Multiple sclerosis (MS) is one of the world’s most common neurological disorders with a global prevalence estimated at 2.8 million people. Exercise has been shown to significantly benefit people with multiple sclerosis (pwMS). Unfortunately, although, the majority of pwMS are well aware of the significant advantages of exercise to help control the disease symptoms and maintain progression, many do not exercise at all. Moreover, the majority of pwMS who do exercise find it difficult to persevere and stop after a relatively short period.
There are several barriers that can account for the reason why pwMS do not regularly exercise or stop altogether. Significant barriers include lack of access to exercise/training facilities and health professionals in the field of physical rehabilitation and exercise training. Furthermore, transportation services can also be a barrier, particularly for those who live in rural areas, have mobility difficulties or are severely disabled. Telerehabilitation (telerehab) has great potential for providing accessible and cost-effective options for exercise therapy training for pwMS in the home environment. However, only a few previous studies have demonstrated positive results when training with telerehabilitation, and enhancing physical activity in pwMS. Moreover, despite the advantages of this treatment strategy, there are still a number of limitations that prevent utilizing this technology on a large scale.
In the present project, we intend to implement a cutting-edge artificial intelligence (AI) technology for a home-based exercise therapy program for pwMS. Advantages of the adopted telerehabilitation system include its technical simplicity. The system requires only a mobile phone, tablet, or a personal computer, without the need for any additional 3rd party hardware. This feature is extremely important for pwMS who commonly suffer from cognitive deficits. Furthermore, the technology uses an AI algorithm (based on range of motion and speed), thus, enabling real time feedback as well as positive encouragement during practice. The system also includes over 800 exercise drills that can be customized by the therapist according to his/her patients’ goals and needs. This revolutionary telerehabilitation technology (https://www.wix.wizecare.com/) has been implemented in numerous healthcare services, with thousands of users (mainly in the field of orthopaedic rehabilitation), exhibiting encouraging results in conjunction with positive feedback from patients, physical therapists, and stakeholders. Although, this system has never been implemented in the MS population, it could easily be implemented into the clinical practice of pwMS. Therefore, our overall goal is to implement an innovative telerehabilitation exercise training system for pwMS through assessment of its efficacy on mobility. For this primary aim, we propose a pragmatic multicentre randomized controlled trial conducted in established MS centres across the EU community (Israel, Italy, Ireland, and Denmark) comparing exercise delivery via telehealth with facility-based physical therapy. Further innovative aims of the project include: (1) assessing the impact of a telerehabilitation exercise training program on the pwMS’s mood, social participation and quality of life; (2) validating a set of remote mobility clinical tests delivered via the telerehabilitation system with the objective to evaluate balance and functional mobility in pwMS; and (3) examining the cost-effective value of the telerehabilitation exercise intervention program for pwMS. This information does not exist in the treatment of pwMS.
Ultimately, knowledge gained from this research will not only be relevant for pwMS, it is expected to be of great value in understanding the most useful way to deliver and benefit from this home-based exercise therapy in vulnerable populations, including many “healthy” older adults and others with neurological impairments.