تأثیر مداخلة ترکیبی حرکتی و شناختی بر کیفیت زندگی، سرعت راه‌رفتن و ترس از افتادن بیماران مبتلا به مولتیپل اسکلروزیس: یک کارآزمایی بالینی کنترل‌شده

نوع مقاله : مقاله پژوهشی / Released under (CC BY-NC 4.0) license/ Open Access

نویسندگان

1 گروه علوم رفتاری و شناختی و رزشی، دانشکده علوم ورزشی و تندرستی، دانشگاه تهران، تهران، ایران

2 گروه رفتار حرکتی و روانشناسی ورزشی، دانشکده علوم ورزشی، دانشگاه اراک، اراک، ایران

3 3. گروه داخلی مغز و اعصاب، دانشکده پزشکی، دانشگاه علوم پزشکی اراک، اراک، ایران

چکیده

مولتیپل اسکلروزیس، نوعی بیماری خود‌ایمنی در سیستم اعصاب مرکزی، می‌تواند باعث افت در کیفیّت زندگی، سرعت راه رفتن و ترس از کارآمدی افتادن شود. در این پژوهش تأثیر یک مداخلة ترکیبی بر کیفیت زندگی، سرعت راه رفتن و ترس از افتادن بیماران مبتلا به مولتیپل اسکلروزیس بررسی‌گردید.
پژوهش از نوع نیمه‌تجربی با طرح پیش‌آزمون و پس‌آزمون بود. جامعه آماری مبتلایان به مولتیپل اسکلروزیس شهر اراک بودند که از بین آنها 30 نفر مبتلا به MS عضو انجمن MS با دامنه سنی 60-20 سال، به‌صورت در دسترس انتخاب و به‌‌طور تصادفی به دو گروه 15 نفره تجربی و کنترل اختصاص یافتند. در پیش‌آزمون، شرکت‌کنندگان پرسش‌نامۀ کیفیّت زندگی بیماران مولتیپل اسکلروزیس و مقیاس کوتاه "کارآمــدی افتــادن"بیماران مولتیپل اسکلروزیس را تکمیل و آزمون 25 فوت راه رفتن را اجرا کردند. پس از اِعمال 6 هفته برنامۀ مداخله تمرینی ترکیبی حرکتی - شناختی، پس‌آزمون انجام شد. داده‌ها با استفاده آزﻣون تحلیل واریانس مرکب با نرم‌افزار SPSS-16 تحلیل شد. میانگین نمرۀ پس‌آزمون سرعت راه‌رفتن گروه تجربی (p≤0.001) و نمره کل مقیاس کیفیت زندگی (p≤0.001) متعاقب مداخله ترکیبی به طور معنی‌داری بهبود یافت. (p≤0/05). اما در میانگین نمره پس‌آزمون مقیاس ترس از افتادن، در دو گروه آزمایش و کنترل تفاوت معنی‌داری مشاهده نشد (p≤0.05).
به دلیل تأثیر این برنامۀ مداخله ترکیبی حرکتی-شناختی بر افزایش کیفیت زندگی و سرعت راه رفتن آزمودنی‌ها، بپیشنهاد می‌شود این برنامه به عنوان مکمل درمان بیماران MS استفاده شود. عدم تأثیر این برنامه مداخله ترکیبی بر کاهش ترس از افتادن ممکن است با ماهیت این سازه و مدت مداخله مرتبط باشد.

