Purpose: To demonstrate proof-of-concept for a combined
physical therapy and pharmacological intervention and obtain preliminary estimates of the therapeutic efficacy of a motor-relearning
physical therapy intervention with and without concurrent
dalfampridine treatment on gait speed in people with
mobility limitations due to
multiple sclerosis (MS). Methods: Using a non-randomized, two-group design, 4 individuals with MS newly prescribed
dalfampridine as part of their routine medical care, and 4 individuals with MS not taking
dalfampridine completed a 3-week
drug run-in or no-treatment baseline, respectively. After 3 weeks, all participants commenced
physical therapy twice weekly for 6 weeks. Participants taking
dalfampridine took the medication for the study duration. The
physical therapy program comprised functional strengthening, gait training, balance training, and dual-task training. The primary outcome was Timed 25-foot Walk (T25FW) at the end of the 6-week
physical therapy program. Results: For the 4 participants taking
dalfampridine, average improvement in T25FW on
drug only was 12.8% (95% CI 1.2 to 24.4%). During the 6-week
physical therapy phase, both groups significantly improved T25FW, but the effect tended to favor the group taking
dalfampridine (mean difference = -0.93 s, 95% CI -1.9 to 0.07 s, p = 0.064, d = 1.6). Whereas the
physical therapy group had average T25FW improvement of 10.8% (95% CI 1.0 to 20.5%), the
physical therapy plus
dalfampridine group demonstrated average improvement of 20.7% (95% CI 3.8 to 37.6%). Conclusions: Further research is warranted to examine whether
dalfampridine for mobility impairment may be augmented by
physical therapy in people with MS.