Barriers and solutions to participation in exercise for moderately disabled people with multiple sclerosis not currently exercising: a consensus development study using nominal group technique

A Characterization of Physical Activity in People Living With Advanced Multiple Sclerosis

Little is known about physical activity (PA) participation in people with advanced multiple sclerosis (MS). The purpose of this study was to (a) characterize self-reported PA levels and (b) explore how PA levels might differ based on sociodemographic (e.g., gender) and clinical (e.g., MS clinical course) characteristics in people with advanced MS. We used a cross-sectional online survey design with 101 participants. PA was measured using the Physical Activity Scale for Individuals With Physical Disabilities. The mean score on the scale was 4.5 (SD = 5.9) metabolic equivalent hours per day. There was a significant difference in scores based on employment, population density, living situation, disability, and assistive-device type (all p < .05). PA levels were higher in those who were employed, lived alone, required bilateral support for mobility, and were manual wheelchair users (all p < .05). This study highlights low PA levels in people with advanced MS and potential variables that might impact PA in this MS subgroup.

Factors influencing adherence to Physical Exercise in patients with multiple sclerosis: a systematic review focusing on Exercise over General Physical Activity

BACKGROUND

While the barriers and facilitators of physical activity adherence are well-defined, there is a limited number of studies focusing specifically on exercise adherence, which is crucial to identify in patients with multiple sclerosis (MS) due to its known disease-modifying effect.

OBJECTIVE

To investigate the factors affecting adherence to physical exercise in MS patients.

METHODS

Literature search was conducted in PubMed, Cochrane, Web of Science, and Scopus electronic databases up to the current date. Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS) for quantitative studies and the McMaster Critical Appraisal Tool for qualitative studies, with evidence synthesis conducted using the Modified Bakker Scale.

RESULTS

The systematic review incorporated thirteen studies, consisting of seven qualitative and six quantitative ones. These studies' methodological quality was high; 12 were high, and the other was medium (unclear). In all reviewed studies, the primary patient-related and environmental barriers with high levels of evidence regarding exercise adherence included fatigue (38%), false beliefs (18%), cost (18%), and lack of time (15%). Barriers identified in very few studies included cognitive problems (3%), bladder-bowel problems (3%), and family support and advice (3%), indicating a necessity for further research to reveal their impact on exercise adherence.

CONCLUSION

The scarcity of studies on exercise barriers in MS is partly due to the absence of reliable assessment methods for evaluating exercise adherence, along with the prevalent emphasis on physical activity. Future research should prioritize the development of adherence scales tailored to physical exercise and shifting focus towards less explored barriers.

"How can we help you?": results of a scoping review on the perceived needs of people living with chronic pain regarding physiotherapy

BACKGROUND

Physiotherapy is effective to reduce pain and improve the quality of life of people living with chronic pain. To offer high-quality physiotherapy services, these services must be patient-centred and respond to patients' needs. However, few studies seem to target patients' perceived needs, whereas more studies tend to focus on needs assessed by healthcare experts, which are not always in line with patients' perceived needs. In addition, people living with chronic pain are often faced with several health inequities and may have varied perceived needs depending on their personal conditions. To offer services that truly meet patients' needs, it is therefore crucial to understand these needs. This scoping review aims to identify and map the perceived needs of people living with chronic pain towards physiotherapy services.

METHODS

To conduct this review, we followed the six stages framework proposed by Arksey and O'Malley. We searched four databases (Medline, Embase, CINHAL and APA PsycINFO) as well as the grey literature. We included all studies describing the needs, demands, preferences or expectations of adults living with chronic pain towards physiotherapy. We then performed an inductive thematic analysis of the results and discussion sections of these studies to identify the perceived needs. Once those needs were identified, we mapped them into the seven dimensions of the patient-centred healthcare delivery framework.

RESULTS

Our review included 96 studies. Various perceived needs were identified through the thematic analysis, such as the needs for an empathetic relationship; for a clear, adapted and supervised exercise program; and for personalized treatment. Our mapping into the patient-centred healthcare delivery framework showed that most studies reported needs associated with the dimensions of interpersonal care, individualized healthcare and professional care. Needs associated with the other dimensions of the framework (access; coordination and continuity; services and facilities; data and information) were less frequently mentioned.

CONCLUSIONS

The results of this review have enabled us to identify and better understand multiple needs perceived by people living with chronic pain regarding physiotherapy services. The perceived needs identified through this scoping review were mapped within the seven dimensions of the Patient-centred healthcare delivery framework.

