Around 110,000 people in the UK have MS

Standing frame intervention improves life for people with MS, research shows

A new study has shown that people in the advanced stage of multiple sclerosis (MS) experience significant improvements in movement and balance thanks to a specialised standing frame.

The study in people with progressive MS, involving the University of Exeter Medical School and led by the University of Plymouth, also showed that the intervention appeared cost-effective, leading researchers to conclude that it could be routinely implemented within MS care throughout the UK. The study was published in The Lancet Neurology.

Around 110,000 people in the UK have MS, a lifelong condition that affects the central nervous system (the brain and spinal cord) and often leads to increasing disability. Often spending their time sitting, people with MS can develop muscle weakness from disuse, pain, constipation, loss of movement at joints and pressure ulcers.

The study, called Standing Up in Multiple Sclerosis (SUMS), was funded by the National Institute for Health Research (NIHR) Research for Patient Benefit Programme, and sponsored by University Hospitals Plymouth NHS Trust.

The Oswestry standing frame is designed to help slow the development of these problems in people in the more advanced stages of the condition, by enabling them to regularly stand and carry out strengthening and balance exercises in a supported position, with the help of a friend or family member if needed.

Dr Annie Hawton, Senior Research Fellow in Health Economics, said: “Our analyses suggest that the standing frame intervention costs approximately £14,700 per quality-adjusted life-year (QALY). This is below the of £20,000–£30,000 per QALY threshold set by the National Institute for Health and Care Excellence (NICE), for interventions to be recommended for funding on the NHS.

“This indicates that providing standing frames to people with progressive MS is likely to be a ‘cost-effective’ treatment strategy”.

Results showed that, on average, people who used the standing frame scored more highly on an assessment of their movement and balance function, as objectively assessed by a physiotherapist.
On average the intervention costs around £800, so the use of the standing frame also appeared to be cost-effective according to the criteria set out by The National Institute for Health and Care Excellence (NICE). This is an important factor when considering new interventions for use in the NHS.

Participants assigned to the standing frame also reported experiencing improvements in quality of life. In particular, they highlighted reduced stiffness in their legs, improvements to balance and mobility, and improved bladder and bowel control.

Lead author of the study, Jenny Freeman, Professor of Physiotherapy and Rehabilitation at the University of Plymouth, said: “Mobility is a major concern for people with MS – not just in terms of standing and walking, but also, for example, moving about in bed. Nearly 25% of people with MS eventually become wheelchair dependent. However, very little research had previously taken place into how to preserve and improve mobility in people with more severe disability, or how effective the standing frame was for this patient group.

“This is one of the first physiotherapy interventions proven to be effective in this group of people and, as it was tested within an NHS context, it’s something that could be rolled out almost straight away.”

To find out more about the study, visit the SUMS website.

Find out more about Exeter's Health Economics Group here.

Case study 1: John Kendrick

John Kendrick from Sparkwell near Plymouth, Devon was assigned the standing frame intervention and, after years of not being able to move a great distance, was able to walk his daughter down the aisle on her wedding day.

He said: “There is absolutely no doubt in my mind that had it not been for the standing frame, I would not have been able to walk my daughter into church to marry her husband. It was a challenge, using a crutch to help me and obviously holding on to her too, but I’m so proud I did it.

“With secondary progressive MS, my mobility has decreased and I’m starting to lose feeling in my right hand. But the standing frame, which I’m continuing to use, has helped to keep me mobile.”

Case study 2: Nick Jarvis

Nick Jarvis from Norwich was also assigned the standing frame intervention, and described how it has changed his life.

“I’d used a standing frame briefly in physiotherapy sessions after being diagnosed with MS in 2011, but fast-forward several years and the option came up to take part in the SUMS study, which saw me have to use the standing frame at home. It was a little painful to begin with because I hadn’t really stood up in a long time, but it gradually became a hugely positive part of my day.

“Whether it was watching telly or playing a game on my phone, I would keep myself occupied while in the frame, and I went from using it for 90 minutes a week to 90 minutes a day. I now get around on foot at home roughly 70% of the time, on crutches or holding onto worktops for support, whereas I never walked at all before using the frame.

“I feel more positive, my core is stronger and my mood is so much higher. It really has been life-changing, so I hope more people like me can benefit from it in future.”

Date: 8 July 2019