ADSTEP: Preliminary investigation of a multicomponent walking aid program in people with multiple sclerosis

Publication date: Available online 26 June 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Douglas N. Martini, Eline Zeeboer, Andrea Hildebrand, Brett W. Fling, Cinda L. Hugos, Michelle H. Cameron
ObjectiveTo evaluate the impact of the Assistive Device Selection, Training and Education Program (ADSTEP) on falls and walking and sitting activity in people with multiple sclerosis (PwMS).DesignRandomized controlled trial.SettingVeterans Affairs medical center.ParticipantsForty PwMS using a walking aid at baseline who had fallen in the previous year.InterventionsParticipants were randomly assigned to ADSTEP or control. ADSTEP had six weekly, 40-minute, one-on-one sessions with a physical therapist, starting with walking aid selection and fitting, followed by task-oriented progressive gait training. Control was usual medical care with the option of ADSTEP after the study.Main Outcome MeasuresThe following were assessed at baseline, intervention completion, and three months later: falls, Timed Up and Go, Timed 25-Foot Walk, Two-Minute Walk, Four Square Step Test, International Physical Activity Questionnaire, Quebec User Evaluation of Satisfaction with Assistive Technologies, Multiple Sclerosis Walking Scale-12, Activities-specific Balance Confidence scale, and Multiple Sclerosis Impact Scale-29. Effect on these outcomes was estimated by a two-by-two repeated measures general linear model.ResultsFewer ADSTEP than control participants fell (χ²=3.96, p<0.05. NNT=3.3). Time spent sitting changed significantly differently with ADSTEP than with control from baseline to intervention completion (F=11.16, p=0.002. ADSTEP: reduced 87.00±194.89 minutes/day; control: increased 103.50±142.21 minutes/day; d=0.88) and to three-month follow-up (F=9.25, p=0.004. ADSTEP: reduced 75.79±171.57 minutes/day; control: increased 84.50±149.23 minutes/day; d=0.79). ADSTEP yielded a moderate effect on time spent walking compared to control at three-month follow-up (p>0.05. ADSTEP 117.53±148.40 minutes/day; control 46.43±58.55 minutes/day; d=0.63).ConclusionsADSTEP prevents falls, reduces sitting, and may increase walking in PwMS.



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