Balance Right in Multiple Sclerosis

BRiMS is an innovative evidence-based, user-focused, self-management intervention designed to improve safe mobility and minimise falls in MS. The thirteen-week therapy-led personalised education and exercise programme is structured to maximise the development of self-efficacy and support participant engagement. 

BRiMS addresses modifiable fall risk factors such as poor balance and mobility and enables self-management by the use of individualised mobility, safety and falls risk management strategies. The BRiMS programme includes a strong focus on home-based activities, supported by an online resource and three group sessions interspersed over the duration of the programme.

The BRiMS programme includes two one to one sessions to enable individualised assessment, goal planning and development of exercise plans. Three interspersed sessions pre-scheduled throughout the programme bring participants together in small groups (five participants per group) for peer support and facilitated learning activities. 

The group size has been chosen so that it is small enough to enable the session to be facilitated safely by a single therapist (hence minimising costs), whilst remaining large enough to allow for the group benefits to be maintained should attendance rates vary (which may sometimes occur). 

A home-based work package overarches the programme, supporting both educational and exercise components and enabling participants to personalise and apply the programme in their daily lives from the outset. Developing and supporting motivation is addressed throughout using new functional imagery techniques to supplement established motivational techniques. 

The BRiMS programme is fully manualised to optimise consistency of content, approach and delivery methods and to enable roll-out across the NHS should it prove to be effective. 

However, the programme is structured to enable the components to be tailored to meet the needs of individual participants within the parameters of the manual.

The BRiMS education component aims to improve exercise self-efficacy and support the development of individualised falls prevention and management practices through the acquisition and application of relevant knowledge and skills. 

 The majority of the falls prevention content is based on the Safe at Home BAASE programme, developed by Finlayson and Peterson (Finlayson et al, 2009). 

The exercise self-efficacy content draws on new work undertaken by one of our team members (Jackie Andrade) on imagery and motivation to support goal setting, action planning and adherence.

The BRiMS exercise component is designed to achieve a minimum of 120 minutes of individualised, progressive, gait, balance and functional training per week. 

The content is guided by a literature review of MS balance exercise interventions (Gunn et al, 2015b), whilst structure and format is informed by comprehensive stakeholder input (Gunn et al, 2015c).

The BRiMS exercise component has been designed to be predominantly home-based, with exercise planning and progression undertaken in partnership between the participant and the programme leader. 

The group sessions include exercise activities to encourage peer support and problem solving. Motivational support is built into both elements. 

Additionally, BRiMS integrates an online exercise prescription resource (Paul et al, 2014) to support and guide participants’ home-based practice (webbasedphysio.com). 

This resource is a novel web-based physiotherapy system which has been developed by two of the BRiMS team (Lorna Paul, Linda Renfrew).