therapeutic exercise on walking in pwMS was B-level on capacity domain, and C-level on performance domain. In the future, outcomes of studies should be more focused on the performance level, to measure participation. It is important to measure walking during physiotherapy and to examine the subjects experience on walking difficulties at an everyday/participation level.
In conclusion, the results of this thesis are in line with previous studies. Therapeutic exercise produces statistically significant and clinically relevant improvements on walking in pwMS on capacity and performance levels, and therapeutic exercise can be recommended to pwMS. There are, however, a number of challenges when examining neurological, progressive disease, and RCT settings do not always take into account all of the confounding factors.
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[{"key": "dc.contributor.advisor", "value": "Sj\u00f6gren, Tuulikki", "language": "", "element": "contributor", "qualifier": "advisor", "schema": "dc"}, {"key": "dc.contributor.advisor", "value": "Waller, Benjamin", "language": "", "element": "contributor", "qualifier": "advisor", "schema": "dc"}, {"key": "dc.contributor.advisor", "value": "Korpi, Hilkka", "language": "", "element": "contributor", "qualifier": "advisor", "schema": "dc"}, {"key": "dc.contributor.author", "value": "K\u00f6ng\u00e4s, Riikka", "language": "", "element": "contributor", "qualifier": "author", "schema": "dc"}, {"key": "dc.date.accessioned", "value": "2019-04-24T08:00:33Z", "language": null, "element": "date", "qualifier": "accessioned", "schema": "dc"}, {"key": "dc.date.available", "value": "2019-04-24T08:00:33Z", "language": null, "element": "date", "qualifier": "available", "schema": "dc"}, {"key": "dc.date.issued", "value": "2019", "language": "", "element": "date", "qualifier": "issued", "schema": "dc"}, {"key": "dc.identifier.uri", "value": "https://jyx.jyu.fi/handle/123456789/63588", "language": null, "element": "identifier", "qualifier": "uri", "schema": "dc"}, {"key": "dc.description.abstract", "value": "MS-taudissa k\u00e4velyn ja tasapainon vaikeudet koetaan rajoitteeksi, erityisesti arjen osallistumiseen liittyviss\u00e4 toiminnoissa. Aiemmissa katsauksissa terapeuttisen harjoittelun on todettu olevan vaikuttavaa MS-tautia sairastavien k\u00e4velyn kohentamisessa. Tutkielman tarkoituksena oli selvitt\u00e4\u00e4 j\u00e4rjestelm\u00e4llisen kirjallisuus-katsauksen ja meta-analyysin avulla aktiivisen terapeuttisen harjoittelun vaikuttavuutta MS-tautia sairastavan k\u00e4velyyn ICF:n suorituskyvyn ja suoritustason alueilla, verrattuna ei-hoitoon, ja p\u00e4ivitt\u00e4\u00e4 t\u00e4ten aiempaa tutkimustietoa ja tuottaa tietoa harjoittelun vaikuttavuudesta sek\u00e4 suoritusten ett\u00e4 osallistumisen tasolle.\n\nJ\u00e4rjestelm\u00e4llinen haku tehtiin tietokantoihin: OVID Medline, Cinahl, Embase, Cochrane Database of Systematic Reviews, PEDro, Cochrane Controlled Trials Register (CENTRAL) ja Web of Science (WOS). Sis\u00e4\u00e4nottokriteerein\u00e4 oli PICOS:n mukaan: MS-tautia sairastavat aikuiset, terapeutti-sen harjoittelun interventiot, ei-hoitoa saava kontrolliryhm\u00e4, lopputulos-muuttujana k\u00e4vely, ja RCT-tutkimukset. Tutkimusten harhan riski\u00e4 arviointiin Cochranen Risk of bias-ty\u00f6kalulla. Interventio- ja kontrolliryhmien v\u00e4lisi\u00e4 eroja tarkasteltiin meta-analyysilla Review Manager-ohjelmalla satunnaisvaikutusten mallilla, standardoitujen keskiarvojen erotuksien (SMD) ja keskiarvojen erotuksien (MD) avulla.