Remote Exercise and Physiotherapy Programs Show Benefit for Depressive Symptoms in MS


If in-person interventions are unavailable, remote forms of telerehabilitation may be considered as a solution with very little cost-effectiveness and an easy option for physiotherapists and patients, even if it is for a short period of time.

Georgios Marios Kyriakatis, BSc, a physiotherapist in the department of physiotherapy in the Human Performance & Rehabilitation Laboratory of the School of Health Sciences at the University of Thessaly, in Lamia, Greece

Georgios Marios Kyriakatis, BSc

In a recently published systematic review and meta-analysis in Multiple Sclerosis and Related Disorders, remote forms of exercise programs based on assessment, personal goals and daily life, and motor imagery training demonstrated beneficial effects on depression in patients with multiple sclerosis (MS). These findings suggest that virtual interventions such as telephone communication or other electronic monitoring systems of exercise and physiotherapy can reduce depressive symptoms in patients with MS and may be equivalent in efficacy with in-person programs.1

In the meta-analysis, investigators observed that remote exercise and physiotherapy programs were significantly more effective compared with the control group interventions for the management of depression symptoms among patients with MS (random effects model, Hedges g = –0.41; SE, 0.17; 95% CI, –0.74 to –0.09; P = .01). Then, the subgroup analysis revealed the studies that had chosen no intervention for their control group showed remote programs had a statistically significantly greater effect on reducing depression in patients with MS (random effects model, Hedges g = −0.81; SE, 0.2; 95% CI, −1.18 to −0.43; P <.001) in comparison with those that did have an alternative intervention (random effects model, Hedges’ g = −0.25; SE, 0.16; 95% CI, −0.56 to 0.06; P = .12).

“The systematic review showed that remote exercise and physiotherapy intervention, especially a personalized program based on the patient's needs or the administration of a DVD with exercises and continuous monitoring of the patient by giving advice by phone or monitoring by electronic system helps to improve the symptoms of depression in patients with MS,” lead author Georgios Marios Kyriakatis, BSc, a physiotherapist in the department of physiotherapy in the Human Performance & Rehabilitation Laboratory of the School of Health Sciences at the University of Thessaly, in Lamia, Greece, and colleagues wrote.1 “The meta-analysis found that the Hedges g effect size was 0.41, which is small to moderate, which means that, at the same time as the individual analyses were conducted, the remote interventions chosen by the researchers were better than those of the control groups for each case.”

Clinical Takeaways

  • Remote exercise and therapy programs tailored to the patients' needs and monitored via phone or electronic systems show promise in reducing depression symptoms in multiple sclerosis (MS), offering an alternative to in-person interventions.
  • This recent meta-analysis revealed that remote programs were particularly effective when the control group received no intervention, emphasizing the benefit of remote interventions in managing depression among patients with MS.
  • These findings not only suggest a practical solution for scenarios like the COVID-19 pandemic but also highlight the potential for long-term benefits and patient accessibility, particularly for those unable or uncomfortable with in-person sessions.

Kyriakatis and colleagues conducted a literature search in PubMed, Scopus, PsychInfo, SportDiscus, Web of Science and ResearchGate databases for randomized controlled trials between 2012 and 2022 (n = 176). The keywords featured in the search included telerehabilitation, telecounseling, tele, telephone, physiotherapy, physical therapy, rehabilitation, therapeutic exercise, exercise, depression, depressive disorders, multiple sclerosis, and MS. Additionally, authors noted that some of the inclusion and exclusion criteria were identified for the selection of the final selected studies (n = 6), which were also evaluated with the Physiotherapy Evidence Database scale for quality.2

READ MORE: Aerobic Exercise Provides Benefits for Gait and Fatigue in Multiple Sclerosis

Based on the final analysis, a moderate-intensity exercise program lasting more than 15 minutes or a high-intensity exercise program that includes aerobic, strengthening, balance, and range of motion exercises for at least 45 minutes once to twice a week for 3 months significantly benefited patients in reducing their depressive symptoms. All told, the exercise programs analyzed in the collected studies cannot be compared with other similar studies, however, there is some literature that supports remote therapy in patients with MS that worked very positively in general for their symptoms.3,4

“The clinical significance of the results of this study lies primarily in the fact that if face again with situations like the COVID-19 pandemic, patients will not miss their sessions, but there will be the possibility to carry out remote exercise and physiotherapy programs that will be effective according to our findings, if a proper individualized program has been structured from the beginning,” Kyriakatis et al noted.1 “Secondly, even in the absence of compulsory quarantine and sanitary safety measures against an epidemic or pandemic, the remote form of exercise and physiotherapy can also be used when the patient does not feel comfortable coming to the physiotherapy clinic, have health problems, lives far from urban centers, have a relapse of the disease, due to financial savings or because of the impossibility of being transported by a relative or caregiver.”

The authors of this analysis noted several limitations, including that the studies did not report in detail the program followed by each patient and that the total number of participants is not generalizable to the interested clinical population. It was also noted that many studies did not report whether the patients eventually received the treatment initially allocated to them or whether they changed group and therefore intervention. All the studies selected were conducted for 3 months or more with the possibility of extracting long-term results, although most other studies did not produce any long-term results. In addition, the investigators noted that the results of this analysis cannot be specific to the type or stage of MS or even to the severity of depressive symptoms except for one of them.5

“A remote form of exercise and/or physiotherapy can have a beneficial effect on the depressive symptoms of patients with MS. More specifically, a personalized program with certain exercises or a motor imagery training program, and with the help of telephone communication for monitoring adherence to the program and advice or using electronic systems to monitor the patient's progress, can lead to equivalent results to those of in-person intervention,” Kyriakatis et al noted.1 “However, future research of more forms of remote intervention is necessary to find the appropriate forms of exercise and physiotherapy to improve primarily the daily routine and life of these patients.”

1. Kyriakatis GM, Lykou PM, Dimitriadis Z, Besios T. Efficacy of remote exercise and physiotherapy programs on depressive symptoms in people with multiple sclerosis - A systematic review and meta-analysis. Mult Scler Relat Disord. 2023;79:105067. doi:10.1016/j.msard.2023.105067
2. Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther. 2003;83(8):713-721.
3. Tallner A, Streber R, Hentschke C, et al. Internet-Supported Physical Exercise Training for Persons with Multiple Sclerosis-A Randomised, Controlled Study. Int J Mol Sci. 2016;17(10):1667. Published 2016 Sep 30. doi:10.3390/ijms17101667
4. Di Tella S, Pagliari C, Blasi V, Mendozzi L, Rovaris M, Baglio F. Integrated telerehabilitation approach in multiple sclerosis: A systematic review and meta-analysis. J Telemed Telecare. 2020;26(7-8):385-399. doi:10.1177/1357633X19850381
5. Bombardier CH, Ehde DM, Gibbons LE, et al. Telephone-based physical activity counseling for major depression in people with multiple sclerosis. J Consult Clin Psychol. 2013;81(1):89-99. doi:10.1037/a0031242
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