Comparison of different telerehabilitation protocols for urogenital symptoms in females with multiple sclerosis: a randomized controlled trial

Telerehabilitation has been suggested to be equally effective than in-person rehabilitation, and could be helpful to increase participation and reduce barriers. People with multiple sclerosis (MS) often present urogenital dysfunctions, impairing independence and quality of life (QoL). Since the different available telerehabilitation protocols, the present study aimed to compare a live video urogenital rehabilitation intervention protocol (REMOTE) with a home-based pre-recorded video protocol (SELF). A randomized-controlled trial was performed, with 14 females with MS being allocated in the REMOTE group (36 ± 9 y) and 14 females in the SELF group (37 ± 7 y). Both telerehabilitation protocols were identical in terms of contents (including pelvic floor training and relaxation exercises), frequency and duration, consisting of 10 sessions of 45 min each, every 5 days. Questionnaires were administered at the beginning and the end of the study: Short Form Health Survey 36 (SF-36), Beck Depression Inventory (BDI), Female Sexual Function Index (FSFI), International Consultation on Incontinence Questionnaire (ICIQ) symptoms and related QoL, the main outcome being ICIQ incontinence score. Despite most of the outcomes improved in both groups, REMOTE was found to be more effective than SELF in most of the SF-36 domains (from p < 0.001 pη2 0.555 to p = 0.044 pη2 0.147), FSFI (p = 0.001 pη2 0.373), ICIQ (p = 0.003 pη2 0.291). Despite the home-based pre-recorded videos could be effective in improving urogenital symptoms, live video urogenital rehabilitation results in larger improvements. Telerehabilitation should be encouraged for urogenital dysfunctions in females with MS, and pre-recorded videos could represent an alternative when live sessions are not available. Clinical trial registration This randomized controlled trial was registered on ClinicalTrials.gov with the number NCT05984095.

Ballroom Dancing for People With Multiple Sclerosis: Perceptions of the Experience

BACKGROUND

Multiple sclerosis (MS) encompasses various symptoms, including fatigue, pain, spasticity, motor dysfunction, postural instability, sexual and bladder dysfunction, and cognitive impairment. Despite the documented benefits of exercise for alleviating MS symptoms, adherence to physical activity guidelines often is low, resulting in sedentary lifestyles among people with MS. This qualitative study explores the experiences of individuals with MS who participated in a ballroom dance intervention.

METHODS

Thirteen community-dwelling individuals with MS participated in five 1-hour focus group sessions as part of a larger ballroom dance study. The Framework Method, utilizing NVivo qualitative analysis software, was applied to verbatim transcripts.

RESULTS

Four themes emerged. (1) Physical and psychological benefits: Ballroom dance improved perceived symptoms, including strength, endurance, coordination, and balance, as well as reduced fatigue and alleviated depression. (2) Positive social support leading to enjoyment/fun: Ballroom dance fostered positive support and served as an enjoyable activity, including for couples. (3) Improved confidence: The dance intervention instilled confidence in physical abilities and emotional well-being. (4) Physical and social facilitation of activity: Ballroom dancing facilitated activity because partners were able to assist when fatigue or balance issues occurred, and the intervention provided social acceptability.

CONCLUSIONS

Recreational ballroom or social dance was well tolerated, and individuals with MS and researchers perceived it as beneficial as it led to positive physical and psychological changes. This partnered social dance intervention provided an emotionally and physically supportive environment, improved confidence, and facilitated activity. This study contributes to the understanding of the potential of recreational ballroom dancing to promote physical activity and well-being among people who are living with MS.

Consultative, Proactive Physical Therapy in Early Multiple Sclerosis

BACKGROUND

Exercise training may be the most effective nonpharmacological symptomatic treatment for patients with multiple sclerosis (MS). Physical therapy (PT) can facilitate increased exercise through education, individualized exercise routines, goal setting, and supportive resources. However, traditional PT focuses on function restoration rather than proactive measures to prevent the advancement of morbidity. We present the application of a proactive physical therapy (PAPT) approach for individuals with MS.

METHODS

Neurologists referred patients to PT shortly after their MS diagnosis. Patients completed a shared decision-making-based evaluation of their current functional level, received education on exercise guidelines and goal-setting support, and established an exercise routine of an appropriate intensity. The patient and physical therapist communicated via email and telephone at 1 and 3 months. Assessments included physical function, Fatigue Severity Scale (FSS), and self-reported exercise at 6 months.

