Blood Flow Restriction for Upper Limb Rehabilitation in People With Multiple Sclerosis. A Randomized Controlled Trial (BFRT-EM)

Summary

Although the Blood Flow Restriction Training (BFRT) system has attracted the attention of health professionals, research on this tool in people with neurological pathology, particularly multiple sclerosis (MS), is very limited. Furthermore, to our knowledge, studies on the effect of the BFRT system on forearm-hand muscle strength and fatigability, coordination and dexterity, functionality and quality of life in people with MS are nonexistent.

The main objective of our study are:

-To know the effects of low intensity training in combination with the BFRT system on upper limb strength and forearm and hand fatigability, dexterity, functionality and quality of life in people with MS.

Secondary Objectives

* To know if a low-intensity muscle strengthening program in combination with the BFRT system is superior to a conventional strengthening program.
* To know the adherence and satisfaction with the experimental intervention.

The investigators propose to conduct a randomized controlled trial (RCT) with examiner blinding with pre-intervention, post-intervention and follow-up assessment, following the recommendations of the CONSORT guidelines, designed to study the effects of the application of a low-intensity muscle strengthening program in combination with the BFRT system. This intervention will be carried out at the Leganés Multiple Sclerosis Association (ALEM). Patients will be randomly assigned through the GraphPad Software® QuickCalcs application to 2 study groups. A control group, which will receive a low intensity strengthening program in combination with the BFRT system; and an experimental group, which will receive a high intensity strengthening program.

Voluntary participation will be requested from patients diagnosed with MS in the Leganés Multiple Sclerosis Association (ALEM) who meet the inclusion criteria. Acceptance of the study and signature of the informed consent form will be required prior to the start of the program.

As this is the first study to evaluate the effectiveness and feasibility of a low-intensity muscle strengthening protocol in combination with BFRT on forearm and hand muscle strength and fatigability, coordination, dexterity, functionality and quality of life in people with MS, the sample size will be determined based on the most similar scientific literature possible. Hill et al developed an investigation comparing the adaptations of MS patients to two types of intervention: high intensity or conventional strengthening program versus low intensity in combination with BFRT. Since this is the only investigation to date that includes MMSS exercises in their intervention, we consider that the sample size proposed by Hill et al is the most appropriate for our investigation. The sample size obtained in that investigation was 19 subjects, so for the sample size of the present investigation a total of 19 subjects is proposed. However, estimating a 10% possible percentage of losses, we estimate a total of 21 total participants to be recruited.

Patients will be randomly assigned via the GraphPad Software® QuickCalcs application to 2 study groups. A control group, which will receive a low-intensity strengthening program in combination with the BFRT system; and an experimental group, which will receive a high-intensity strengthening program.

Conditions

• Multiple Sclerosis

Interventions

OTHER

Muscle strengthening (BFRT)

The experimental group will perform a low-intensity strengthening program (20% 1RM) in combination with the BFRT system consisting of the following exercises: palmar flexion and dorsal flexion; ulnar deviation and radial deviation; pronation and supination; elbow flexion and extension, performing 4 sets of 30/15/15/15 repetitions as usual in this type of interventions. Once the first exercise has been completed, a rest of 3 - 4 minutes should be taken depending on the fatigue perceived by the patient. Subsequently, the other two exercises will be performed following the scheme already outlined. Taking into account the scientific evidence concerning the safety and adverse effects linked to the BFRT system, it is determined that the pressure applied in the experimental protocol will be 60% of the TRP of each subject, following the recommendations that locate the effective pressure between 50 - 80% of the TRP of each subject.

OTHER

Conventional physical therapy

The control group will perform a conventional muscle strengthening protocol consisting of the following exercises: palmar flexion and dorsal flexion; ulnar deviation and radial deviation; pronation and supination; elbow flexion and extension, with a dumbbell at 70% of 1RM, performing a total of 4 sets of 8 - 12 repetitions each, avoiding muscle failure in each set.

Sponsors & Collaborators

• Universidad Rey Juan Carlos

  lead OTHER

Principal Investigators

• Roberto Cano de la Cuerda, PT, PhD · Universidad Rey Juan Carlos

Study Design

Allocation

RANDOMIZED

Purpose

OTHER

Masking

DOUBLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2025-03-01

Primary Completion

2026-12-31

Completion

2026-12-31

Countries

• Spain

Study Locations