کلیدواژه‌ها

موضوعات


عنوان مقاله [English]

The effect of a combined motor-cognitive program intervention of quality of life, walking speed, and fear of falling in multiple sclerosis (MS) patients: A controlled clinical trial

نویسندگان [English]

  • Daryoush Khajavi 1
  • Hadis TahmasebiArashloopour 2
  • Fardin Faraji 3
1 Behavioral and Cognitive Sciences in Sport,, Sport and Health Sciences Faculty, University of Tehran, Tehran, Iran.
2 1. Department of Motor Behavior and Sport Psychology, Faculty of Sport Science, University of Arak, Arak, Iran
3 3. Department of Neurology, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran
چکیده [English]

Multiple Sclerosis (MS) as a central nervous system’s self-immune disease can decrease quality of life and walking speed. In this research, the effect of a combined intervention program on MS patients’ quality of life, walking speed, and fear of falling was examined.
The research subjects in were 30 patients with MS members of Arak’s MS Association, age range between 20-60 years, with a disability score of 2-4, randomly allocated to experiment or control groups. Subjects completed the MS Quality of Life Questionnaire and Falls Efficacy Scale-International, Fall Efficacy-International Questionnaire, and performed a 25-foot walking test at pre-test. After the intervention program, post-test performed. Data were was analyzed by paired t-test, independent t-test, and SPSS-21 software.
The mMean score of quality of life total score (p≤0.001) and 25-foot walking speed test after the combined intervention improved significantly at post-test ( (p≤0.001) (p≤0/05). No significant differences were observed between the experimental and control groups’ mean score of fear of falling at on the post-test (p≤0/05).
Because of the effects of the combined motor-cognitive intervention program on MS patients’ quality of life and fear of falling, the program is recommended as a complement part of if treatment of MS patients. The Llack of effect of the combined intervention program on fear of falling reduction may be related to the construct nature (subjectivity), and the nature and time of the program.
Keywords. Combined Intervention, Quality of Life, Fear of Falling, Multiple Sclerosis.

کلیدواژه‌ها [English]