RESULTS

Three patients were referred directly to PAPT, and 1 transitioned from restorative PT. At 6 months, 3 patients reported regular aerobic, strengthening, and flexibility participation that met or exceeded established exercise recommendations. Two of 3 patients demonstrated clinically meaningful changes in functional outcome measures (eg, 10-meter Walk Test), a third patient remained stable in all functional outcome measures. Three patients reported significant improvements on the FSS at 6 months. The fourth patient did not complete the 6-month follow-up due to pregnancy complications but reported meeting guidelines at 3 months.

CONCLUSIONS

A PAPT model of care is feasible and effective for patients who have been newly diagnosed with MS. With minimal PT visits, patients met established exercise guidelines and maintained or improved physical function.

Neurological conditions and community-based physical activity: physical therapists' belief and actions

Introduction

Physical therapists (PTs) are key actors in physical activity (PA) promotion. However, it remains unclear whether PTs in community settings promote community-based PA such as adapted physical activity (APA) and adaptive sports (AS) to their patients with neurological conditions (NCs). The main purposes were to evaluate the beliefs PTs have of APA and AS, and to explore actions they undertake to promote it to their patients with NCs.

Methods

An online survey was created specifically for the study. PT associations and institutions were contacted and licensed PTs working in community-based settings, treating at least one patient with a NC, were invited to participate. Questionnaires were analyzed only if all mandatory questions had been answered.

Results

A total of 165 questionnaires were analyzed. PTs reported prioritizing active treatment. They viewed APA and AS as beneficial for their patients with NCs; however, its promotion remained largely infrequent due to a number of barriers. The PTs' own level of PA seemed to significantly influence their beliefs of the benefits of APA and AS (p = 0.001), while being specialized in neurologic physical therapy enabled the PTs to increase frequency of promotion (p = 0.003).

Conclusion

Though community-based PTs are aware of the importance of PA for individuals with NCs, they face difficulties in promoting it to their patients. However, these difficulties are reduced among PTs who are specialized in neurologic physical therapy. Efforts should be made toward educating PTs to neurological pathologies and their specificities when it comes to PA.

Feasibility, Outcomes, and Perceptions of a Virtual Group Exercise Program in Multiple Sclerosis

BACKGROUND AND PURPOSE

Individuals with multiple sclerosis (MS) frequently report low physical activity and psychosocial support due to concerns with transportation, time, finances, access to services, and lack of caregiver support. These barriers can be addressed by online group interventions; however, utility of such programs in individuals with MS has not been examined yet. The purpose of this retrospective study was, therefore, to ( a ) investigate the feasibility, safety, and outcomes of a virtual group exercise program in individuals with MS, and ( b ) explore the participant perceptions after the program.

METHODS

Retrospective data from the medical records of 17 individuals with MS (mean [SD] age = 53.5 [12.3] years, body mass index = 28.2 [7.2]) who completed the virtual 13-week group exercise program, pre- and posttraining functional status questionnaires, and the end-of-program feedback were extracted. The exercise program included aerobic, resistance, balance, and flexibility training components recommended for people with MS. Feasibility, safety, outcomes, and participant perceptions were determined by adherence to the prescribed daily exercise dosage, number of adverse events, within-group differences in self-reported functional status, and thematic analysis of the participant feedback, respectively.

RESULTS

Participants were adherent (79%), reported minimal adverse effects, and demonstrated significant changes ( P < 0.05) in functional status posttraining. Several themes on the perceived barriers, facilitators, and suggestions for improvement were identified.

DISCUSSION AND CONCLUSIONS

A virtual 13-week group exercise program can be feasible, safe, effective, and well received by individuals with MS. Future research should investigate the dose-response effectiveness of telehealth and compare various telehealth models of exercise training using large randomized controlled trials.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A434 , which demonstrates an overview of the study).

Stakeholders' Perspectives, Needs, and Barriers to Self-Management for People With Physical Disabilities Experiencing Chronic Conditions: Focus Group Study

BACKGROUND

While self-management programs have had significant improvements for individuals with chronic conditions, less is known about the impact of self-management programs for individuals with physical disabilities who experience chronic conditions, as no holistic self-management programs exist for this population. Similarly, there is limited knowledge of how other stakeholders, such as caregivers, health experts, and researchers, view self-management programs in the context of disability, chronic health conditions, and assistive technologies.

OBJECTIVE

This study aimed to obtain insight into how stakeholders perceive self-management relating to physical disability, chronic conditions, and assistive technologies.

METHODS

Nine focus groups were conducted by 2 trained facilitators using semistructured interview guides. Each guide contained questions relating to stakeholders' experiences, challenges with self-management programs, and perceptions of assistive technologies. Focus groups were audio recorded and transcribed. Thematic analysis was conducted on the focus group data.

