title: Effectiveness of technology-based distance physical rehabilitation interventions on physical activity and walking in multiple sclerosis: a systematic review and meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  To determine the effectiveness of technology-based distance physical rehabilitation interventions in multiple sclerosis (MS) on physical activity and walking.
  
  
  METHODS
  A systematic literature search was conducted in seven databases from January 2000 to September 2016. Randomized controlled trials of technology-based distance physical rehabilitation interventions on physical activity and walking outcome measures were included.
  
  
  METHODS
  Methodological quality of the studies was determined and a meta-analysis was performed. In addition, a subanalysis of technologies and an additional analysis comparing to no treatment were conducted.
  
  
  RESULTS
  The meta-analysis consisted of 11 studies. The methodological quality was good (8/13). The Internet, telephone, exergaming, and pedometers were the technologies enabling distance physical rehabilitation. Technology-based distance physical rehabilitation had a large effect on physical activity (standard mean difference (SMD) 0.59; 95% confidence interval (95% CI) 0.38 to 0.79; p < 0.00001) compared to control group with usual care, minimal treatment, and no treatment. A large effect was also observed on physical activity (SMD 0.59; 95% CI 0.34 to 0.83; p < 0.00001) when compared to no treatment alone. There were no differences in walking and the subanalysis of technologies.
  
  
  CONCLUSIONS
  Technology-based distance physical rehabilitation increased physical activity among persons with MS, but further research on walking in MS is needed. Implications for Rehabilitation Technology-based distance physical rehabilitation interventions increase physical activity among persons with MS. This study was unable to identify if the technologies (Internet, telephone, or combinations) lead to differing effects on physical activity or walking in the distance physical rehabilitation interventions in MS. Further research on the effectiveness of technology-based distance physical rehabilitation interventions on walking in MS is needed.
authors.affiliation: a Faculty of Sport and Health Science , University of Jyvaskyla , Jyvaskyla , Finland.|b Center for Contextual Psychiatry , KU Leuven , Leuven , Belgium.
authors.forename: Aki
authors.initials: A
authors.lastname: Rintala
authors.affiliation: a Faculty of Sport and Health Science , University of Jyvaskyla , Jyvaskyla , Finland.
authors.forename: Sanna
authors.initials: S
authors.lastname: Hakala
authors.affiliation: c School of Health and Social Studies , JAMK University of Applied Sciences , Jyvaskyla , Finland.
authors.forename: Jaana
authors.initials: J
authors.lastname: Paltamaa
authors.affiliation: a Faculty of Sport and Health Science , University of Jyvaskyla , Jyvaskyla , Finland.
authors.forename: Ari
authors.initials: A
authors.lastname: Heinonen
authors.affiliation: d Department of Mathematics and Statistics , University of Jyvaskyla , Jyvaskyla , Finland.
authors.forename: Juha
authors.initials: J
authors.lastname: Karvanen
authors.affiliation: a Faculty of Sport and Health Science , University of Jyvaskyla , Jyvaskyla , Finland.
authors.forename: Tuulikki
authors.initials: T
authors.lastname: Sjögren
mesh_terms: D015444:Exercise / Q000502:physiology*; D006801:Humans; D009103:Multiple Sclerosis / Q000503:physiopathology / Q000534:rehabilitation*; D016032:Randomized Controlled Trials as Topic; D000069350:Telerehabilitation; D016138:Walking / Q000502:physiology*
keywords: Systematic review; distance physical rehabilitation; multiple sclerosis; physical activity; rehabilitation technology; walking