Standing frame improves movement, balance for multiple sclerosis patients

Patients in the advance stage of multiple sclerosis may experience significant improvements in movement and balance with a specialized standing frame, according to a new study published in The Lancet Neurology.

Researchers from the University of Plymouth in England utilized an Oswestry standing frame, designed to help slow the development of movement and balance issues in patients in the more advanced stages of the condition, by enabling them to regularly stand and carry out strengthening and balance exercises in a supported position, with the help of a friend or family member if needed.

The team looked at 71 MS patients who were randomly allocated to undertake the standing frame program over 20 weeks, alongside their usual care. Another 69 participants were randomly allocated to their usual care for the same time period and did not use the standing frame.

The standing frame intervention consisted of two home-based physiotherapy sessions, 60 minutes each, to set up the standing program, supported by six follow-up telephone calls. Participants were asked to stand for 30 minutes, three times weekly, over 20 weeks, with encouragement to continue for 36 weeks and beyond, although no further physiotherapy support was provided.

Results showed that, on average, people who used the standing frame scored more highly on an assessment of their movement and balance function, as objectively assessed by a physiotherapist, according to the study abstract.

In addition, participants assigned to the standing frame intervention reported experiencing personal improvements in their quality of life, such as their ability to balance and move about, reduced stiffness in their legs, and improved bladder and bowel control.

On average the intervention costs around £800 or $900, so researchers say the use of the standing frame also appeared to be cost-effective according to the criteria set out by The National Institute for Health and Care Excellence (NICE). 

Jenny Freeman, PhD, lead author of the study and professor of physiotherapy and rehabilitation at the University of Plymouth said mobility is a major concern for people with MS, not just in terms of standing and walking, but also, for example, moving about in bed. Nearly 25 percent of people with MS eventually become wheelchair dependent, Freeman said. However, very little research had previously taken place on how to preserve and improve mobility in people with more severe disability, or how effective the standing frame was for this patient group.

“This is one of the first physiotherapy interventions proven to be effective in this group of people and…it's something that could be rolled out almost straight away," Freeman said.

Wendy Hendrie, PhD, MSc, MCSP, physiotherapist and investigator in Norfolk Community Health and Care Trust, said maintaining activity in people with severe disability is vital to avoid the complications associated with a sedentary lifestyle. She said this study shows that people severely disabled by MS are able to improve their motor function and balance with regular frame standing and, importantly, are able to self-manage the intervention over the long-term in their own homes with the help of family or caregivers.

"The fact that the results show significant improvement for people with MS is fantastic,” said Hendrie, “and the personal feedback we've had from study participants shows that this work could be life-changing for people with progressive MS."