\n\nHaun tuloksena tutkimuksia oli 35, joissa tutkittavia 1586. Interventioiden kesto oli keskim\u00e4\u00e4rin 10.54 viikkoa (SD 5.03), taudin muoto p\u00e4\u00e4osin relapsoiva remittoiva MS (62.1%), ja toimintakyvyn vajetta kuvaavien EDSS-pisteiden keskiarvo oli 3.94 (SD 1.36). Tutkittavat edustivat hyvin MS-tautia sairastavia. Suorituskyvyn tasolla terapeuttisella harjoittelulla havaittiin efektikooltaan pieni, mutta merkitsev\u00e4 vaikutus MS-tautia sairastavan k\u00e4velyyn, verrattuna ei-hoitoon, SMD 0.28 [0.09, 0.48], I\u00b2=46%, p-arvo 0.005 (n=974). Ala-analyysina kuuden minuutin k\u00e4velytestin keskiarvojen erotus (MD) oli 18.69 metri\u00e4 [-10.37, 47.74], I\u00b2=41%, p-arvo 0.21. Kahden minuutin k\u00e4velytestin MD 13.95 metri\u00e4 [7.19, 20.71], I\u00b2=0%, p-arvo<0.0001, joka oli kliinisesti merkitt\u00e4v\u00e4 interventio-ryhm\u00e4n hyv\u00e4ksi. Lyhyiden matkojen osalta ala-analyysi tehtiin 10 metrin k\u00e4velytestille, MD oli 0.11 m/s [0.03, 0.18], p-arvo 0.007, I\u00b2=43%, joka oli kliinisesti merkitt\u00e4v\u00e4 interventio-ryhm\u00e4n hyv\u00e4ksi. My\u00f6s suoritustason analyysissa havaittiin terapeuttisella harjoittelulla efektikooltaan pieni, mutta merkitsev\u00e4 tulos MS-tautia sairastavan k\u00e4velyyn, verrattuna ei-hoitoon, SMD 0.29 [0.02, 0.57], I\u00b2=0%, p-arvo=0.04 (n=368), MSWS-12 kyselyll\u00e4 mitattuna. Tilastollinen heterogeenisyys (I\u00b2) oli analyyseissa pient\u00e4 tai kohtalaista, ja merkitt\u00e4v\u00e4\u00e4 julkaisuharhaa ei havaittu. Tutkittavien ja interventioiden osalta tutkimuksissa esiintyi kliinist\u00e4 heterogeenisyytt\u00e4. N\u00e4yt\u00f6nasteeltaan terapeuttisen harjoittelun vaikuttavuus k\u00e4velyyn MS-tautia sairastavilla on B suorituskyvyn tasolla, ja C suoritustason tasolla. Jatkossa tutkimusten tulosmuuttujia tulisi kohdentaa yh\u00e4 enemm\u00e4n suoritustason alueelle, mittaamaan osallistumista. K\u00e4vely\u00e4 olisi t\u00e4rke\u00e4 mitata fysioterapian aikana ja kokemuksia k\u00e4velyn vaikeuksista selvitt\u00e4\u00e4 arjen tasolla.\nTulos on samansuuntainen aikaisempien tutkimusten kanssa, ja terapeuttinen harjoittelu on vaikuttavaa MS-tautia sairastavan k\u00e4velyn kohentamisessa suorituskykytasolla. Tutkimus antoi uutta tietoa suoritustason vaikuttavuudesta. Monipuolista terapeuttista harjoittelua voidaan suositella fysioterapiassa suoritusten ja osallistumisen tukemiseen.", "language": "fi", "element": "description", "qualifier": "abstract", "schema": "dc"}, {"key": "dc.description.abstract", "value": "People with multiple sclerosis (pwMS) find walking and balance difficulties as a major con-straint, especially regarding participation on daily activities. In previous reviews, therapeutic ex-ercise has been shown to be effective on improving walking in pwMS. The purpose of this study was to investigate the effectiveness of active therapeutic exercise on walking in pwMS, on ICF capacity and performance domains, compared to no-treatment, through systematic literature re-view and meta-analysis. The objective was to update previous research and provide information on effectiveness of therapeutic exercise, focusing on capacity and performance domains (/activities and participation).\nSystematic search of literature was performed on databases: OVID Medline, Cinahl, Embase, Cochrane Data-base of Systematic Reviews, PEDro, Cochrane Controlled Trials Register (CENTRAL) and Web of Science (WOS). The inclusion criteria were according to PICOS: pwMS, therapeutic exercise interventions, no-treatment control group, walking outcomes, and RCT stud-ies. The risk of bias was assessed with Cochrane's Risk of bias tool. Differences between inter-vention and control groups were examined by meta-analysis conducted using the random effects model of Review Manager program, using standardized mean difference (SMD) and mean differ-ence (MD).