  • Keywords. Combined intervention
  • quality of life
  • walking
  • fear of falling
  • multiple sclerosis
Abasiyanik, Z., Ertekin, O., Kahraman, T., Yigit, P., & Ozakbas, S. (2020). The effects of Clinical
Pilates training on walking, balance, fall risk, respiratory, and cognitive functions in persons
with multiple sclerosis: A randomized controlled trial. Explore (NY), 16(1), 12-20.
https://doi.org/10.1016/j.explore.2019.07.010
Abou, L., Peters, J., Freire, B., & Sosnoff, J. J. (2024). Fear of falling and common symptoms of multiple
sclerosis: Physical function, cognition, fatigue, depression, and sleep - A systematic review.
Mult Scler Relat Disord, 84, 105506. https://doi.org/10.1016/j.msard.2024.105506
Akkan, H., Kallem Seyyar, G., Aslan, B., & Karabulut, E. (2022). The effect of virtual reality-based
therapy on fear of falling in multiple sclerosis: A systematic review and meta-analysis. Mult
Scler Relat Disord, 63, 103791. https://doi.org/10.1016/j.msard.2022.103791
Asgari, M., Hashemi-Nasab, B., Faraji, F. (2012). The Effect of Cognitive-Behavior Stress Management
Treatment on Quality of Life and Depression in Female Multiple Sclerosis Patients. 2(5):140-
146 (in Persian). Journal of Clinical Psychology Studies., 2(5), 140-146.
Ayatollahi, P., Nafissi, S., Eshraghian, M., Tarazi, A. . (2005). Cross-Cultural Adaptation Of The Multiple
Sclerosis Impact Scale (MSIS-29) For Iranian MS Patients, Evaluation Of Reliability And Validity. .
Tehran Univ Med J., 64(1), 62-68. URL: http://tumj.tums.ac.ir/article-1-1006-fa.html (in Persian).
Barnett, A., Smith, B., Lord, S. R., Williams, M., & Baumand, A. (2003). Community-based group
exercise improves balance and reduces falls in at-risk older people: a randomised controlled
trial. Age Ageing, 32(4), 407-414. https://doi.org/10.1093/ageing/32.4.407
Benedict, R. H., Wahlig, E., Bakshi, R., Fishman, I., Munschauer, F., Zivadinov, R., & Weinstock-
Guttman, B. (2005). Predicting quality of life in multiple sclerosis: accounting for physical
disability, fatigue, cognition, mood disorder, personality, and behavior change. J Neurol Sci,
231(1-2), 29-34. https://doi.org/10.1016/j.jns.2004.12.009
Bisht, B., Darling, W. G., White, E. C., White, K. A., Shivapour, E. T., Zimmerman, M. B., & Wahls,
T. L. (2017). Effects of a multimodal intervention on gait and balance of subjects with
progressive multiple sclerosis: a prospective longitudinal pilot study. Degener Neurol
Neuromuscul Dis, 7, 79-93. https://doi.org/10.2147/DNND.S128872
Bryant CX, D. J. (2005). Green Exercise for Older Adults-ACE's Guide for Fitness Professionals. (Vol.
1). American council on exercises.
Carling, A., Forsberg, A., & Nilsagard, Y. (2018). Falls in people with multiple sclerosis: experiences
of 115 fall situations. Clin Rehabil, 32(4), 526-535. https://doi.org/10.1177/0269215517730597
Chen, K. M., Chen, M. H., Chao, H. C., Hung, H. M., Lin, H. S., & Li, C. H. (2009). Sleep quality,
depression state, and health status of older adults after silver yoga exercises: cluster randomized
trial. Int J Nurs Stud, 46(2), 154-163. https://doi.org/10.1016/j.ijnurstu.2008.09.005
David, D., Cristea, I., & Hofmann, S. G. (2018). Why Cognitive Behavioral Therapy Is the Current Gold
Standard of Psychotherapy. Front Psychiatry, 9, 4. https://doi.org/10.3389/fpsyt.2018.00004
DiBrezzo, R., Shadden, B. B., Raybon, B. H., & Powers, M. (2005). Exercise intervention designed to
improve strength and dynamic balance among community-dwelling older adults. J Aging Phys
Act, 13(2), 198-209. https://doi.org/10.1123/japa.13.2.198
Fakolade, A., Z. Awadia, K. Cardwell, et al. . (2023). Physical Activity Together for People with
Multiple Sclerosis (PAT-MS): A Randomized Controlled Feasibility Trial of a Dyadic
Behaviour Change Intervention. . Contemporary Clinical Trials Communications, 36(11).
https://doi.org/https://doi.org/10.1016/j.conctc.2023.101222.
