Neurodynamic Interventions for Multiple Sclerosis

Study Overview
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Brief Summary
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A randomized, parallel-group, clinical trial will be conducted to compare the immediate effects of the inclusion of a neurodynamic intervention into a multimodal physiotherapy program on pressure pain sensitivity, pain and manual dexterity in patients with multiple sclerosis

Official Title
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Effects of Neurodynamic Interventions to Multimodal Physical Therapy in Patients With Multiple Sclerosis

Conditions
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Multiple Sclerosis

Intervention / Treatment
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* Other: Physical Therapy
* Other: Physical Therapy plus Neurodynamic


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: a diagnosis of multiple sclerosis according to the modified McDonald criteria; symptoms of paresthesia and lack of sensitivity in the upper extremity; Expanded Disability Status Scale (EDSS) between 0 and 6.5 points; absence of cognitive deficit. Exclusion Criteria: any exacerbation of multiple sclerosis during the previous 3 months; previous hand surgery or steroid injections treatment in the upper extremity; multiple diagnoses on the upper extremity (e.g., cervical radiculopathy); cervical, shoulder, or upper extremity trauma; other comorbid musculoskeletal medical conditions; mini-mental state examination <25

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Physical Therapy<br>Patients will receive 5 session of multimodal physiotherapy treatment of 30min duration including low-load strength exercises, soft tissue mobilization and muscle-tendon stretching exercises twice per week. | Other: Physical Therapy<br>* Patients will receive 5 session of multimodal physiotherapy treatment of 30min duration including low-load strength exercises, soft tissue mobilization and muscle-tendon stretching exercises twice per week.<br>|
| Experimental: Physical Therapy plus neurodynamic<br>Patients will receive 5 session of multimodal physiotherapy treatment of 30min duration including low-load strength exercises, soft tissue mobilization and muscle-tendon stretching exercises twice per week. In addition, they will also receive bilateral nerve slider neurodynamic interventions targeting the median, ulnar and radial nerves. | Other: Physical Therapy plus Neurodynamic<br>* Patients will receive 5 session of multimodal physiotherapy treatment of 30min duration including low-load strength exercises, soft tissue mobilization and muscle-tendon stretching exercises twice per week. In addition, they will also receive bilateral nerve slider neurodynamic interventions targeting the median, ulnar and radial nerves.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in pressure pain sensitivity | Pressure pain threshold over the median, ulnar and radial nerves, second metacarpal and tibialis anterior | Baseline and one week after the last treatment session | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in upper extremity pain intensity before and after the intervention | A Numerical Pain Rate Scale (NPRS, 0-10) will be used to record the mean and the worst intensity of pain in te upper extremity | Baseline and one week after the last treatment session | 
| Changes in light touch detection threshold | Light touch detection threshold will be assessed with a standardized set of modified twenty von Frey hairs | Baseline and after treatmentBaseline and one week after the last treatment session | 
| Changes in manual dexterity | Bilateral manual dexterity was bilaterally assessed using the nine-hole peg test | Baseline and one week after the last treatment session | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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neurodynamics, pain