The organisation of physiotherapy for people with multiple sclerosis across Europe: a multicentre questionnaire survey

Background Understanding the organisational set-up of physiotherapy services across different countries is increasingly important as clinicians around the world use evidence to improve their practice. This also has to be taken into consideration when multi-centre international clinical trials are conducted. This survey aimed to systematically describe organisational aspects of physiotherapy services for people with multiple sclerosis (MS) across Europe. Methods Representatives from 72 rehabilitation facilities within 23 European countries completed an online web-based questionnaire survey between 2013 and 2014. Countries were categorised according to four European regions (defined by United Nations Statistics). Similarities and differences between regions were examined. Results Most participating centres specialized in rehabilitation (82 %) and neurology (60 %), with only 38 % specialising in MS. Of these, the Western based Specialist MS centres were predominately based on outpatient services (median MS inpatient ratio 0.14), whilst the Eastern based European services were mostly inpatient in nature (median MS inpatient ratio 0.5). In almost all participating countries, medical doctors - specialists in neurology (60 %) and in rehabilitation (64 %) - were responsible for referral to/prescription of physiotherapy. The most frequent reason for referral to/prescription of physiotherapy was the worsening of symptoms (78 % of centres). Physiotherapists were the most common members of the rehabilitation team; comprising 49 % of the team in Eastern countries compared to approximately 30 % in the rest of Europe. Teamwork was commonly adopted; 86 % of centres based in Western countries utilised the interdisciplinary model, whilst the multidisciplinary model was utilised in Eastern based countries (p = 0.046). Conclusion This survey is the first to provide data about organisational aspects of physiotherapy for people with MS across Europe. Overall, care in key organisational aspects of service provision is broadly similar across regions, although some variations, for example the models of teamwork utilised, are apparent. Organisational framework specifics should be considered anytime a multi-centre study is conducted and results from such studies are applied.PubMedWoSScopu

The Influence of Physiotherapy and Climate on Functioning in Multiple Sclerosis. Aspects of physical performance, fatigue and health-related quality of life

Multiple sclerosis (MS) is a chronic, immune-mediated disease affecting the central nervous system (CNS), caused by interplay between predisposing genes and environment. The disease may result in a wide spectre of functional problems, best treated by a multidisciplinary team of professionals. Physiotherapy has shown to improve physical functioning related to mobility and has been advocated as a major component in rehabilitation in MS. The CNS has the ability to change its function and structure depending on demands, and this neuroplasticity also occurs after damage. The Bobath concept is one of the most used treatment approaches in neurological physiotherapy and is based on knowledge of neuroplasticity, aiming to relearn appropriate movement strategies after damage. The thesis includes two intervention studies in MS. The first study is presented in Paper I. The second study (the climate study) is presented in Paper III. Data from the climate study are also used to investigate psychometric properties of a translated version of the self-reported health-related quality of life (HRQoL) questionnaire, the Multiple Sclerosis Impact Scale (MSIS-29) (Paper II), and to analyse associations between fatigue versus other variables (Paper IV). A single-subject experimental design was used in the first intervention study (Paper I), investigating the effect of three weeks of individualized daily outpatient physiotherapy based on the Bobath concept, for two patients being their own controls. Twelve repeated measures were performed over a time period of 17 weeks, using a wide spectre of measurement-tools. We concluded that balance and gait were improved after physiotherapy for the two patients, and that effect of treatment should be further evaluated in a larger study. In Paper II, the objective was to translate the MSIS-29 into Norwegian and to examine psychometric properties of the Norwegian version for use in the climate study. The questionnaire was answered by 64 patients prior to and at a screening session, and reanswered by 59 patients before and after four weeks of physiotherapy. Internal consistency (Cronbach’s ) was 0.92 for the physical- and 0.85 for the psychological subscale. Reliability by intraclass correlation coefficients were 0.86 for the physicaland 0.81 for the psychological subscale, smallest detectable change being 18.4 and 21.1, respectively. The physical- but not the psychological subscale demonstrated mostly satisfactory associations with other physical measures. Responsiveness by area under the receiver operating characteristics (ROC) curve was satisfactory, 0.83 and 0.76, respectively. As hypothesized, effect size was larger for the physical (1.01) than for the psychological (0.76) subscale after treatment. We concluded that MSIS-29, Norwegian Version demonstrated satisfactory psychometric properties. In the main intervention study (Paper III) the objective was to examine climate influence on the effect of physiotherapy in MS by comparing the effect of inpatient physiotherapy in a warm (Spain) versus a cold (Norway) climate in a short- and long term perspective. Sixty patients with gait problems and without heat intolerance were included in a randomized cross-over study of 4-week inpatient physiotherapy. Two groups of 30 patients were treated the first year in either Spain or Norway, and switching treatment centre the year after. The 6-minute walk test (6MWT) as the primary outcome measure, and other physical performance and self-reported measures, were used at screening, baseline, after treatment and at three- and six months followup. Treatment effects were analysed by mixed models. All assessment tools demonstrated improvement after treatment in both warm and cold climate, but to different degrees. After treatment, the mean walking-distance had increased by 70m in Spain and 49m in Norway (p=0.060), and improvement in favour of a warm climate was demonstrated at six months follow-up, 43m (Spain) compared to 20m (Norway) (p=0.048). The patients reported less exertion after walking (6MWT) in favour of treatment in Spain at all time points (p<0.05). No significant differences in change were detected for the other physical performance measures. Most self-reported measures showed more improvement after treatment in Spain, but these improvements were not sustained at follow-up. The results indicate that MS patients without heat intolerance have additional benefits from physiotherapy in a warm climate. In Paper IV, we also used data from the first part of the climate study. The aim was to investigate whether fatigue was associated with demographic-, clinical-, HRQoL- and physical performance variables, and whether change in fatigue after treatment was associated with changes in HRQoL and physical performance. Sixty patients were included for inpatient physiotherapy, and fifty-six completed the study. Fatigue (Fatigue Severity Scale; FSS), HRQoL (MSIS-29) and physical performance (walking ability and balance) were assessed at screening, baseline, after treatment and at followup after three and six months. We analysed possible associations between FSS and other variables at baseline by regression models, and between change in fatigue versus changes in HRQoL and physical performance variables after physiotherapy, by correlation analysis. We found that fatigue at baseline was associated with HRQoL (explained 21.9 % of variance), but not with physical performance tests. Change in fatigue was correlated with change in HRQoL, but not with changes in physical performance. All measures were improved after treatment (p 0.001). While improvements in fatigue and HRQoL were lost at follow-up, improvements in physical performance were sustained for at least six months (p 0.05). The findings suggest that fatigue in MS is not associated with physical performance as assessed in our study, but seemed to be associated with the patients’ experience of HRQoL. The results from both intervention studies indicate that physiotherapy based on the Bobath concept may cause improvement in physical performance in MS, in short- and long term perspectives. For patients without heat intolerance, there seems to be a favourable effect of treatment in a warm climate. The translated version of MSIS-29 demonstrated satisfactory measurement properties in line with the original English version and may therefore be recommended used as a measurement tool of HRQoL in patients with MS. If the aim of treatment is improvement of fatigue, a broader intervention, accounting for both physical and psychological aspects, seems necessary

