Development of an exercise programme for balance abilities in people with multiple sclerosis: a development of concept study using Rasch analysis.
Karl Martin Sattelmayer, Odile Chevalley, Jan Kool and 5 others
PMID 34906261WHAT IT FOUND
Balance exercises for multiple sclerosis are not one single skill.
They split into three distinct types: standing still, shifting weight, and stepping or walking. Each type has its own difficulty scale, so you must pick exercises from the specific area your patient struggles with.
Key findings
01Balance abilities in people with multiple sclerosis are not a single skill but comprise three distinct dimensions: stable base of support, sway, and step and walk.
02Exercises within each dimension have a specific order of difficulty, ranging from standing wide stance (easiest) to one-leg stance (hardest) in the stable base dimension.
03The study established content validity through expert review and structural validity through Rasch analysis, but did not test whether this programme improves patient outcomes.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study did not test whether using this programme improves patient outcomes or reduces falls; it only validated the structure and difficulty of the exercises. The expert round included only physiotherapists, excluding other professions like occupational therapists or sports scientists. The sample size of experts was small (13 physiotherapists). The study included only 19 exercises, which may not cover the full spectrum of balance abilities, particularly at the extremes of difficulty. Patients had difficulty distinguishing between some difficulty ratings (e.g., 'very easy' vs 'easy'), suggesting the self-report scale needs refinement. The participants were mostly women (74%) and had a median EDSS score of 5, so findings may not apply to men or those with more severe or milder disability.
Declared interests
The study was funded by the Swiss Multiple Sclerosis Society. The authors declared no other conflicts of interest.
The easy way to misread this
Do not assume this programme has been proven to reduce falls or improve balance in patients. This study only validated the classification and difficulty of the exercises. It did not measure clinical outcomes, so it provides a tool for prescribing, not evidence of efficacy.