\nThe systematic search found n=35 studies, with n=1586 subjects. The duration of intervention was 10.54 weeks (SD 5.03) on average, most pwMS had relapsing remitting MS (62.1%), and average EDSS score was 3.94 (SD 1.36). The subjects were a representative sample of pwMS. At capacity level therapeutic exercise yielded a small, but significant effect size on walking in pwMS, compared to no-treatment, SMD 0.28 [0.09, 0.48], I\u00b2=46%, p-value 0.005 (n=974). As a sub-analysis, the difference in means for the six-minute walking test was 18.69 meters [-10.37, 47.74], I\u00b2 =41%, p-value 0.21, and for the two-minute walking test 13.95 meters [7.19, 20.71], I\u00b2=0 %, p-value <0.0001. For short distances, a sub-analysis was performed for 10-meter walk test, MD was 0.11 m/s [0.03, 0.18], p-value 0.007, I\u00b2=43%. At performance level, therapeutic exercise also yielded a small but significant effect size, on walking in pwMS, compared to no-treatment, SMD 0.29 [0.02, 0.57], I\u00b2= 0%, p-value=0.04 (n=368), measured by MSWS-12. The statistical heterogeneity (I\u00b2) was moderate or low, and no significant publication bias was found. Clinical heterogeneity was observed in the studies. The level of evidence (n\u00e4yt\u00f6naste) of therapeutic exercise on walking in pwMS was B-level on capacity domain, and C-level on performance domain. In the future, outcomes of studies should be more focused on the performance level, to measure participation. It is important to measure walking during physiotherapy and to examine the subjects experience on walking difficulties at an everyday/participation level.\nIn conclusion, the results of this thesis are in line with previous studies. Therapeutic exercise produces statistically significant and clinically relevant improvements on walking in pwMS on capacity and performance levels, and therapeutic exercise can be recommended to pwMS. There are, however, a number of challenges when examining neurological, progressive disease, and RCT settings do not always take into account all of the confounding factors.", "language": "en", "element": "description", "qualifier": "abstract", "schema": "dc"}, {"key": "dc.description.provenance", "value": "Submitted by Paivi Vuorio (paelvuor@jyu.fi) on 2019-04-24T08:00:33Z\nNo. of bitstreams: 0", "language": "en", "element": "description", "qualifier": "provenance", "schema": "dc"}, {"key": "dc.description.provenance", "value": "Made available in DSpace on 2019-04-24T08:00:33Z (GMT). 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Therefore the material can be read only at the archival workstation at Jyv\u00e4skyl\u00e4 University Library (https://kirjasto.jyu.fi/en/workspaces/facilities).", "language": "en", "element": "rights", "qualifier": "accessrights", "schema": "dc"}, {"key": "dc.rights.accessrights", "value": "Tekij\u00e4 ei ole antanut lupaa avoimeen julkaisuun, joten aineisto on luettavissa vain Jyv\u00e4skyl\u00e4n yliopiston kirjaston arkistoty\u00f6semalta. Ks. https://kirjasto.jyu.fi/fi/tyoskentelytilat/laitteet-ja-tilat..", "language": "fi", "element": "rights", "qualifier": "accessrights", "schema": "dc"}, {"key": "dc.type.okm", "value": "G2", "language": null, "element": "type", "qualifier": "okm", "schema": "dc"}]
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