RESULTS

A total of 47 individuals participated in the focus groups. By using a constructivist grounded approach and inductive data collection, three main themes emerged from the focus groups: (1) perspectives, (2) needs, and (3) barriers of stakeholders. Stakeholders emphasized the importance of physical activity, mental health, symptom management, medication management, participant centeredness, and chronic disease and disability education. Participants viewed technology as a beneficial aide to their daily self-management and expressed their desire to have peer-to-peer support in web-based self-management programs. Additional views of technology included the ability to access individualized, educational content and connect with other individuals who experience similar health conditions or struggle with caregiving duties.

CONCLUSIONS

The findings suggest that the development of any web-based self-management program should include mental health education and resources in addition to physical activity content and symptom management and be cost-effective. Beyond the inclusion of educational resources, stakeholders desired customization or patient centeredness in the program to meet the overall needs of individuals with physical disabilities and caregivers. The development of web-based self-management programs should be holistic in meeting the needs of all stakeholders.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05481593; https://clinicaltrials.gov/study/NCT05481593.

Exploring the socio-ecological factors impacting lifestyle management of multiple sclerosis: A scoping review

BACKGROUND

Multiple sclerosis (MS) is a chronic, autoimmune, neurodegenerative disorder affecting over 2.9 million people worldwide. First line care revolves around disease modifying therapy and supporting people living with MS to manage their disease. Early management often sees lifestyle modification as people living with MS try to gain a sense of control. Lifestyle management is an evolving area of care with variable strength of evidence for different lifestyle factors.

OBJECTIVE

To explore factors that impact on the self-management of MS with a socio-ecological focus.

METHODS

A scoping review following the Joanna Briggs Institute guidelines for a systematic search was conducted across six databases with 9241 articles identified and 51 included in the review. The results were analysed in conjunction with the socio-ecological model considering the categories: individual, interpersonal, organisational, community, and public policy.

RESULTS

A map of health behaviour (lifestyle) factors extending across all levels of the socio-ecological model revealed a complex web of pathways to behavioural patterns impacting MS self-management. Factors followed a cascading effect towards either of two key principles: (1) self-identity or (2) accessibility. These principles in-turn impact on an individual's self-efficacy, and hence, effectiveness of MS self-management strategies.

CONCLUSIONS

MS care is highly individualised to the personal context and circumstances of the individual, with consideration towards suitable management strategies required. Healthcare professionals must consider these lifestyle influences and coordinate an approach to assisting people living with MS to self-manage their disease in relation to their personal circumstances. Person-centred care addressing both barriers and motivators to health behaviour changes is key to effective MS self-management.

The MoxFo initiative - outcomes: Outcome measures in studies of exercise training in multiple sclerosis; scoping review of reviews and classification according to the ICF framework

BACKGROUND

The number of published studies of exercise training in multiple sclerosis (MS) has grown exponentially with increasing numbers of outcomes capturing exercise effects. This has complicated the selection of relevant indicators and interpretation of intervention effects.

OBJECTIVES

The Outcomes subgroup of the MoXFo initiative aimed to (1) identify outcome measures and biomarkers in studies of exercise training in MS; (2) systematically map retrieved outcomes to International Classification of Functioning, Disability and Health (ICF) categories; (3) identify gaps where relevant ICF categories have been omitted.

METHODS

Electronic databases and registers were searched from 2010 to July 2020 to identify systematic reviews or meta-analyses of controlled trials of exercise training on any outcome in MS. Retrieved outcomes/biomarkers were mapped to the corresponding ICF category.

RESULTS

Eighty-one review articles reporting 235 different outcomes were included. The outcomes corresponded to 15 chapters and 45 categories within the ICF. Outcomes mapped primarily to body function (30 categories) and activities and participation (9 categories) components. Few outcomes mapped to body structures (2 categories) or environmental factors (1 category).

CONCLUSION

This sets the stage to develop a resource for researchers/clinicians that will aid in the selection of appropriate outcomes/biomarkers when examining exercise effects in MS.

The lived experience of physical exertion for persons with advanced multiple sclerosis: making connections with the world

PURPOSE

To explore the lived experience of physical exertion for persons living with advanced multiple sclerosis (MS).

METHOD

An interpretive (hermeneutic) phenomenological approach was undertaken with 8 persons living with advanced MS. Interviews were conducted with exploratory questions that explored participants' experiences of physical exertion. Data was analysed using phenomenological methods and the findings presented as hermeneutic stories.

