The goal of the present study is to evaluate the effects of a dance-based concept entitled MS Ballroom Fitness (developed in Denmark by PT Elisabeth Dalsgaard) in persons with multiple sclerosis (pwMS). A total of 88 pwMS will be enrolled and equally randomized into an intervention group or a control-waitlist group. Those in the intervention group will undertake 7 weeks of MS Ballroom Fitness, with 2 sessions per week. The investigators assume that balance, walking capacity as well as well-being will be improved.
Multiple sclerosis (MS) is a chronic inflammatory and neurodegenerative disease of the central nervous system (CNS) causing demyelination of axons within the CNS as well as loss of axons and neurons. While a wide range of symptoms potentially develops due to the pathology of MS, lower extremity motor function appears preferentially affected. It is therefore not surprising that substantial impairments in balance and walking capacity have been reported in pwMS, based on both subjective (patient perspectives) and objective assessments. This is problematic as balance and walking capacity are rated among the most important bodily functions, and furthermore associated with mental well-being and quality of life. In pwMS, walking balance/coordination can be assessed by the six spot step test (SSST). Dynamic balance/coordination can be assessed by the four sqaure step test (FSST). Balance can also be assessed by the functional reach test (FRT) as well as the 30-second single leg stance test. Other measures of walking capacity can be assessed by a 'simple' short distance walk test (e.g., the timed 25 foot maximal walk test (T25FWT)) and a long distance 'endurance' walk test (e.g., the 6-minute maximal walk test (6MWT)). In addition to these, the 12-item MS Walking Scale (MSWS-12) are commonly used to assess the patient-reported impact of MS on different aspects of walking ability. Different modalities of exercise therapy have been shown effective in counteracting the deterioration of balance and walking capacity observed in pwMS, with improvements reported across all the tests outlined above. Interestingly, dance (including mixed modalities with a predominant dance-based content) appear particularly potent in terms of targeting impairments in balance AND walking capacity. Whilst some pilot/exploratory studies involving pwMS exist, the summarized evidence appear sparse and contain three major limitations. First, the majority of pwMS studies are small exploratory non-controlled studies lacking sample size calculations. Second, none of the identified dance studies provide a personalized approach, i.e., by designing interventions that embrace the needs and physical functional level of each participant. Third, none of the identified dance studies have assessed whether dance-induced adaptations in balance and walking capacity are accompanied by - or even translates into - improvements in mental well-being and quality of life. Physiotherapist Elisabeth Dalsgaard has developed a dance-based concept entitled MS Ballroom FitnessTM (abbreviated MSB-Fit) with a specific focus on joy of life and inclusion. It is specifically adapted to pwMS, having three difficulty levels that correspond to three overall disability categories (sitting, standing, and walking pwMS). The study sample size was calculated based on unpublished SSST pilot data from n=11 pwMS undergoing 7 weeks of MSB-Fit, corresponding to what was offered in the present study. The estimate (α = 0.05; power = 0.90; control mean post intervention 7.16±1.18 s; MSB-Fit mean post intervention 6.27±1.18 s; dropout rate = 15%) suggested that a total of n=88 pwMS should be enrolled in the present study.
A personalized dance-based concept focusing on balance, walking capacity, and well-being.
Aarhus University, Exercise Biology
Aarhus C, Jutland, Denmark
Six spot step test (SSST)
Objective test that measures walking coordination and balance. Unit: seconds.
Time frame: Change from Baseline to 7 weeks
WHO5 wellbeing index
Questionnaire that measures current mental well-being. Unit: score (0-100; 100 is better).
Time frame: Change from Baseline to 7 weeks
Static balance
Objective test that measures static balance (total score based on 2 different tests; 20s right leg foot stand, 20s left leg foot stand). Unit: seconds (0-40s; 40s is better)
Time frame: Change from Baseline to 7 weeks
Functional reach test
Objective test that measures how far a person can reach with one arm in standing position. Unit: cm.
Time frame: Change from Baseline to 7 weeks
Modified functional reach test
Objective test that measures how far a person can reach (forward, left, right) with one arm in sitting position. Unit: cm. NB: This test is used for wheel-chair users only.
Time frame: Change from Baseline to 7 weeks
Four square step test (FSST)
Objective test that measures dynamic stability and co-ordination. Unit: s.
Time frame: Change from Baseline to 7 weeks
6-minute walk test
Objective test that measures walking endurance. Unit: meters.
Time frame: Change from Baseline to 7 weeks
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Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
95
Trunk Impairment Scale 2.0
Rater-evaluated test that measures static and dynamic sitting balance as well as co-ordination of trunk movement. Unit: score (0-23; 23 is better). NB: This test is used for wheel-chair users only.
Time frame: Change from Baseline to 7 weeks
Patient determined disease steps
Questionnaire that measures level of disability in multiple sclerosis. Unit: score (0-8; 0 is better).
Time frame: Change from Baseline to 7 weeks
Multiple Sclerosis Walking Scale
Questionnaire that measures walking limitations in multiple sclerosis. Unit: score (0-100; 0 is better).
Time frame: Change from Baseline to 7 weeks
Health-related quality of life visual analogue scale (HR-QoL VAS)
Questionnaire/scale that measures quality of life. Unit: score (0-100; 0 is better).
Time frame: Change from Baseline to 7 weeks
Modified fatigue impact scale
Questionnaire that measures the impact fatigue has on daily life. Unit: score (0-84; 0 is better)
Time frame: Change from Baseline to 7 weeks
Falls-efficacy scale - international
Questionnaire that measures concerns about falling. Unit: score (16-64; 16 is better)
Time frame: Change from Baseline to 7 weeks
Falls
Number of falls in the past year
Time frame: Change from Baseline to 7 weeks