Effects of a home-based step training programme on balance, stepping, cognition and functional performance in people with multiple sclerosis - a randomized controlled trial

Background: Stepping impairments increase fall risk in people with MS. No studies have evaluated step training for reducing fall risk in this population. Objectives: To determine if step training can improve physical and neuropsychological measures associated with falls in MS. Methods: 50 PwMS with moderate disability participated in a randomized controlled trial in which intervention group participants (n=28) performed step training for 12 weeks while controls (n=22) continued usual physical activity. The primary outcomes were choice stepping reaction time (CSRT) and Stroop stepping test (SST) time. Secondary outcomes included balance test (postural sway, CSRT components), gait speed and cognitive tests, nine-hole peg test (9-HPT) and MS functional composite (MSFC) score. Results: 44 participants completed the study and no adverse events were reported. Compared with the control group, the intervention group performed significantly better at retest in CSRT and SST times, and tests of sway with eyes open, 9-HPT, single and dual task gait speed and MSFC score. There was a non-significant trend for fewer falls in the intervention group. Conclusions: The findings indicate that the step training programme is feasible, safe and effective in improving stepping, standing balance, coordination and functional performance in people with MS.