11. Effects of Trunk Rehabilitation on Balance, Gait, Fall and Community Mobility in Patients with Multiple Sclerosis: A Randomised Clinical Trial

Multiple Sclerosis (MS) causes difficulties and impacts daily living and social life, which affects quality of life. Balance, gait, and risk of falls are often associated with trunk impairment in MS patients. There is a need for interventions addressing these concerns and exploring the potential effects of trunk rehabilitation. 40 patients were randomly assigned to Trunk Group and Core Group. Trunk Group received trunk exercises in multiplanar movements on unstable surfaces, alongside dual-task training. Core Group received standard core stability exercises. Both groups received conventional treatment with intervention. The primary outcome was the Trunk Impairment Scale (TIS). Secondary outcomes were the Berg Balance Scale (BBS), Timed Up and Go (TUG), Modified Falls Efficacy (FES), Modified Fatigue Impact Scale (MFIS), Hospital Anxiety and Depression Scale (HADS), and Reintegration to Normal Living Index (RNLI). For analysis, we performed a two-way Mixed Model ANOVA. Results of the two-way ANOVA group into time interaction indicated significant improvements for the Trunk group in the Primary outcome TIS compared to the core group (MD=3.33, P≤0,001). In addition, BBS scores significantly increased (MD=5.42, P≤ 0.001). TUG (MD= -10.3, p=0.06). Community mobility measured by RNLI also increased significantly for the trunk group (MD=0.15, P=0.003). Furthermore, the trunk group had a significant reduction in depression and anxiety in HADS scores (MD= -3.7, P=0.008) and Fatigue, measured by MFIS (MD= -9.63, P=0.007). Additionally, showed a higher score in the MFES (MD=27.5, P≤0.001). Trunk training suggested in this study shows promising evidence to enhance trunk control, balance, and gait in PwMS effectively. Reducing their risk of falling and improving their mental well-being, confidence, and community mobility.