Effectiveness of robotic-assisted walking (lokomat) on quality of life, gait, activity level, and balance in patients with multiple sclerosis

INTERVENTION: All interventions will take place in a rehabilitation setting (three weeks). All interventions during the rehabilitation period (three weeks) are based on scientific evidence, on expert consensus and on patient preferences. Control (?traditional?): Gait‐training in group three times a week, maximum of 30 minutes walking, individual physiotherapy including balance related training, three times per week, MOTOmed, hippotherapy, 'neuro'‐group in water, sitting group/mat group, no treadmill training. Intervention (Lokomat): Automated locomotor training three times a week, maximal of 30 minutes of walking, individual physiotherapy including balance related training, three times per week, MOTOmed, hippotherapy, 'neuro'‐group in water, sitting group/mat group, no treadmill training. Although the rehabilitation is defined 'traditional' rehabilitation it is based on newest evidence and on patient preference. The volume (intensity and frequency) of the interventions are defined by the patients and the medical team. Intensity of training is defined by the patients its self‐evaluation, the patient should work with an intensity of 13 to 17 on the Borg scale (6 to 20) (Borg Dyspnea Scale, which has shown a good mean to monitor and regulate physical exercise). To prevent persistent deterioration of the patient's condition, the level of exertion and well being is evaluated two hours after every training session and intensity will be adapted in the next training sessions if fatigue, exertion and well‐being is reduced. Physiotherapy will be administered and directed in accordance with the ideas, experience and techniques of the personal physiotherapist. This might typically include body awareness training, posture and dynamic control, and non‐impact aerobic exercises, accompanied by a range of passive modalities such as massage, stretching, electrotherapy, etc. No attempt will be made to standardise the therapy given by individual therapists, as the treatment is inten CONDITION: Multiple sclerosis ; Nervous System Diseases ; Demyelinating diseases PRIMARY OUTCOME: 1. Quality of life will be measured at baseline, at discharge (three weeks) and at 3 and 12 months; 2. Activity level will be measured during seven days before the rehabilitation, in the middle week of the rehabilitation, and 3 and 12 months after discharge of rehabilitation; 3. Gait‐parameters (symmetry, gait security, gait speed, gait capacity) will be measured only during rehabilitation setting (at baseline, before and after the third, sixth and ninth gait intervention) SECONDARY OUTCOME: 1. Pain will be measured at baseline, before and after gait interventions (each time), each day in the evening, at three weeks (discharge rehabilitation), 3 and 12 months post rehabilitation; 2. Fatique will be measured at baseline, before and after gait interventions (each time), each day in the evening, at three weeks (discharge rehabilitation), 3 and 12 months post rehabilitation; 3. Spasticity will be measured at baseline and discharge (at the end of three weeks rehabilitation) INCLUSION CRITERIA: 1. Aged 18 or older 2. Diagnosed with multiple sclerosis confirmed by a specialist in neurology by the mean of the McDonald criteria 3. EDSS score equal or higher than 3 and lower or equal than 7.0 4. Able to walk 14 metres (with or without assistive devices) 5. Willingness to comply with any programme to which randomly assigned