The Trunk Impairment Scale - modified to ordinal scales in the Norwegian version

Purpose: To translate the Trunk Impairment Scale (TIS), a measure of trunk control in patients with stroke, into Norwegian (TIS-NV), and to explore its construct validity, internal consistency, intertester and test-retest reliability. Method: The TIS was translated according to international guidelines. 201 patients with acute stroke were recruited for the validity study, and 50 inpatients with acquired brain lesions were recruited for the study of intertester and test-retest reliability. Construct validity was analysed using explorative factor analysis, confirmatory factor analysis and item response theory, internal consistency with Cronbach’s alpha test, and intertester and test-retest reliability with kappa and intraclass correlation coefficient tests. Results: The back-translated version of TIS-NV was validated by the original developer. The subscale Static sitting balance was removed from the test. Six testlets were hierarchically constructed by combining items from the subscales Dynamic sitting balance and Coordination, and renamed modified TIS-NV (TIS-modNV). After these modifications the TIS-modNV fitted well to a locally dependent unidimensional item response theory model. The test demonstrated good construct validity, excellent internal consistency, as well as high intertester and test-retest reliability for the total score. Conclusions: The TIS-modNV is a valid and reliable scale for use in clinical practice and research

Trunk Control and Lesion Locations According to Alberta Stroke Program Early CT Score in Acute Stroke: A Cross-Sectional Study

Background: Stroke is a leading cause of disability in elderly people. Lesion location and size, and trunk control early after stroke have been found predictive of functional outcome. Trunk control is an important aspect of postural control, and commonly found to be impaired. A hemispheric difference in the regulation of postural control has been suggested, but limited knowledge of a relationship between specific lesions and trunk control exists. Objective: To explore the relationship between middle cerebral artery (MCA) lesion locations and trunk control post stroke, and compare trunk control between patients with lesions in single and multiple locations, and between left and right hemispheres. Methods: A cross-sectional design was used. Patients were recruited from a hospital stroke unit. Assessment tools: Trunk Impairment Scale–modified Norwegian version and Alberta Stroke Program Early CT Score (ASPECTS). Statistics: Descriptive, Independent t-test, Mann-Whitney’s U-test, Chi-Square test. Results:109 patients with first time middle cerebral artery lesions were included, 71 with multiple and 38 with single ASPECT locations. Trunk control was poorer in multiple (median 8.0) than in single (median 11.0) lesion locations, P=0.011. The most common single lesion locationswereM5 (50%) and internal capsule (18.4%). M5 is situated in the anterior parts of the MCA territory and hypothesized to represent sensory and motor areas of the cortex. Patients with lesions of M5 locations in the right hemisphere achieved poorer scores on trunk control than patients with left sided locations, P=0.030. Conclusions: The results indicate that patients with lesions in multiple ASPECT locations have poorer trunk control than patients with single locations, and that trunk control is poorer after single right M5 lesions as compared to left. We recommend therapists to have specific attention towards trunk control in rehabilitation of patients with MCA lesions and especially with a right M5 location early post stroke

