Optimizing Rehabilitation in People with Multiple Sclerosis

General aim: to determine the long-term effects of optimal conditions in square stepping exercises on physical and motor functions (static and dynamic balance and walking speed) and psychological factors (including depressive symptoms), motor and cognitive fatigue, and quality of life in MS patients.

Patients will be randomly divided into intervention (optimal) and control groups by simple randomization method and using Excel software. The research will be single-blind.

Participants will be randomly divided into optimal rehabilitation (N = 17) or control rehabilitation (N = 17). For both groups, the square stepping rehabilitation program will be implemented three times a week for eight weeks at Isfahan MS Comprehensive Center. Each session will consist of a five-minute warm-up followed by a 30-minute rehabilitation program.

clinical diagnosis of MS, years of age 30-50, Expanded Disability Status Scale (EDSS): 2.0–4.0, ability to walk without aid (e.g., cane),

Optimized and control groups

Static and dynamic balance, walking speed, depression symptoms, fatigue and quality of life

A simple randomization method. For this purpose, the participants were listed alphabetically and each participant was assigned numbers one and two from this list. The unit of randomization was individual, and randomization was produced and applied using Excel software and the combination of two commands, SORTBY and ARRAYRAND. By applying this method, each participant will be randomly replaced in the control or optimal group, and the role of all related/unrelated variables in the selection of participants in the two groups will be randomly neutralized.

The participants of both groups of this study will be told in general that they are going to participate in a course of personalized stepping exercises for MS patients. Permission to use this trial was obtained from the ethics committee. It should be noted that the type of exercises of both groups will be exactly the same and the only difference between the groups is the feedback they receive while performing the movement exercises. All items measured in the pre-test and post-test, the instructions given/not given to perform the tests and movement exercises will be exactly the same for all participants. The participants of both groups will be unaware of the exact purpose of doing the exercises that are included in the specific research hypotheses. However, all participants (MS patients) will be blinded in the study. At the time of allocating the participants to the control and optimal groups, according to the method used for randomization, both the participants and the researcher will be unaware of the allocation of the participants in the study groups and has no role in the allocation. However, due to the nature of the trials that will be applied over 8 weeks, there will be differences in the feedback provided to the groups. To avoid the bias of the evaluators/trainers, one person is used for this purpose for both groups. Therefore, during the experiments, the main researcher (evaluator/trainer) will necessarily know which group each participant belongs to. For this reason, the one-sided blind study option was chosen and it cannot be considered completely double-blind.