Past Research

Past Research

The effect of core stability training on balance and mobility in ambulant individuals with multiple sclerosis: a multi-centre series of replicated single case studies

Posted by: Margaret Gear | Senior Neuro-Physiotherapist | NHS Shetland

People with Multiple Sclerosis (MS) frequently experience balance and mobility impairments, including reduced trunk stability. Pilates-based core stability training is aimed at improving control of the body’s stabilising muscles. Despite a lack of evidence regarding its effectiveness, this exercise approach is now popular with both people with MS and therapists. Evidence regarding efficacy is vital in order that people with MS can use limited time, energy and therapy resources to best effect.

A replicated single case series study facilitated by the Therapists in MS Group, recently provided preliminary evidence that core stability training improves balance and mobility in ambulant people with MS:

Freeman JA, Gear M, Pauli A, Cowan P, Finnigan C, Hunter H, Mobberley C, Nock A, Sims R, Thain J. The effect of core stability training on balance and mobility in ambulant individuals with multiple sclerosis: a multi-centre series of replicated single case studies. Multiple Sclerosis 2010; 16: 11; 1377 – 1384.

A lay version of this article was published in Open Door:

Biographical Disruption in Long Term Chronic Illness: urban and remote rural experiences

Posted By: Dr Sue Barnard | |  Previous Research Undertaken in 2005/6

Background.  Multiple sclerosis (MS) is a long term, chronic condition affecting the choices people are able to make about their lives and ambitions. People with MS employ statutory, voluntary and informal services to reduce this biographical disruption through alleviating symptoms and managing disability.

Objectives: To explore the impact of statutory and non statutory health and social support on the experiences and life ambitions of adults with MS living in two different environments.

Design: Qualitative design, purposive and theoretical sampling, thematic analysis. Data collected through semi-structured interviews and documentation.  Data saturation optimised through feedback from open meetings.

Setting: The remote rural community of Orkney and the urban City of Portsmouth.

Subjects: Twenty three adults with multiple sclerosis, diagnosed 2 or more years, living in Orkney (12) or Portsmouth (11).

Results:  Both locations have similar service provision. The experiences, frustrations and fears of people with MS are comparable in both environments.  Living in Orkney had limitations for accessing specialist medical services but people with MS enjoyed more continuity of paid carer services due to the smaller population.  In an inter-dependent community it is easier to identify the most appropriate provider for particular needs.  If carer and service user are not compatible, problems may arise due to limited alternatives.  In Portsmouth, people with MS have the advantage of specialist services on the doorstep but the large population increases waiting times and rapid staff turn over can lead to a loss of continuity of care.  The large population means a bigger choice of services but also a bigger disabled population wanting to access them.  

Conclusions: The major factors contributing to a good life biography are having a role in work, community or family life, a strong sense of identity and an ability to adapt these as the disease progresses.  Having choice enables people to have some control and empowers them to manage their lives.  Good diagnostic, health and social support is essential as are the vital roles played by the voluntary services and informal carers.  Ultimately, regardless of how much funding and support is available, it is the unpredictable nature of the disease, often more than disability alone, that is the main disruptor to the person’s life ambitions and biography.


Partnership or power: exploring the older person/clinician relationship

Posted By: Sue Barnard | | Prrevious Research 2003

In recent years clinicians have been encouraged to break down the traditional health care hierarchies and work in partnership with their patients.  The effect of this was explored in a study of physiotherapy clinicians and older patients, investigating the perceptions and experiences of the relationship that develops between them.  Semi-structured interviews were conducted with fifteen physiotherapy clinicians and eleven older patients receiving medium to long term rehabilitation.  The sampling and data analysis was informed by grounded theory.  Four follow up case studies tested the emergent themes.  Both clinicians and older patients were found to play dual roles in the relationship.  Clinicians adopted both professional and befriender roles to engender trust and compliance.  The older persons were happy to adopt the patient or sick role in response but failed to understand the apparent partnership into which they were expected to engage, assuming a ‘reluctant partner’ role.  The concept of equality in health was unfamiliar to the older patients and undermining the power differential that they expected in the clinical situation appeared to remove the one predictable element in an otherwise alien clinical situation.  This research explored the juxtaposition of role, hierarchy and partnership in the relationship between older patients and clinicians.