{
  "abstract": "Background Motor and cognitive dysfunctions are common and disabling features in multiple sclerosis (MS) that remain challenging to treat. Here, we aimed to explore the effect of exergames as a stand-alone approach for people with MS and impaired processing speed.Methods This was a three-arm, randomised, rater-blinded, sham-controlled trial. People with MS and impaired processing speed were randomised in a 1:1:1 ratio to an 8-week home-based training with exergames (intervention of interest), adaptive Cognitive Training Kit (COGNI-TRAcK) (working memory training as comparator intervention) or sham intervention. A postintervention assessment was scheduled at week 16 postrandomisation. Statistical analyses were conducted to test the hypotheses that exergames were superior to sham intervention and non-inferior to adaptive COGNI-TRAcK on the symbol digit modalities test (SDMT).Results We screened 165 people with MS, of whom 102 were randomised (34 per arm). At week 8, both exergames and adaptive COGNI-TRAcK yielded improvements in SDMT, with adjusted mean differences versus sham intervention of 4.3 (95% CI 0.1 to 8.5) and 5.7 (95% CI 1.3 to 10.1) points, respectively. The non-inferiority analysis was inconclusive, as the mean between-arm difference (adaptive COGNI-TRAcK versus exergames) was 1.3 points (90% CI –1.7 to 4.3), crossing the predefined non-inferiority margin of 4 SDMT points. Exergames additionally demonstrated benefits on executive function, dynamic balance, fatigue and reduced work absenteeism. None of these benefits was retained at week 16.Conclusion This study provides evidence that home-based exergames are suitable as a standalone approach to improve some specific MS-related cognitive and motor dysfunctions, but there is no evidence about their non-inferiority to working memory training.Trial registration number NCT04169750.",
  "authors": [
    {
      "affiliations": [
        "Department of Neurosciences, San Camillo Forlanini Hospital, Roma, Italy"
      ],
      "name": "Luca Prosperini"
    },
    {
      "affiliations": [
        "neuroBRITE Research Center, Italian Multiple Sclerosis Foundation, Genoa, Italy"
      ],
      "name": "Andrea Tacchino"
    },
    {
      "affiliations": [
        "Department of Neurosciences, San Camillo Forlanini Hospital, Roma, Italy"
      ],
      "name": "Serena Ruggieri"
    },
    {
      "affiliations": [
        "neuroBRITE Research Center, Italian Multiple Sclerosis Foundation, Genoa, Italy",
        "AISM Rehabilitation Center, Genoa, Italy"
      ],
      "name": "Giampaolo Brichetto"
    },
    {
      "affiliations": [
        "neuroBRITE Research Center, Italian Multiple Sclerosis Foundation, Genoa, Italy"
      ],
      "name": "Jessica Podda"
    },
    {
      "affiliations": [
        "IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy"
      ],
      "name": "Denise Anastasi"
    },
    {
      "affiliations": [
        "Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy"
      ],
      "name": "Rebecca Cardini"
    },
    {
      "affiliations": [
        "IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy"
      ],
      "name": "Chiara Corrini"
    },
    {
      "affiliations": [
        "Department of Neurosciences, San Camillo Forlanini Hospital, Roma, Italy"
      ],
      "name": "Maria Esmeralda Quartuccio"
    },
    {
      "affiliations": [
        "Azienda Sanitaria Locale RM/2, Roma, Italy"
      ],
      "name": "Irene Alcamisi"
    },
    {
      "affiliations": [
        "Rehabilitation Unit ML Novarese, Hospital Moncrivello, Moncrivello, Italy"
      ],
      "name": "Rachele Di Giovanni"
    },
    {
      "affiliations": [
        "Department of Neurorehabilitation Sciences, Casa di Cura Igea, Milan, Italy"
      ],
      "name": "Giulia Gamberini"
    },
    {
      "affiliations": [
        "neuroBRITE Research Center, Italian Multiple Sclerosis Foundation, Genoa, Italy"
      ],
      "name": "Erica Grange"
    },
    {
      "affiliations": [
        "Multiple Sclerosis Centre, Clinical Neurology Unit, SS Annunziata University Hospital, Chieti, Italy",
        "Institute for Advanced Biomedical Technologies (ITAB), Dept. of Neurosciences, Imaging and Clinical Sciences, University G. d’Annunzio of Chieti-Pescara, Chieti, Italy",
        "University Centre for Rehabilitation, Disability and Sport Medicine (CARES), Dept. of Neurosciences, Imaging and Clinical Sciences, University G. d’Annunzio of Chieti-Pescara, Chieti, Italy"
      ],
      "name": "Erika Pietrolongo"
    },
    {
      "affiliations": [
        "Multiple Sclerosis Centre, Clinical Neurology Unit, SS Annunziata University Hospital, Chieti, Italy",
        "Institute for Advanced Biomedical Technologies (ITAB), Dept. of Neurosciences, Imaging and Clinical Sciences, University G. d’Annunzio of Chieti-Pescara, Chieti, Italy",
        "University Centre for Rehabilitation, Disability and Sport Medicine (CARES), Dept. of Neurosciences, Imaging and Clinical Sciences, University G. d’Annunzio of Chieti-Pescara, Chieti, Italy"
      ],
      "name": "Marianna Gabriella Rispoli"
    },
    {
      "affiliations": [
        "Multiple Sclerosis Centre, Clinical Neurology Unit, SS Annunziata University Hospital, Chieti, Italy",
        "Institute for Advanced Biomedical Technologies (ITAB), Dept. of Neurosciences, Imaging and Clinical Sciences, University G. d’Annunzio of Chieti-Pescara, Chieti, Italy",
        "University Centre for Rehabilitation, Disability and Sport Medicine (CARES), Dept. of Neurosciences, Imaging and Clinical Sciences, University G. d’Annunzio of Chieti-Pescara, Chieti, Italy"
      ],
      "name": "Valentina Tomassini"
    },
    {
      "affiliations": [
        "IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy",
        "Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy"
      ],
      "name": "Davide Cattaneo"
    },
    {
      "affiliations": [
        "Neurology Unit, Galliera Hospital, Genoa, Italy"
      ],
      "name": "Claudio Solaro"
    }
  ],
  "title": "Home-based EXergames To impRovE cognitive function in MUltiple Sclerosis (EXTREMUS)",
  "uid": "92564ac4-6ab8-504b-9855-086f0ac24633"
}