title: A personalized, intense physical rehabilitation program improves walking in people with multiple sclerosis presenting with different levels of disability: a retrospective cohort.
abstract: BACKGROUND
  People with multiple sclerosis (PwMS) endure walking limitations. To address this restriction, various physical rehabilitation programs have been implemented with no consensus regarding their efficacy. Our objective was to report on the efficacy of an integrated tailored physical rehabilitation program on walking in people with multiple sclerosis categorized according to their level of neurological disability.
  
  
  METHODS
  Retrospective data were examined and analyzed. Specifically, data obtained from all patients who participated in the Multiple Sclerosis Center's 3 week rehabilitation program were extracted for in depth exploration. The personalized rehabilitation program included three major components modified according to the patient's specific impairments and functional needs: (a) goal directed physical therapy (b) moderately intense aerobic exercise training on a bicycle ergometer and (c) aquatic therapy chiefly oriented to body structures appropriate to movement. Gait outcome measurements included the 10 meter, 20 meter, Timed up and go and 2 minute walking tests measured pre and post the rehabilitation program. Three hundred and twelve people with relapsing-remitting multiple sclerosis were included in the final analysis. Patients were categorized into mild (n = 87), moderate (n = 104) and severely (n = 121) disabled groups.
  
  
  RESULTS
  All clinical walking outcome measurements demonstrated statistically significant improvements, however, only an increase in the 2 minute walking test was above the minimal clinical difference value. The moderate and severe groups considerably improved compared to the mild gait disability group. Mean change scores (%) of the pre-post intervention period of the 2 minute walking test were 19.0 (S.E. = 3.4) in the moderate group, 16.2 (S.E. = 5.4) in the severe group and 10.9 (S.E. = 2.3) in the mild gait disability group.
  
  
  CONCLUSIONS
  We presented comprehensive evidence verifying the effects of an intense goal-directed physical rehabilitation program on ambulation in people with multiple sclerosis presenting with different neurological impairment levels.
authors.affiliation: Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel. Alkalron@gmail.com.|Department of Physical Therapy, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. Alkalron@gmail.com.
authors.forename: Alon
authors.initials: A
authors.lastname: Kalron
authors.affiliation: Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel. Dalia.Nitzani@sheba.health.gov.il.
authors.forename: Dalia
authors.initials: D
authors.lastname: Nitzani
authors.affiliation: Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel. David.Magalashvilli@sheba.health.gov.il.
authors.forename: David
authors.initials: D
authors.lastname: Magalashvili
authors.affiliation: Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel. Mark.Dolev@sheba.health.gov.il.
authors.forename: Mark
authors.initials: M
authors.lastname: Dolev
authors.affiliation: Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel. Shay.Menascu@sheba.health.gov.il.
authors.forename: Shay
authors.initials: S
authors.lastname: Menascu
authors.affiliation: Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel. Yael.Stern@sheba.health.gov.il.
authors.forename: Yael
authors.initials: Y
authors.lastname: Stern
authors.affiliation: Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel. Uri.Rosenblum@sheba.health.gov.il.
authors.forename: Uri
authors.initials: U
authors.lastname: Rosenblum
authors.affiliation: Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel. Diana.Pasitselsky@sheba.health.gov.il.
authors.forename: Diana
authors.initials: D
authors.lastname: Pasitselsky
authors.affiliation: Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel. Lior.Frid@sheba.health.gov.il.
authors.forename: Lior
authors.initials: L
authors.lastname: Frid
authors.affiliation: Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel. Gabi.Zeilig@sheba.health.gov.il.
authors.forename: Gabi
authors.initials: G
authors.lastname: Zeilig
authors.affiliation: Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel. Caroline.Barmatz@sheba.health.gov.il.
authors.forename: Caroline
authors.initials: C
authors.lastname: Barmatz
authors.affiliation: Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel. Uri.Givon@sheba.health.gov.il.
authors.forename: Uri
authors.initials: U
authors.lastname: Givon
authors.affiliation: Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel. Anat.Achiron@sheba.health.gov.il.
authors.forename: Anat
authors.initials: A
authors.lastname: Achiron
mesh_terms: D000328:Adult; D015331:Cohort Studies; D006233:Persons with Disabilities / Q000534:rehabilitation*; D005080:Exercise Test; D005260:Female; D005684:Gait / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000503:physiopathology / Q000534:rehabilitation*; D012189:Retrospective Studies; D016138:Walking / Q000502:physiology*