Flores, V. A., Šilić, P., DuBose, N. G., Zheng, P., Jeng, B., & Motl, R. W. (2023). Effects of aerobic,
resistance, and combined exercise training on health-related quality of life in multiple sclerosis:
Systematic review and meta-analysis. Multiple Sclerosis and Related Disorders, 75, 104746.
https://doi.org/https://doi.org/10.1016/j.msard.2023.104746
Goldenberg, M. M. (2012). Multiple sclerosis review. P T, 37(3), 175-184.
https://www.ncbi.nlm.nih.gov/pubmed/22605909
Hajilou, M., Ahadi, H., Seirafi, M., Shahbeigi, S., Rafiepoor, A. (2019). The effectiveness of stress
management training based on cognitive-behavioral model on quality of life in patients with
MS. . Journal of Psychological Science., 17(72), 893-897. URL:
http://psychologicalscience.ir/article-1-38-fa.html (in Persian).
Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012). The Efficacy of Cognitive
Behavioral Therapy: A Review of Meta-analyses. Cognitive Therapy and Research, 36(5), 427-
440. https://doi.org/10.1007/s10608-012-9476-1
Justine, M., & Hamid, T. A. (2010). A multicomponent exercise program for institutionalized older
adults. J Gerontol Nurs, 36(10), 32-41. https://doi.org/10.3928/00989134-20100330-09
Kaczkurkin, A. N., & Foa, E. B. (2015). Cognitive-behavioral therapy for anxiety disorders: an update
on the empirical evidence. Dialogues in Clinical Neuroscience, 17(3), 337-346.
https://doi.org/10.31887/DCNS.2015.17.3/akaczkurkin
Kallb, R., Giesser, B., Costello, K. . (2012). Multiple sclerosis For Dummies (M. Ravanbakhsh, Trans.;
Vol. 1). Avand Danesh.
Kalron, A., Rosenblum, U., Frid, L., & Achiron, A. (2017). Pilates exercise training vs. physical therapy
for improving walking and balance in people with multiple sclerosis: a randomized controlled
trial. Clin Rehabil, 31(3), 319-328. https://doi.org/10.1177/0269215516637202
Kashani, V., GolMohamadi, B., AttarzadehFadaki, S. (2016). Psychometric Properties of Persian
Shortened Version of the Falls Efficacy Scale-International in People with Multiple Sclerosis. .
Motor Behavior, 8(25), 2583-2102. https://doi.org/https://doi.org/10.22089/mbj.2016.804
Khajavi, D., Farokhi, A., JaberiMoghadam, A. A., & Kazemnejad, A. (2014). The Impact of a Training
Intervention Program on Fall-related Psychological Factors Among Male Older Adults in Arak.
Salmand: Iranian Journal of Ageing. 9 (1) :32-39. Salmand: Iranian Journal of Ageing, 9(1),
32-39. http://salmandj.uswr.ac.ir/article-1-498-fa.html (in Persian).
Khanmohammadi, R., Sheikh, M., Bagherzadeh, F., Hoomanian, D., Khajav, D. (2022). The
Effectiveness of Cognitive Rehabilitation Program on Balance and Gait in Man Schizophrenic
Patients with Depressive Disorder. . Motor Behavior, 14(47), 65-90. https://doi.org/Doi:
10.22089/MBJ.2020.8547.1861 (in Persian).
Li, F., Harmer, P., Fisher, K. J., McAuley, E., Chaumeton, N., Eckstrom, E., & Wilson, N. L. (2005).
Tai Chi and fall reductions in older adults: a randomized controlled trial. J Gerontol A Biol Sci
Med Sci, 60(2), 187-194. https://doi.org/10.1093/gerona/60.2.187
Lucien, A., Francis, H., Wu, W., Woldhuis, T., & Gandy, M. (2024). The efficacy of cognitive
behavioural therapy for depression and anxiety in multiple sclerosis: A systematic review and
meta-analysis. Multiple Sclerosis and Related Disorders, 91, 105858.
https://doi.org/https://doi.org/10.1016/j.msard.2024.105858
Motl, R. W., Cohen, J. A., Benedict, R., Phillips, G., LaRocca, N., Hudson, L. D., Rudick, R., & Multiple
Sclerosis Outcome Assessments, C. (2017). Validity of the timed 25-foot walk as an ambulatory
performance outcome measure for multiple sclerosis. Mult Scler, 23(5), 704-710.
https://doi.org/10.1177/1352458517690823
Nationalmssociety.org. (2018). U.S.A.: Muitiple sclerosis, Available from:
http://www.nationalmssociety.org. .
Nilsagard, Y., Gunn, H., Freeman, J., Hoang, P., Lord, S., Mazumder, R., & Cameron, M. (2015). Falls
in people with MS--an individual data meta-analysis from studies from Australia, Sweden,