Architecting and Modeling Automotive Embedded Systems

Dealing properly with electronics and software will be a strong competitive advantage in the automotive sector in the near future. Electronics are driving current innovations and are at the same time becoming a larger part of the cost of the vehicle. In order to be successful as an automotive manufacturer, innovations must be introduced in the vehicle without compromising the final price tag. Also, the electronics has to compete with, and win over, the dependability of well known and proven mechanical solutions. Structure related costs can be reduced by designing a modular system, volume related costs can be reduced by utilizing fewer electronic control units that shares software performing a variety of functions. To achieve a modular system careful consideration must be applied in the architecture design process. Architecting is commonly referred to as an art, performed in a qualitative manner. This thesis provides a quantitative method for architecture design and evaluation targeting modular architectures. The architecture design method is based on a simple underlying information model. This model is extended through practical experiences in case studies to include support for configuration and documentation. An information model is a key enabler for managing the increasing complexity of automotive embedded systems. The model provides the basis for establishing the analyzable documentation that is required to ensure the dependability of the systems, specifically in terms of need for reliability, maintainability and safety. An information model supports traceability both within the product, across components, and also between different organizational units using different views of the product throughout the lifecycle. Further, some general issues of systems engineering and model based development related to the engineering of automotive embedded systems are discussed. Considerations for introducing a model based development process are covered. Also, the maturity of development processes and requirements on tools in an automotive context are evaluated. The ideas and methods presented in this thesis have been developed and tried in an industrial setting through a range of case studies.QC 2010102

Balance and walking after three different models of stroke rehabilitation: early supported discharge in a day unit or at home, and traditional treatment (control)

Objective: To compare the effects on balance and walking of three models of stroke rehabilitation: early supported discharge with rehabilitation in a day unit or at home, and traditional uncoordinated treatment (control). Design: Group comparison study within a randomised controlled trial. Setting: Hospital stroke unit and primary healthcare. Participants: Inclusion criteria: a score of 2–26 on National Institutes of Health Stroke Scale, assessed with Postural Assessment Scale for Stroke (PASS), and discharge directly home from the hospital stroke unit. Interventions: Two intervention groups were given early supported discharge with treatment in either a day unit or the patient’s own home. The controls were offered traditional, uncoordinated treatment. Outcome measures: Primary: PASS. Secondary: Trunk Impairment Scale—modified Norwegian version; timed Up-and-Go; 5 m timed walk; self-reports on problems with walking, balance, ADL, physical activity, pain and tiredness. The patients were tested before randomisation and 3 months after inclusion. Results: From a total of 306 randomised patients, 167 were tested with PASS at baseline and discharged directly home. 105 were retested at 3 months: mean age 69 years, 63 men, 27 patients in day unit rehabilitation, 43 in home rehabilitation and 35 in a control group. There were no group differences, either at baseline for demographic and test data or for length of stroke unit stay. At 3 months, there was no group difference in change on PASS ( p>0.05). Some secondary measures tended to show better outcome for the intervention groups, that is, trunk control, median (95% CI): day unit, 2 (0.28 to 2.31); home rehabilitation, 4 (1.80 to 3.78); control, 1 (0.56 to 2.53), p=0.044; and for self-report on walking, p=0.021 and ADL, p=0.016. Conclusions: There was no difference in change between the groups for postural balance, but the secondary outcomes indicated that improvement of trunk control and walking was better in the intervention groups than in the control group

The impact of the COVID-19 pandemic on physical therapy practice for people with multiple sclerosis : a multicenter survey study of the RIMS network

