Balance Right in Multiple Sclerosis (BRiMS): a guided self-management programme to reduce falls and improve quality of life, balance and mobility in people with multiple sclerosis

Gunn H, Andrade J, Paul L, Miller L, Creanor S, Stevens K, Green C, Ewings P, Barton A, Berrow M, Vickery J, Marshall B, Zajicek J, Freeman J
Record ID 32016001020
Authors' objectives: The ability to walk safely, free of falls and fear of falling, is highly valued by people with multiple sclerosis (pwMS) since it impacts directly on their quality of life, productivity and independence. This is challenging for those in the secondary progressive phase, since most people experience significant difficulties with balance and mobility, with approximately 70% falling regularly (26 falls/per person/year). It is therefore unsurprising that interventions aimed at enhancing safe mobility are consistently rated by pwMS as their highest priority. The economic cost of impaired mobility and falls is significant. More than 10% of falls lead to injuries, which impacts on emergency hospital admissions and health and social care services. People lose confidence in their own abilities if they are fearful of falling and many further restrict their daily activities to minimise falls which may cause social isolation and a downward spiral of increasing immobility and accumulation of disability. Effective rehabilitation interventions which aim to address these issues are crucial since medical interventions are limited in their ability to slow down this deterioration. Currently however there is no evidence-based guidance to inform falls management in people with secondary progressive MS, since there are few relevant studies. Over the past five years we have undertaken a series of inter-related research studies which have focused on systematically developing a new evidence-based intervention which is designed to improve safe mobility and reduce falls for pwMS. This programme is called Balance Right in MS (BRiMS). Throughout, we have worked very closely with pwMS and health professionals working in this area, so that the programme has relevance to their needs, is practical to implement, and sustainable in terms of NHS service delivery. We have also worked closely with researchers from around the world to ensure the programme is based on the latest available evidence and scientific thinking in this area. Of importance, this is a self management programme, designed to be incorporated into people s daily lives. It is now critical to assess the delivery of this programme and how to evaluate it. We do not yet know enough to design and undertake a large scale clinical trial and so are conducting first a smaller feasibility study. This will be undertaken in two regions (Devon/Cornwall and Ayrshire) and involve 60 people with secondary progressive MS who have mobility and balance difficulties and who are falling. Participants will be randomly allocated to either the BRiMS programme plus usual care, or usual care alone. Those allocated to the BRiMS intervention will attend a 13 week-therapy led education and exercise programme, comprising three group sessions, two individual sessions and a home based package which will be delivered via an existing interactive web resource. We will measure a wide range of outcomes including quality of life, number of falls, balance, mobility and people's fear of falling, so that we can gain a better understanding of how these outcomes may change. We will also gain an understanding of how many people are suitable for this programme, and their experiences of participating in this study. This is necessary to allow us to proceed more confidently in the future with a larger multi-centre randomised controlled trial which will provide definitive evidence of the effectiveness and cost effectiveness of this programme.
Project Status: Completed
Year Published: 2019
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: England
MeSH Terms
  • Gait
  • Exercise Therapy
  • Accidental Falls
  • Multiple Sclerosis
  • Postural Balance
  • Quality of Life
  • Self Care
Organisation Name: NIHR Health Technology Assessment programme
Contact Address: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK
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