The Patient-Centered Outcomes Research Institute (PCORI) Board of Governors has approved a $5.8 million grant to the University of Alabama at Birmingham School of Health Professions' James Rimmer, PhD to fund a study to determine whether people with multiple sclerosis get as much benefit from an exercise-based rehabilitation program delivered via internet and telephone as they do when the therapy is provided in a clinic.
Rimmer, who is director of the UAB / Lakeshore Research Collaborative, where the study is headquartered, is a pioneer in exercise and disability research, and was recently awarded more than $10 million for research in this area by the National Institutes of Health.
"Dr. Rimmer's projects should provide important evidence for the potential to use technology to deliver rehabilitation approaches to people in remote areas," said Bruce Bebo, PhD, executive vice president, Research, National Multiple Sclerosis Society.
Mohna Thirumalai, PhD
"Our telehealth framework is enabled to work under complete absence of internet connectivity, so this project moves the field of telerehabilitation beyond its current limitations," said Mohan Thirumalai, PhD, director of Information and Communication Technologies, UAB / Lakeshore Research Collaborative. "The internet is not necessary because of preloading content, enabling offline data (usage pattern) collection and pairing with interactive voice response technology. This enables us to recruit participants all across Alabama and Mississippi, irrespective of their internet availability."
Emily Sherrill Riser, MD
For this project, the research team will work with Emily Sherrill Riser, MD, adjunct faculty member in the UAB Department of Physical Therapy. Riser, who is also on the faculty in the UAB Department of Neurology, is one of the pre-eminent neurologists in Alabama, and the medical director of the Tanner Center for MS in Birmingham.
Riser knows that clinics able to provide rehabilitation services are scarce in rural and low-income areas, which is why the trial will be conducted with MS patients in communities across Alabama and Mississippi.
"We are reaching out to people in rural areas with limited or no access to health care or technology because they face more barriers to quality care," Riser said. "We are going to test whether the traditional model of rehabilitation or the in-home telerehabilitation model is better, and if telehealth works the way we believe it will, then we are creating something that is going to be a game-changer for their lives."
Robert Motl, PhD, professor in the Department of Physical Therapy, joined the UAB team last summer from the University of Illinois at Urbana-Champaign and will play a lead role on the project.
"This study will provide the strongest evidence to date on the effectiveness of exercise-based rehabilitation for restoring function and improving symptoms in people with MS," Motl said.
Dori Pekmezi, PhD, associate professor in the Department of Health Behavior, recommended the use of interactive voice response systems to support the intervention.
"Stakeholders emphasized that MS symptoms, such as fatigue, low endurance and pain, make it challenging for participants to adhere to the treatment protocol, and that strategies will be required to help keep them engaged," Pekmezi said. "Based on this feedback, regular motivational contacts and accountability will be provided through an interactive voice response system."
The researchers plan to recruit 820 people to be part of the project. In addition, the research involves 65 clinicians from 30 clinical sites across the two states.
Rimmer believes the time has come to meet the needs of an under-resourced community of people living with MS in Alabama and Mississippi. "If we can demonstrate that we can have an impact in two greatly underserved states, it will serve as a benchmark for the nation," he said.