Backward vs Forward Walking Training for Multiple Sclerosis

(TRAIN-BW Trial)

Overseen by Nora Fritz, PhD

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: Wayne State University

Disqualifiers: Neurological disorder, Orthopedic injury, others

No Placebo Group

Trial Summary

What is the purpose of this trial?

This trial will test if practicing walking backward can help people with multiple sclerosis (MS) improve their balance and reduce their risk of falling. People with MS often have trouble with mobility and thinking, leading to frequent falls. Current methods like forward walking exercises haven't been very effective. The study will compare backward walking to forward walking to see which is better for improving motor function and preventing falls.

Do I have to stop taking my current medications for this trial?

The trial protocol does not specify whether you need to stop taking your current medications.

What data supports the idea that Backward vs Forward Walking Training for Multiple Sclerosis is an effective treatment?

The available research shows that backward walking training (BWT) can improve balance, walking ability, and overall mobility in people with multiple sclerosis (MS). Although the studies specifically on MS are limited, BWT has been shown to be beneficial for similar conditions like stroke and Parkinson's disease, where it improved balance and walking speed. This suggests that BWT could be a promising treatment for MS as well. ^{1 2 3 4 5}

What safety data exists for backward and forward walking training in multiple sclerosis?

The provided research does not directly address safety data for backward and forward walking training in multiple sclerosis. However, studies on backward walking training in other neurological conditions like stroke and Parkinson's disease suggest it is feasible and can improve balance, gait, and functional mobility. These studies imply that backward walking training is generally safe and beneficial, but specific safety data for multiple sclerosis is not detailed in the abstracts. ^{1 2 4 6 7}

Is Backward Walking Training a promising treatment for people with Multiple Sclerosis?

Yes, Backward Walking Training is a promising treatment for people with Multiple Sclerosis. It can improve balance, walking ability, and overall movement, which are important for daily activities. ^{1 2 3 7 8}

Research Team

Nora Fritz, PhD

Principal Investigator

Wayne State University

Eligibility Criteria

This trial is for individuals with multiple sclerosis who have trouble walking or have fallen at least twice in the past six months. They must be able to walk with or without help most of the time and not be in a current MS relapse. People can't join if they have other neurological disorders, can't follow instructions, or have recent orthopedic injuries.

Inclusion Criteria

I can walk with or without help more than half the time.

I have been diagnosed with multiple sclerosis (MS).

I often have trouble walking or have fallen twice or more in the last 6 months.

Exclusion Criteria

I have had an MS flare-up in the last 30 days.

I have a neurological disorder.

I can follow instructions related to the study.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo backward walking training or forward walking training once a week for 8 weeks, along with a home exercise program

8 weeks

8 visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment, including the number of falls reported in a 6-month period

6 months

Treatment Details

Interventions

• Backward Walking Training (Behavioural Intervention)
• Forward Walking Training (Behavioural Intervention)

Trial Overview The study compares backward walking training (BW) to forward walking training (FW) to see which is better at improving motor function and reducing fall risk in people with multiple sclerosis. It's checking if BW training could be a feasible and acceptable method for these patients.

Participant Groups

Group I: TRAIN-BW Experimental Treatment 1 Intervention

1x/week for 8 weeks + home exercise program

Group II: TRAIN-FW Active Control 1 Intervention

1x/week for 8 weeks + home exercise program

Who Is Running the Clinical Trial?

Wayne State University

Lead Sponsor

Trials

318

Recruited

111,000+

Amanda Bryant-Friedrich

Wayne State University

Chief Executive Officer since 2023

PhD in Pharmaceutical Sciences

Dr. Polsky

Wayne State University

Chief Medical Officer since 2023

MD from Wayne State University

Findings from Research

A backward walking (BW) intervention was found to be feasible and safe for individuals with multiple sclerosis (MS), with a high adherence rate of 99.7% and no safety concerns reported during the study.

Participants in the BW group showed significant improvements in dominant hip flexion strength compared to those in the forward walking (FW) group, suggesting that BW may be an effective method to enhance strength in individuals with MS.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of Backward and Forward Walking on Lower Limb Strength, Balance, and Gait in Multiple Sclerosis: A Randomized Feasibility Trial. DelMastro, HM., Ruiz, JA., Simaitis, LB., et al.[2023]

In a study involving 19 people with multiple sclerosis, backward walking training (BWT) combined with conventional walking training (CWT) led to significant improvements in balance, gait, and functional mobility compared to CWT alone after 8 weeks of training.

