1. Multiple Sclerosis Functional Electrical Stimulation Service Evaluation Jenny Thain - MS Clinical Specialist Physiotherapist Background People diagnosed with a long-term condition such as Multiple Sclerosis (MS) often accumulate a variety of symptoms which preclude active participation in their usual activities of daily living, including leisure and social pursuits Patients describe a gradual reduction in their socialisation, quality of life and consequent impact on their mood and motivation One of the most common symptoms is a reduction in mobility or walking Functional Electrical Stimulation (FES) FES is an orthotic and therapeutic intervention to improve walking for people who have upper motor neurone conditions FES can only be of benefit in patients with foot drop resulting from disorders of the central nervous system for example MS The documented benefits of FES include a reduction in effort of walking, falls and trips, reduction in pain and it aids functional activity promoting an improved quality of life Regional Innovation Funding (Dec 2013) allowed us to explore how the provision of an FES service locally could be incorporated into current services and to conduct a long-term evaluation a revised model assessment and provision pathway Design ‘Measures pack’ sent to participants with SAE Set 1 = before FES assessment Set 2 = approx 6 weeks after provision of FES Set 3 = approx 6 months later Evaluation Patient reported quality of life (open question) Timed 10m walk 6 Minute walking test (6MWT) MS Impact Scale – 29 (MSIS-29) MS Walking Scale -12 (MSWS -12) Neurological Fatigue Index – MS (NFI – MS) WHO QoL – Bref Falls Efficacy Scale - UK (FESUK) Results 43 assessments completed 41 supplied with FES Results for 10 patients analysed Evaluation is on-going Sample of data presented Statistical analysis not conducted, only simple analysis of means scores in each domain –Green = improvement of indicator –Red = worsening of indicator –Purple = no change overall “Has use of FES made a difference to your quality of life?” Patient 2 - ‘not so tired, more willing to go places’, ‘I am able to do a lot more things for myself as I feel more confident… my wife does not worry about me as much’ Patient 5 – ‘it has helped me enough to be a Nordic walking instructor….. improved my quality of life by being able to feel more included’ Patient 6 – ‘going out less stressful’ Patient 10 – ‘its given me more confidence when I do go out anywhere as I do not stumble or trip as much’, ‘the psychological effect …… is a positive’ Conclusion The adoption of this innovation has benefitted patients who were waiting for FES provision by reducing the time they have to wait for assessment and provision The outcome measures used demonstrated that access to FES has impacted positively on patient’s quality of life, bringing improved mobility and facilitating socialisation Acknowledgments Participants, WCFT RD & I Department, WCFT Purchasing Department, WCFT MS Team, WCFT Odstock Medical Team Discussion Improvement in 10m walking speed between with or without stimulation 6MWT distance improves between set 2 and set 3 Some reduction in the impact of MS on physical activities or psychological well-being Slightly less limitation due to mobility at set 2 but not sustained at set 3. Less impact of fatigue on nocturnal sleep and cognition Slightly higher quality of life in relation to physical activity and psychological well-being Some increase in confidence when completing tasks without falls at set 2 but not sustained Objective Walking Tests DomainSet 1Set 2Set 3 10 m walk NO FES (time in secs) 13.5212.9613.75 10 m walk WITH FES (time in secs) 11.5411.3911.57 6 MWT (distance in metres) 266313 MSIS – 29, MSWS-12 & FESUK DomainSet 1Set 2Set 3 MSIS – 29 Lower score = less impact of MS on activity Physical (20 - 100) 62.260.460.3 Psychological (9 – 45) 20.92219.2 MSWS - 12 (12 – 60) Lower score = less limitation due to mobility 4948.749.5 FESUK (10 – 100) Low score = higher confidence in task 39.738.942.4 Neurological Fatigue Index - MS Domain Low score = less fatigue Set 1Set 2Set 3 Physical (0 – 24)15.1715.3816.31 Cognition (0 – 12)6.416.446.30 Diurnal Sleep (0 – 18)8.999.0310.24 Nocturnal Sleep (0 – 15)7.987.918.23 Summary (0 – 30)18.718.1918.83 WHO QoL – Bref Domain (0 – 100) High score = higher reported QoL Set 1Set 2Set 3 Physical42.14243.3 Psychological59.558.261.9 Social Relationships76.868.776.4 Environment71.373.168.9