title: The influence of warm versus cold climate on the effect of physiotherapy in multiple sclerosis.
abstract: OBJECTIVE
  To compare the effect of inpatient physiotherapy in a warm versus cold climate in short- and long-term perspectives.
  
  
  METHODS
  Sixty multiple sclerosis (MS) patients with gait problems, without heat intolerance, were included in a randomized cross-over study of 4-week inpatient physiotherapy in warm (Spain) and cold (Norway) climate. The primary outcome, 6-min walk test (6MWT), and secondary physical performance and self-reported measures were scored at screening, baseline, after treatment and at 3 and 6 months of follow-up. Treatment effects were analysed by mixed models.
  
  
  RESULTS
  After treatment, the mean walking distance had increased by 70 m in Spain and 49 m in Norway (P = 0.060). Improvement in favour of warm climate was demonstrated at 6 months of follow-up, 43 m (Spain) compared to 20 m (Norway) (P = 0.048). The patients reported less exertion after walking (6MWT) in favour of treatment in Spain at all time points (P < 0.05). No significant differences in change were detected for the other physical performance measures. Most self-reported measures showed more improvement after treatment in Spain, but these improvements were not sustained at follow-up.
  
  
  CONCLUSIONS
  The results indicate that MS patients without heat intolerance have additional benefits from physiotherapy in a warm climate.
authors.affiliation: Department of Neurology, The Norwegian Multiple Sclerosis Competence Centre, Haukeland University Hospital, Bergen, Norway. tori.smedal@helse-bergen.no
authors.forename: T
authors.initials: T
authors.lastname: Smedal
authors.forename: K-M
authors.initials: KM
authors.lastname: Myhr
authors.forename: J H
authors.initials: JH
authors.lastname: Aarseth
authors.forename: B
authors.initials: B
authors.lastname: Gjelsvik
authors.forename: A G
authors.initials: AG
authors.lastname: Beiske
authors.forename: S B
authors.initials: SB
authors.lastname: Glad
authors.forename: L I
authors.initials: LI
authors.lastname: Strand
mesh_terms: D000293:Adolescent; D000328:Adult; D002980:Climate; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000628:therapy*; D009664:Norway; D026741:Physical Therapy Modalities; D011788:Quality of Life; D013030:Spain; D013696:Temperature; D016896:Treatment Outcome; D016138:Walking