Effects of Vestibular Rehabilitation on Multiple Sclerosis–Related Fatigue and Upright Postural Control: A Randomized Controlled Trial

• Published in: Physical therapy 2011-08, Vol.91 (8), p.1166-1183
• Main Authors: Hebert, Jeffrey R, Corboy, John R, Manago, Mark M, Schenkman, Margaret
• Format: Article
• Language: English
• Subjects: Adult; Analysis of Variance; Brain; Care and treatment; Complications and side effects; Data collection; Depression - diagnosis; Diagnosis; Disability Evaluation; Dizziness - etiology; Dizziness - rehabilitation; Education; Energy conservation; Exercise; Exercise physiology; Fatigue; Fatigue - rehabilitation; Female; Humans; Intervention; Male; Middle Aged; Multiple sclerosis; Multiple Sclerosis - complications; Multiple Sclerosis - rehabilitation; Muscle Stretching Exercises; Physical Endurance - physiology; Physical therapists; Physical Therapy Modalities; Physiological aspects; Postural Balance - physiology; Quality of life; Single-Blind Method; Sleep disorders; Studies; Surveys and Questionnaires; Treatment Outcome; Walking - physiology
• ISSN: 0031-9023; 1538-6724
• DOI: 10.2522/ptj.20100399

Fatigue and impaired upright postural control (balance) are the 2 most common findings in people with multiple sclerosis (MS), with treatment approaches varying greatly in effectiveness. The aim of this study was to investigate the benefits of implementing a vestibular rehabilitation program for the purpose of decreasing fatigue and improving balance in patients with MS. The study was a 14-week, single-blinded, stratified blocked randomized controlled trial. Measurements were conducted in an outpatient clinical setting, and interventions were performed in a human performance laboratory. Thirty-eight patients with MS were randomly assigned to an experimental group, an exercise control group, or a wait-listed control group. The experimental group underwent vestibular rehabilitation, the exercise control group underwent bicycle endurance and stretching exercises, and the wait-listed control group received usual medical care. Primary measures were a measure of fatigue (Modified Fatigue Impact Scale), a measure of balance (posturography), and a measure of walking (Six-Minute Walk Test). Secondary measures were a measure of disability due to dizziness or disequilibrium (Dizziness Handicap Inventory) and a measure of depression (Beck Depression Inventory-II). Following intervention, the experimental group had greater improvements in fatigue, balance, and disability due to dizziness or disequilibrium compared with the exercise control group and the wait-listed control group. These results changed minimally at the 4-week follow-up. Limitations The study was limited by the small sample size. Further investigations are needed to determine the underlying mechanisms associated with the changes in the outcome measures due to the vestibular rehabilitation program. A 6-week vestibular rehabilitation program demonstrated both statistically significant and clinically relevant change in fatigue, impaired balance, and disability due to dizziness or disequilibrium in patients with MS.