Background: The impact of the COVID-19 pandemic on physical therapy services for people with multiple sclerosis (pwMS) is unknown. Thefore, the Special Interest Group for Mobility (SIG Mobility) of the European Network for Best Practice and Research in Multiple Sclerosis Rehabilitation (RIMS) has undertaken the initiative to examine the impact of the COVID-19 outbreak on physical therapy services and physical activity participation in pwMS across Europe, Israel and Australia. Objective: To describe the impact of the COVID-19 outbreak on physical therapy practice from the perspective of the therapist. Methods: An online survey was developed and conducted from December 2020 to July 2021. The survey (50 questions), included multiple-choice questions and open-ended responses. Results: In total, 215 physical therapists (PT's) from 9 countries (Australia, Belgium, the Czech Republic, Ireland, Israel, Italy, Norway, Spain, and Turkey) participated in the study. The therapy most affected during the pandemic was aerobic training/conditioning exercises; 33.5% reported that these activities were either reduced or unavailable. In contrast, 15% of the PTs reported increased use of relaxation/mind body techniques and/or fatigue management programs during the pandemic. PTs reported a mixture of positive and negative feelings about the therapeutic sessions offered during the pandemic. Most reported positive feelings included "positive" (26.5%), and "optimistic" (24.7%). Negative feelings most frequently reported included "worried" (30.7%), and "hesitant" (20.9%). The PTs reported a 10% decrease in the use of hands-on techniques and a 10% increase in the use of oral instructions when treating moderately and severely pwMS during as compared to before the pandemic. Conclusion: The COVID-19 pandemic has affected physical therapy services in pwMS internationally in terms of content, frequency of use and format

Physical activity in multiple sclerosis: meeting the guidelines at the time of COVID-19 pandemic

Background and Purpose: Regular physical activity (PA) helps to reduce the severity of physical and mental symptoms and improves quality of life in people with multiple sclerosis (PwMS). Based on current evidence and expert opinion, the recent MS guidelines recommend at least 150 min/week of PA. This study presents the results of a survey analysing whether and how PwMS met the guidelines before and during pandemic. Methods: We developed and disseminated an international online survey between December 2020 and July 2021, investigating changes in self-reported PA type, duration, frequency and intensity due to the COVID-19 outbreak in PwMS with differing disability levels. Results: Among respondents (n=3810), 3725 were eligible. The proportion of those who conducted at least one activity decreased with increasing disability level at both time-points (pre and during). Overall 60% of respondents met the guidelines before the pandemic (mild: 64.43%; moderate: 51.53%; severe: 39.34%; X2(2)=109.13, p<0.01); a reduction of ~10% occurred during pandemic in all disability groups (mild: 54.76%; moderate: 42.47%; severe: 29.48%; X2(2)=109.67, p<0.01). Respondents with higher disability participated more in physical therapy and less in walking, cycling and running at both time-points. Most respondents reported practicing PA at a moderate intensity at both time-points; frequency and duration of sessions decreased as disability level increased. Discussion and Conclusions: The percentage of those meeting the guidelines reduced with increasing disability level and during the pandemic. PA type and intensity varied widely across the disability categories. Interventions accounting for disability level are required to enable more PwMS to reap the benefits.  https://journals.lww.com/jnpt/pages/default.aspxinpressinpres

The impact of the COVID-19 pandemic on physical activity and associated technology use in persons with multiple sclerosis: an international RIMS-SIG Mobility survey study.

From Elsevier via Jisc Publications RouterHistory: accepted 2022-06-05, issued 2022-06-26Article version: AMPublication status: AcceptedObjective To investigate the impact of the COVID-19 pandemic on physical activity (PA) in persons with multiple sclerosis (PwMS). Design and Setting A multi-centre international online survey study was conducted within 11 participating countries. Each country launched the survey using online platforms from May to July 2021. Participants This was an electronic survey study targeting PwMS. Intervention Not applicable. Outcome measures The survey ascertained PA performance and its intensity, the nature of the activities conducted and the use of technology to support home-based physical activity before and during the pandemic. Results 3725 respondents completed the survey. Pre-pandemic, the majority (83%) of respondents reported being physically active, and this decreased to 75% during the pandemic. This change was significant for moderate and high intensity activity (p<.0001). Activities carried out in physiotherapy centres, gyms or pools decreased the most. Walking was the most frequently performed activity pre-pandemic (27%) and increased during the pandemic (33%). 24% of those inactive during the pandemic had no intention of changing their PA behaviour post-pandemic. 58% of the respondents did not use technology to support PA during the pandemic. Of those who did use technology, wearables were most used (24%). Of those currently non-active (25%) expressed a preference for an in-person format to conduct PA post-pandemic. Conclusion PA performance, especially activities at moderate and high intensities, decreased during the pandemic in PwMS compared to pre-pandemic. Walking and using wearables gained popularity to stay active. As we move towards an endemic-COVID-19, a call for action to develop interventions focused on walking programmes, with specific emphasis on increasing PA of persons with MS is proposed

Changes in physical activity participation during the COVID-19 pandemic in people with Multiple Sclerosis: an international survey study [Letter to the editor]

Marietta van der Linden - ORCID: 0000-0003-2256-6673 https://orcid.org/0000-0003-2256-6673Item is restricted in this repository until 12 months after publication date.in pressinpres