United Kingdom and the United States. Mult Scler, 21(1), 92-100.
https://doi.org/10.1177/1352458514538884
Oh, E., Hong, G.-R. S., Lee, S., & Han, S. (2017). Fear of falling and its predictors among community-
living older adults in Korea. Aging & mental health, 21(4), 369-378.
Peebles, A. T., Bruetsch, A. P., Lynch, S. G., & Huisinga, J. M. (2017). Dynamic balance in persons
with multiple sclerosis who have a falls history is altered compared to non-fallers and to healthy
controls. J Biomech, 63, 158-163. https://doi.org/10.1016/j.jbiomech.2017.08.023
Reinsch, S., MacRae, P., Lachenbruch, P. A., & Tobis, J. S. (1992). Attempts to prevent falls and injury:
a prospective community study. Gerontologist, 32(4), 450-456.
https://doi.org/10.1093/geront/32.4.450
Saebi, S., Khajavi, D., Faraji, F. (2017). The Effect of Balance Training with Educational and
Motivational Self-Talk on Balance in the Women with Multiple Sclerosis. 48-58. J Arak Uni
Med Sci, 19(10), 48-58. URL: http://jams.arakmu.ac.ir/article-1-4574-fa.html (in Persian).
Scholz, M., Haase, R., Trentzsch, K., Weidemann, M. L., & Ziemssen, T. (2021). Fear of falling and
falls in people with multiple sclerosis: A literature review. Mult Scler Relat Disord, 47, 102609.
https://doi.org/10.1016/j.msard.2020.102609
Sedaghati, P., Hosseini, A. H., & Zarei, H. (2021). Effect of Exercise Programs on Fear of Falling in
Multiple Sclerosis: A Systematic Review and Meta-analysis of Randomized Clinical Trials.
Caspian Journal of Neurological Sciences, 7(4), 227-235.
https://doi.org/10.32598/CJNS.7.27.7
Shams, A., Taheri, H., Nikkhah, K. (2015). The effect of 8 weeks selective training programs with instructions
focus of attention on walking speed of patients with multiple sclerosis. . Medical Journal of Mashhad
University of Medical Sciences., 57(9), 969-975. https://doi.org/ 10.22038/mjms.2015.3915
Shiri, H., Soltaniyan, M. A., Asghari, N. (2017). The Effect of 7 Weeks of Core Stability and Balance Training on
Motor Function and Cognitive Failures in Women with Multiple Sclerosis. Motor Behavior. . Motor
Behavior, 9(27), 17-34. https://doi.org/Doi:10.22089/mbj.2017.1479.11577 (in Persian).
Snook, E. M., & Motl, R. W. (2009). Effect of exercise training on walking mobility in multiple
sclerosis: a meta-analysis. Neurorehabil Neural Repair, 23(2), 108-116.
https://doi.org/10.1177/1545968308320641
Sosnoff, J. J., Socie, M. J., Boes, M. K., Sandroff, B. M., Pula, J. H., Suh, Y., Weikert, M., Balantrapu,
S., Morrison, S., & Motl, R. W. (2011). Mobility, balance and falls in persons with multiple
sclerosis. PLoS One, 6(11), e28021. https://doi.org/10.1371/journal.pone.0028021
Taggart, H. M. (2002). Effects of Tai Chi exercise on balance, functional mobility, and fear of falling
among older women. Appl Nurs Res, 15(4), 235-242. https://doi.org/10.1053/apnr.2002.35975
Van Emmerik, R. E., Remelius, J. G., Johnson, M. B., Chung, L. H., & Kent-Braun, J. A. (2010).
Postural control in women with multiple sclerosis: effects of task, vision and symptomatic
fatigue. Gait Posture, 32(4), 608-614. https://doi.org/10.1016/j.gaitpost.2010.09.002
Wallhagen, M. I., Strawbridge, W. J., Shema, S. J., Kurata, J., & Kaplan, G. A. (2001). Comparative
impact of hearing and vision impairment on subsequent functioning. Journal of the American
Geriatrics Society, 49(8), 1086-1092.
Walton, C., King, R., Rechtman, L., Kaye, W., Leray, E., Marrie, R. A., Robertson, N., La Rocca, N.,
Uitdehaag, B., van der Mei, I., Wallin, M., Helme, A., Angood Napier, C., Rijke, N., & Baneke,
P. (2020). Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS,
third edition. Mult Scler, 26(14), 1816-1821. https://doi.org/10.1177/1352458520970841
Zwibel, H. L., & Smrtka, J. (2011). Improving quality of life in multiple sclerosis: an unmet need. Am
J Manag Care, 17 Suppl 5 Improving, S139-145.
https://www.ncbi.nlm.nih.gov/pubmed/21761952