Effect of vestibular rehabilitation therapy on fatigue in patients with multiple sclerosis: a randomized controlled trial

OBJECTIVES: To investigate the effect of additional Vestibular Rehabilitation Therap (VRT) program on Multiple Sclerosi (MS) related fatigue METHODS: DESIGN: Single blinded, parallel randomized controlled trial. SETTINGS: The Out-Patient Clinic at Faculty of Physical Therapy, Kasr Al-Ainy Multiple Sclerosis Unit (KAMSU) and Clinical Neurophysiology Unit, Cairo University, Egypt. PARTICIPANTS: 40 patients with remitting-relapsing MS (RRMS). INTERVENTION: Patients were randomized into control and intervention groups; 20 patients each. Over four successive weeks, all patients received stationary bicycle endurance training. The intervention group received an additional VRT program. OUTCOMES: The primary outcome measures included; fatigue perception (fatigue severity scale (FSS), functional walking capacity (the timed 25-feet walk (T25-FW) test), and cognitive performance (the Paced Auditory Serial Addition Test) during three (PASAT#3) and two (PASAT#2) seconds. The secondary outcome was the cortical activity measurement using quantitative electroencephalogram (QEEG). RESULTS: 55 patients were recruited. 40 patients were randomized and only 36 completed the study. An intention to treat analysis was applied. After treatment, the intervention group showed a remarkable improvement in cognitive performance (PASAT#3) and cortical activity (QEEG) over different sites (P < 0.05). Other outcomes showed insignificant differences between groups (P > 0.05). CONCLUSIONS: Adding VRT to stationary bicycle endurance training has a positive effect on cognitive fatigue in RRMS. Besides, VRT enhances cortical reorganization at the areas concerned with sensorimotor integration, attention as well as memory.