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Standing Device Improves Lower Limb Function in People with Progressive MS

July 17, 2019

SUMMARY:
  • A new study reports that use of a standing frame (a wooden frame that supports a person in the standing position) improved lower limb function in people with progressive MS who had severe motor impairment.
  • These results yield important evidence to help justify the use of this rehabilitation device.  Michelle Ploughman, PhD (Memorial University of Newfoundland) comments in an accompanying editorial on the high quality of this study. “The findings support that some of the impairment and functional losses observed in people with progressive multiple sclerosis are indeed reversible,” she writes.
  • The cost of standing frames can vary greatly in the United States, and these may not be covered by insurance companies for MS. People with MS who are interested in this intervention can consult with a physical or occupational therapist for guidance.
  • The team (Professor Jennifer Freeman at the University of Plymouth, UK, and colleagues) reports results in Lancet Neurology (2019;18:736-747). The study, also known as the Standing Up in MS (SUMS) study, was funded by the United Kingdom National Institute of Health Research.
 
DETAILS
Background: As MS disabilities progress, function is lost, depriving people of moving, thinking and feeling their best. There is a confusing array of messages about how quality of life can be improved, but little clear evidence. Because of this, managing symptoms and making decisions about lifestyle, rehabilitation and exercise are often hard.
 
Standing frames are used by people with spinal cord injury and provide support to enable them to stand safely. Research has shown that regular use can minimize complications associated with prolonged immobility, and can increase feelings of well-being. A team led by Professor Jennifer Freeman (University of Plymouth, UK)  interviewed  people with progressive MS, and found that they were enthusiastic about the idea of using standing frames to help them manage MS, but had difficulty gaining access to this type of device because of the lack of data to support its use. The team worked further with people with significant disability to define the outcomes of their planned study and determine its feasibility. The study, also known as the Standing Up in MS (SUMS) study, was funded by the United Kingdom National Institute of Health Research.
 
 
The Study: The team randomly assigned 122 people with progressive MS who experienced severe motor impairment to a program using the standing frame in addition to usual care or to usual care alone for 20 weeks. A wooden standing frame was delivered to the home of those enrolled in the standing frame group. The intervention comprised two sessions at home with a physical therapist to set up the program, after which participants were asked to stand for 30 minutes, three times each week. Physical therapists supported them with six follow-up telephone calls. Participants were provided with instructions on how to incorporate upper limb exercises and these instructions were available online.
 
The primary outcome tested in the study was motor function, as measured by a clinical scale, at week 36. The scale measures key functional activities of the trunk and lower limbs (such as rolling in bed, sit-to-stand, and sitting and standing balance), as well as how the hips and knees move in lying, sitting, and standing positions. Adverse events were collected through a diary. An economic assessment evaluated the cost effectiveness of the standing frame intervention.
 
Results: Use of the standing frame was found to be safe and resulted in a significant increase in lower limb and trunk function compared with usual care at week 36; this means that results were maintained for 16 weeks after the trial ended. Short-term muscle pain occurred more frequently in the standing frame group. The economic analysis indicated that the standing frame would more often be cost effective than usual care.
 
The team report results in an open-access paper in Lancet Neurology (2019;18:736-747)
 
Conclusions: These results provide important evidence to help justify the use of this approach for improving lower limb function in people with severe disability caused by progressive MS. Michelle Ploughman, PhD (Memorial University of Newfoundland, St John’s, Canada), comments in an accompanying editorial on the high quality of this study, and the fact that the successful results were likely due in part to the instructions and guidance provided by experienced physical therapists. “The findings support that some of the impairment and functional losses observed in people with progressive multiple sclerosis are indeed reversible,” she writes. Dr. Ploughman adds that the increase in muscle pain may not be surprising, since participants were long-time users of walking aids and many had increased muscle weakness.
 
The cost of standing frames can vary greatly in the United States, and these may not be covered by insurance companies for MS. People with MS who are interested in this intervention can consult with a physical or occupational therapist for guidance.
 
Read More
Read more on the SUMS web site
Read more about efforts to end progressive MS, from the International Progressive MS Alliance

About Multiple Sclerosis

Multiple sclerosis is an unpredictable, often disabling disease of the central nervous system that disrupts the flow of information within the brain, and between the brain and body. Symptoms range from numbness and tingling to blindness and paralysis. The progress, severity and specific symptoms of MS in any one person cannot yet be predicted, but advances in research and treatment are leading to better understanding and moving us closer to a world free of MS. Most people with MS are diagnosed between the ages of 20 and 50, with at least two to three times more women than men being diagnosed with the disease. MS affects more than 2.3 million people worldwide.

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