Impairment of upper limb function is common in Multiple Sclerosis (MS). Rehabilitation remains a key strategy to manage symptoms and improve quality of life. The Under & Over study assessed the effectiveness of a rehabilitation programme in people with advanced MS. To determine if repeated use of Under & Over can improve upper limb function for people with MS. One hundred and six ( = 106) people with MS participated in this 3-month study. The primary outcome measure was the cardboard 9-hole peg test (c9HPT), with secondary outcomes including the EuroQol-5Dimensions, 5-Level Questionnaire (EQ5D-5 L) questionnaire. There were three arms Arm 1a, the 'Daily Group', engaged with the Under & Over tool daily for 30 min. Arm 1b, the 'Free Use Group', used the same tool without time constraints, with the added feature of a community sharing platform. Arm 2, the 'Delayed Start Group', initially completed the c9HPT for three months before switching to the 'Free Use' programme. 43/106 (41 %) of those randomised completed the primary end point. No significant difference between c9HPT at baseline and 3 months was seen in Arm 1a or 1b. Participants in Arm 2 who had been completing the c9HPT 5 days a week for 3 months showed a training effect in the dominant hand (mean speed at baseline 0.0455 (s), mean at 3 months 0.0341, difference 0.011; 95 % CI 0.0080 to 0.0148, < 0.001). No significant difference was seen in c9HPT time following 3 months of active use of the Under & Over tool. The study faced significant limitations, notably in participant adherence, with fewer than half (43/106 (41 %)) completing the final assessment. This study demonstrates how a small, engaged, and motivated group were able to complete a remote rehabilitation programme. Future remote intervention studies could benefit from incorporating adaptive engagement strategies, such as personalised reminders and participant-tailored activity adjustments, to enhance adherence and capture a broader spectrum of patient experiences.

中文翻译：

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Under & Over：一项随机对照研究，旨在为多发性硬化症患者开发上肢康复工具

上肢功能损伤在多发性硬化症 (MS) 中很常见。康复仍然是控制症状和提高生活质量的关键策略。Under & Over 研究评估了晚期多发性硬化症患者康复计划的有效性。确定重复使用 Under & Over 是否可以改善多发性硬化症患者的上肢功能。一百零六 (= 106) 名多发性硬化症患者参加了这项为期 3 个月的研究。主要结果测量是纸板 9 孔钉测试 (c9HPT)，次要结果包括 EuroQol-5Dimensions、5 级问卷 (EQ5D-5 L) 问卷。三个臂（臂 1a）（“每日组”）每天使用 Under & Over 工具 30 分钟。Arm 1b（“免费使用组”）使用相同的工具，没有时间限制，并增加了社区共享平台的功能。第 2 臂（“延迟启动组”）最初完成了三个月的 c9HPT，然后转向“免费使用”计划。43/106 (41%) 的随机参与者完成了主要终点。第 1a 组或第 1b 组的基线和 3 个月 c9HPT 之间没有显着差异。第 2 组中每周 5 天完成 c9HPT、持续 3 个月的参与者表现出优势手的训练效果（基线平均速度 0.0455 (s)，3 个月平均速度 0.0341，差异 0.011；95% CI 0.0080 至 0.0148 ，< 0.001)。积极使用 Under & Over 工具 3 个月后，c9HPT 时间没有发现显着差异。该研究面临重大限制，特别是在参与者的依从性方面，只有不到一半 (43/106 (41%)) 完成了最终评估。这项研究展示了一个小型、积极参与且积极主动的团体如何能够完成远程康复计划。未来的远程干预研究可以受益于纳入自适应参与策略，例如个性化提醒和参与者定制的活动调整，以提高依从性并捕获更广泛的患者体验。