The experimental group that received BWT showed enhanced performance in multiple assessments, including the Berg Balance Scale and the Dynamic Gait Index, indicating that BWT can be an effective addition to rehabilitation strategies for individuals with MS.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of backward walking training on balance, gait, and functional mobility in people with multiple sclerosis: A randomized controlled study. Soke, F., Aydin, F., Karakoc, S., et al.[2023]

Body weight supported (BWS) treadmill training results in smaller trunk and pelvis movement amplitudes in persons with multiple sclerosis (PwMS) compared to walking without BWS, indicating a potential limitation in the effectiveness of this training method.

The study suggests that using a BWS level lower than 30% may be more beneficial for treadmill training, as higher levels may restrict natural movement patterns essential for rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Trunk kinematics during walking in persons with multiple sclerosis: the influence of body weight support. Swinnen, E., Baeyens, JP., Pintens, S., et al.[2014]

An additional backward walking (BW) training program, combined with standard inpatient rehabilitation, led to significant improvements in balance and walking ability in eight patients less than two weeks post-stroke, despite their severe impairments.

All participants showed clinically meaningful increases in forward walking speed, indicating that BW training can be an effective intervention for enhancing rehabilitation outcomes in stroke patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinical application of backward walking training to improve walking function, balance, and fall-risk in acute stroke: a case series. DeMark, L., Fox, EJ., Spigel, PM., et al.[2020]

Backward walking (BW) training significantly improves gait velocity and balance in stroke patients compared to conventional treatments, based on a meta-analysis of ten studies.

The improvements in balance (Berg balance score) and walking performance were statistically significant, indicating that BW training can be an effective rehabilitation strategy for stroke patients, although more high-quality research is needed to confirm these findings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of backward walking for people affected by stroke: A systematic review and meta-analysis of randomized controlled trials. Chen, ZH., Ye, XL., Chen, WJ., et al.[2021]

Backward walking training (BWT) significantly improved various motor functions in stroke patients, including walking speed, cadence, balance, and step lengths, based on a meta-analysis of seven studies.

The analysis showed that BWT led to measurable improvements in the 10-meter walk test, cadence (4 steps/minute increase), and balance (4.38 points on the Berg balance scale), indicating its effectiveness as a rehabilitation strategy for stroke recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Backward Walking Training Impacts Positive Effect on Improving Walking Capacity after Stroke: A Meta-Analysis. Wen, H., Wang, M.[2023]

An eight-week study involving 29 participants with Parkinson's disease showed that both forward and backward gait retraining programs improved usual gait speed, with backward walking showing additional benefits in cadence and stride length.

Backward walking training (BWG) was particularly effective, leading to significant improvements in gait parameters, which may help reduce fall risk and enhance mobility in daily activities for individuals with Parkinson's disease.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Backward compared to forward over ground gait retraining have additional benefits for gait in individuals with mild to moderate Parkinson's disease: A randomized controlled trial. Grobbelaar, R., Venter, R., Welman, KE.[2018]

Backward walking (BW) training using body weight supported treadmill training (BWSTT) showed greater improvements in the 5-repetition sit-to-stand test compared to forward walking (FW) training in a 57-year-old male with incomplete spinal cord injury, indicating its potential efficacy for enhancing specific functional movements.

Both BW and FW training resulted in similar improvements in overall gait parameters and aerobic endurance, suggesting that BWSTT can be a beneficial alternative to traditional forward walking training for individuals with spinal cord injuries.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of forward versus backward walking using body weight supported treadmill training in an individual with a spinal cord injury: a single subject design. Moriello, G., Pathare, N., Cirone, C., et al.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

Effect of Backward and Forward Walking on Lower Limb Strength, Balance, and Gait in Multiple Sclerosis: A Randomized Feasibility Trial. [2023]

2. Netherlands pubmed.ncbi.nlm.nih.gov

Effects of backward walking training on balance, gait, and functional mobility in people with multiple sclerosis: A randomized controlled study. [2023]

3. Netherlands pubmed.ncbi.nlm.nih.gov

Trunk kinematics during walking in persons with multiple sclerosis: the influence of body weight support. [2014]

4. England pubmed.ncbi.nlm.nih.gov

Clinical application of backward walking training to improve walking function, balance, and fall-risk in acute stroke: a case series. [2020]

5. United States pubmed.ncbi.nlm.nih.gov

Effectiveness of backward walking for people affected by stroke: A systematic review and meta-analysis of randomized controlled trials. [2021]

6. Switzerland pubmed.ncbi.nlm.nih.gov

Backward Walking Training Impacts Positive Effect on Improving Walking Capacity after Stroke: A Meta-Analysis. [2023]

7. England pubmed.ncbi.nlm.nih.gov

Backward compared to forward over ground gait retraining have additional benefits for gait in individuals with mild to moderate Parkinson's disease: A randomized controlled trial. [2018]

8. England pubmed.ncbi.nlm.nih.gov

Comparison of forward versus backward walking using body weight supported treadmill training in an individual with a spinal cord injury: a single subject design. [2022]