RESULTS

Participants conveyed physical exertion as a means of influencing their connection with the world. Interpretation identified four subthemes; Lived Body, Sense of Self, Purpose of exertion, and Attributes of the World and an overarching superordinate theme Body-World engagement. Hermeneutic stories illuminated the intertwined relationship between the themes and the idiographic nature of physical exertion.

CONCLUSION

The experience of physical exertion was meaningfully related to participants' sense of self, agency, and 'being in the world'.

Dance for Multiple Sclerosis: A Systematic Review

BACKGROUND

Evidence of the benefits of dance for people with Parkinson disease is well established, but only recently has dance been investigated for people with multiple sclerosis (MS). The purpose of this review was to identify and evaluate the feasibility and effectiveness of dance interventions to improve functional, psychosocial, and participation outcomes in people with MS.

METHODS

Eight databases and gray literature sources were searched from inception to March 2022. Quantitative, mixed-methods, and qualitative studies evaluating dance interventions for adults with MS were included. Included studies were critically appraised using the Mixed Methods Appraisal Tool, and results were analyzed through a parallel-results convergent synthesis.

RESULTS

Thirteen studies were included, with a total of 174 participants. Various dance genres were investigated, and only 1 mild adverse event was reported. Four to 12 weeks of twice-weekly, 60-minute dance sessions were feasible in those with mild to moderate relapsing-remitting MS. Positive effects were identified mainly in motor outcomes, with qualitative themes indicating psychological and social benefits.

CONCLUSIONS

A variety of dance interventions are likely feasible and potentially beneficial for people with mild to moderate relapsing-remitting MS, but studies were generally of low-moderate quality. High-quality studies are needed to determine the effectiveness of dance interventions for people with MS, including those with progressive forms of MS and higher levels of disability.

Disabled in Society - A Scoping Review on Persons Living with Multiple Sclerosis and Disability

Multiple sclerosis (MS) is a chronic neurological disease with an increasing prevalence. As such, most studies are devoted to various medical aspects of the disease. The theoretical framework used in this scoping review was the social model of disability - a perspective focusing on environmental barriers and discrimination that disabled people face in society. The aim was to explore previous research on disabling barriers and discrimination against persons with MS, and to identify research gaps in connection with this population. The scoping review was performed in two steps: (1) a main search in 8 databases, followed by (2) citation and reference searches. The final sample consisted of 96 included articles. The result showed that most studies had been conducted in the US, and the dominant area of research was employment discrimination. Previous research has studied MS related to various areas, such as employment, social welfare and social services, transportation, housing and accessibility of public places, health services, and in relation to others within society. However, this scoping review showed that although several areas of disability and MS had been included in the previous research, most of the identified areas were researched in few studies without the possibility to generalize the findings to a larger population or a cross-cultural context. Few studies compared differences between persons with MS based on gender, age, and ethnicity. What impact the invisible symptoms of MS had on disability was also researched to a limited extent. The findings have implications for future research and clinical practice. To better understand living conditions for persons with MS from a global perspective, more research across countries is needed. Healthcare professionals need to assess the individual's situation regarding both symptoms of the disease and the impact of societal barriers and discrimination to optimize care of persons with MS.

Accessible and inclusive transportation for youth with disabilities: exploring innovative solutions

Background: Although access to reliable transportation is an essential component of quality of life, young people with disabilities encounter many transportation-related obstacles.Objective: To explore solutions to the challenges that youth with disabilities encounter in accessing and navigating transportation.Methods: A nominal group technique was used in two consultation workshops (one involving rehabilitation clinicians and accessible transportation stakeholders; and one with youth with disabilities and parents). Fifteen participants across two workshops took part and prioritized their solutions and we used a comparative analysis within and between groups to explore overarching themes.Results: The workshops resulted in 122 solutions (76 from youth/parents; 46 from stakeholders). Although there was considerable overlap within the ideas generated between the groups, they each prioritized them differently. The following themes emerged across the two group's prioritized solutions: training, funding, enhancing access, and improved efficiency.Conclusions: Our findings highlight that youth with disabilities, parents and key stakeholders offered many practical solutions for enhancing accessible transportation for youth with disabilities.Implications for RehabilitationClinicians and educators should explore different apps and transportation training programs that could help support youth with disabilities to enhance their independence and participation in the communityClinicians and educators should be involved in the development of disability awareness training programs for public transit and school bus drivers to enhance youth's inclusion and participation in society.Clinicians, educators, youth and parents should continue to advocate for inclusive, accessible, affordable and efficient transportation for people with disabilities.