Effectiveness of In-Clinic Rehabilitation Versus Home-Based Telerehabilitation for Adults With MS in the Deep South: the TEAMS Cluster Randomized Trial

OBJECTIVE: To compare the effectiveness of a 12‐week complementary and alternative medicine (CAM) program for people with multiple sclerosis (MS) delivered by a therapist in a clinic (DirectCAM) vs self‐initiated at home (TeleCAM). DESIGN: Pragmatic cluster‐randomized controlled trial. SETTING: Forty‐three clinics across Alabama, Mississippi, and Tennessee. PARTICIPANTS: A total of N=759 adults with MS were enrolled (DirectCAM, n=382; TeleCAM, n=377). Eligible participants were aged 18‐70 years, had a self‐reported diagnosis of MS, had a Patient‐Determined Disease Steps score between 0 and 7, could use their arms or legs for exercise, and had physician clearance. INTERVENTIONS: Participants received the same 12‐week CAM exercise program delivered either on‐site by a therapist (DirectCAM) or at home using preloaded exercise videos (TeleCAM). MAIN OUTCOME MEASURES: Patient‐reported outcomes included the Modified Fatigue Impact Scale, the 36‐Item Short‐Form Health Survey (SF‐36) Pain domain, SF‐36 Physical and Mental Component scores, and the Godin Leisure‐Time Exercise Questionnaire. Performance‐based outcomes included the Berg Balance Scale (BBS), the Five Times Sit‐to‐Stand Test (FTSST), the Timed Up and Go test, the Timed 25‐Foot Walk (T25‐FW), the 6‐minute walk test (6MWT), and grip strength. Outcomes were assessed at baseline and at 3, 6, and 12 months. RESULTS: Of the 759 participants across 43 clinics, 382 were assigned to DirectCAM and 377 to TeleCAM. No statistically significant between‐group differences were observed in patient‐reported outcomes at 3, 6, or 12 months. For performance‐based outcomes, improvement on the BBS from baseline to 12 months was greater in DirectCAM than in TeleCAM (2.1; 95% confidence interval, 1.4‐2.9; adjusted P<.001). No statistically significant between‐group differences were observed in changes in 6MWT, FTSST, or T25‐FW. CONCLUSIONS: DirectCAM and TeleCAM produced comparable improvements in patient‐reported outcomes. DirectCAM was superior only on the BBS. Therefore, the hypothesis that TeleCAM would be superior to DirectCAM was not supported.