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. 2019 Nov 28;2019(11):CD012475. doi: 10.1002/14651858.CD012475.pub2

Coote 2013.

Methods Multi‐centre single‐blinded block randomised controlled trial. Allocation of blocks by sealed envelope with a piece of paper for each group, emitted once selected.
Participants n=111, randomised & analysed groups: 1. Group physiotherapy (GP) = 48; 2. 1‐to‐1 physiotherapy = 35; Yoga = 13,
C = 15
Baseline characteristics of intervention groups not reported. Differences between fallers & non‐fallers were: significantly greater physical and psychological impact of MS and impact of fatigue for fallers
Interventions All interventions were for 1 hour per week for 10 weeks
GP: physiotherapist supervised circuit class of 6 strength & balance exercises with progressions
1‐to‐1 physiotherapy: at discretion of physiotherapist (focus was exercise to improve balance and strength)
Yoga instructor classes, focus on yoga postures, stretching, breathing, meditation and relaxation exercises
Outcomes
  1. The number of falls in the last 3 months, coded as 0 for no falls or 1 for one or more falls.

  2. The proportion of fallers (people who reported 1 or more falls in the last 3 months),


Participants were asked retrospectively about the number of falls in the 3 months before the baseline assessment. They were reassessed at week 12, during which they were asked about the number of falls in the 3 months before that assessment.
  • At impairment level, lower limb sensation was evaluated using a simple verbal numerical rating scale, with 0 indicating no feeling at all and 10 indicating normal sensation. Three areas of the lower limb were tested bilaterally; thus a total of 60 indicated normal sensation.

  • Proprioception was assessed by placing participants’ big toe in an “up” or “down” position and asking participants to identify where their toe was. It was scored as either normal or abnormal.

  • At activities level, balance was assessed using the Berg Balance Scale (BBS), a 14‐item clinical scale that evaluates balance in sitting and standing and rates performance from 0 (cannot perform) to 4 (normal performance).

  • Walking endurance was measured using the 6‐minute walk test (6MWT).

  • At participation level, the Multiple Sclerosis Impact Scale‐29 version 230 (MSIS‐29v2) physical and psychological components were used.

  • The impact of fatigue was measured using the Modified Fatigue Impact Scale (MFIS)

Notes  
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Unclear risk Insufficient information presented in the paper to permit a judgement of low or high risk of bias
Allocation concealment (selection bias) Unclear risk Insufficient information presented in the paper to permit a judgement of low or high risk of bias
Blinding of participants and personnel (performance bias) 
 All outcomes Unclear risk Insufficient information presented in the paper to permit a judgement of low or high risk of bias
Blinding of outcome assessment (detection bias) 
 All outcomes Unclear risk Insufficient information presented in the paper to permit a judgement of low or high risk of bias
Incomplete outcome data (attrition bias) 
 All outcomes Unclear risk Insufficient information presented in the paper to permit a judgement of low or high risk of bias
Selective reporting (reporting bias) High risk Some outcome data not reported, e.g. PCI and HHD
Other bias Unclear risk No sample size calculation reported in the paper. Study may be exposed to a type II error