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Table 4 Results on feasibility aspects and related uncertainties

From: A highly challenging balance training intervention for people with multiple sclerosis: a feasibility trial

Feasibility aspect

Summary of responses

Consideration

Study procedures

 Accuracy of information and communication about intervention and study procedures

All participants reported that information and communication corresponded with their experiences of the intervention and study procedures or that they had been pleasantly surprised about the difficulty and challenge level of the exercises in the intervention.

Feasible

 Inclusion and exclusion assessment

The inclusion assessment with the Expanded Disability Status Scale and the exclusion assessment with the Montreal Cognitive Assessment were considered feasible.

Feasible

 Assessment of demographic and clinical characteristics

Baseline data collection through semi-structured interview was considered feasible.

Feasible

 Acceptability of time required for assessment procedures

Time required for the baseline and follow-up assessments at Karolinska Institutet were considered acceptable.

Feasible

 Blood-sampling procedure

Sampling of blood was feasible.

Feasible

 Attitude towards long-term follow-up assessments

All participants reported that they are likely to participate in long-term follow-up measurements up to 6 months post-intervention.

Feasible

Intervention delivery

 Training session time of day and weekly frequency

Several training sessions available, enabling the participants to choose session time and weekly frequency themselves, contributed to feasibility.

Feasible

 Duration of training session

Training sessions of 60 min were feasible for most participants since the time spent on transport also needed to be considered. A few expressed a wish for longer sessions.

Feasible

 Individual adjustment of exercises related to intervention progression

Initially, more careful guidance on how exercises could be adapted was required but participants gradually became more confident in adjusting the exercises themselves.

Feasible

 Individual adjustment of challenge level across the progression blocks

The progression blocks were considered supportive to stimulate progression and create new challenges. The participants could gradually, through increased awareness and knowledge of their own ability, adjust progression and challenge level themselves. Guidance by the trainers was required to calibrate the exercise complexity and to suggest rest when needed.

Feasible

 Individual adjustment of exercises related to disability level and variation in daily capacity

Initially, some participants reported the exercise challenge level to be somewhat low in relation to their own disability level, but the appropriate challenge level could subsequently be implemented. Individual adjustments related to variation in daily capacity were considered throughout the intervention period, which made exercises easier or more difficult, i.e., the challenge level was altered.

Feasible

 Monitoring of level of challenge

The rating scale for assessment of challenge level in the balance training was reported to be comprehensible and easy-to-use. It was perceived easier to rate specific exercises than to make an overall assessment of the challenge level for an entire balance training session.

Feasible

 Group training despite divergence in level of overall MS disability

Variations in overall MS disability between participants was perceived as a source of inspiration rather than a disadvantage as it contributed to reflection and new perspectives.

Feasible

Individual balance exercises

The individual balance exercises were considered relevant and useful where individual adjustment of challenge level specifically related to individual disabilities could be in focus.

Feasible

 Safety in training

The intervention was perceived to be safe. Falling was considered a part of the risk when participating in a highly challenging balance intervention.

Feasible

 Home exercise program as substitute for group training session

Training at home was considered a possible supplement, but could not replace guided group training sessions; the high intensity and challenge level carried out during training sessions could not be reached at home, and exercise equipment was not available.

Feasible but not requested

 Individual effort required for participation

A majority of the participants stated a need to refrain from other activities (e.g., rearrangement of work and family activities) in order to be able to prioritize the intervention, since their regular schedule was full.

Feasible

 Motivation in training

All participants reported feeling motivated to participate in the intervention. Factors contributing to motivation were the increased awareness and knowledge of their own balance capacity, which was accomplished through feedback given by the trainers and peer participants.

Feasible

 Perceived intervention effect on balance control

Perceived effects of the intervention were increased safety and improved balance control or maintained balance control if an ongoing deterioration in physical status was present. Examples of enhanced confidence were climbing stairs without a handrail or walking on slippery or uneven surfaces.

Feasible

Potential outcome measures

 Assessment of primary and secondary outcomes

Mini-BESTesta

Feasible

10-meter walk testa

2-minute walk testa

APDMb Gait analysis (spatial and temporal gait parameters)

APDMb Sway test

Six Spot Step Testa

Multiple Sclerosis Walking Scalea

Falls Efficacy Scale Internationala

Frenchay Activities Index

Multiple Sclerosis Impact Scale-29a

Modified Fatigue Impact Scalea

Hospital Anxiety and Depression Scale

EuroQol 5D (Index and Visual Analog Scalea)

Life Satisfaction Scale

Acceptance of Chronic Health Condition Scale

Trail Making Testa

Ray Auditory Verbal Learning Testa

Symbol Digit Modalities Testa

Immunological markers in blood

  1. aTrend in outcome response presented in Table 5
  2. bAPDM APDM’s Mobility Lab™ a body-worn sensor technology for assessment of balance and gait