Efficacy of Balance and Eye-Movement Exercises for Persons With Multiple Sclerosis (BEEMS)

Abstract

Objective: To determine whether a multifaceted vestibular-related rehabilitation program (Balance and Eye-Movement Exercises for Persons with Multiple Sclerosis; BEEMS) improves balance in persons with MS and whether there are differences in outcomes based on brainstem/cerebellar lesion involvement.

Methods: A 2-arm, examiner-blinded, stratified (involvement vs no involvement of brainstem/cerebellar structures), randomized controlled trial was implemented. Eighty-eight participants were allocated to BEEMS or no treatment control. Computerized Dynamic Posturography-Sensory Organization Test (CDP-SOT) measured balance control. The Dizziness Handicap Inventory (DHI), Modified Fatigue Impact Scale (MFIS), and Short Form-36 Health Status Questionnaire (SF-36) were also administered. Linear mixed models were used to investigate the primary and secondary aims.

Results: From baseline to 6 weeks, BEEMS participants experienced greater improvements compared to control participants in CDP-SOT composite (model-estimated difference in change 4.9, 95% confidence interval 1.39-8.38, p = 0.006), DHI total (-13.5, -17.7 to -7.25, p < 0.0001), MFIS total (-11.4, -15.7 to -7.0, p < 0.0001), SF-36 Mental (5.6, 2.43-8.71, p = 0.0006), and SF-36 Physical (3.5, 1.12-5.81, p = 0.004) scores and from baseline to 14 weeks in CDP-SOT composite (8.3, 4.73-11.9, p < 0.0001), DHI total (-13.9, -19.3 to -8.62, p < 0.0001), MFIS total (-12.3, -16.7 to -7.79, p < 0.0001), SF-36 Mental (3.9, 0.70-7.16, p = 0.02), and SF-36 Physical (3.2, 0.79-5.62, p = 0.01) scores. From baseline to 6 weeks, BEEMS participants with brainstem/cerebellar lesion involvement experienced greater improvements compared to those without in CDP-SOT composite (5.26, 0.34-10.2, p = 0.04) and MFIS total (-7.6, -14.0 to -1.33, p = 0.02) scores.

Conclusion: BEEMS improved multiple outcomes regardless of whether brainstem/cerebellar lesions were present, supporting the generalizability of BEEMS for ambulatory people with MS who have at least minimally impaired balance and fatigue.

Clinical trialsgov identifier: NCT01698086.

Classification of evidence: This study provides Class I evidence that BEEMS training improves dynamic posturography-based balance, dizziness, fatigue, and quality of life in persons with MS.