Arch Phys Med Rehabil. 2026 Aug 15:S0003-9993(26)00882-8. doi: 10.1016/j.apmr.2026.08.007. Online ahead of print.
ABSTRACT
OBJECTIVE: To compare the effectiveness of a 12-week complementary and alternative medicine (CAM) program for people with multiple sclerosis (pwMS) delivered by a therapist in a clinic (DirectCAM) versus self-initiated at home (TeleCAM).
DESIGN: Pragmatic cluster-randomized controlled trial.
SETTING: Forty-three clinics across Alabama, Mississippi, and Tennessee.
PARTICIPANTS: A total of 759 adults with MS were enrolled (DirectCAM, n=382; TeleCAM, n=377). Eligible participants were aged 18-70 years, self-reported a diagnosis of MS, had a Patient-Determined Disease Steps (PDDS) score between 0 and 7, were able to use their arms or legs for exercise, and had physician clearance.
INTERVENTIONS: Participants received the same 12-week CAM exercise program delivered either onsite by a therapist (DirectCAM) or at home using preloaded exercise videos (TeleCAM).
MAIN OUTCOME MEASURE(S): Patient-reported outcomes included the Modified Fatigue Impact Scale (MFIS), the 36-Item Short Form Health Survey (SF-36) Pain domain, the SF-36 physical and mental component scores, and Godin Leisure-Time Exercise Questionnaire (GLTEQ). Performance-based outcomes included the Berg Balance Scale (BBS), the Five Times Sit-to-Stand Test (FTSST), the Timed Up and Go (TUG) test, the Timed 25-Foot Walk (T25-FW), the six-minute walk test (6MWT), and grip strength. Outcomes were assessed at baseline and 3, 6, and 12 months.
RESULTS: Of the 759 participants across 43 clinics, 382 were assigned to DirectCAM and 377 to TeleCAM. No statistically significant between-group differences were observed for patient-reported outcomes at 3, 6, or 12 months. For performance-based outcomes, improvement in BBS from baseline to 12 months was greater in DirectCAM than TeleCAM (2.1 [95% CI, 1.4-2.9], adjusted P<.001). No statistically significant between-group differences were observed for changes in 6MWT, FTSST, or T25-FW.
CONCLUSIONS: DirectCAM and TeleCAM produced comparable improvements in patient-reported outcomes. DirectCAM was superior only for BBS. Therefore, the hypothesis that TeleCAM would be superior to DirectCAM was not supported.
PMID:42603596 | DOI:10.1016/j.apmr.2026.08.007
