Real-World Goal Setting and Use of Outcome Measures According to the International Classification of Functioning, Disability and Health: A European Survey of Physical Therapy Practice in Multiple Sclerosis

Goal setting is a core component of physical therapy in multiple sclerosis (MS). It is unknown whether and to what extent goals are set at different levels of the International Classification of Functioning, Disability and Health (ICF), and whether, and to which, standardized outcome measures are used in real life for evaluation at the different ICF levels. Our aim was to describe the real-world use of goal setting and outcome measures in Europe. An online cross-sectional survey, completed by 212 physical therapists (PTs) specialized in MS from 26 European countries, was conducted. Differences between European regions and relationships between goals and assessments were analyzed. PTs regularly set goals, but did not always apply the Specific, Measurable, Achievable, Realistic, Timed (SMART) criteria. Regions did not differ in the range of activities assessed, but in goals set (e.g., Western and Northern regions set significantly more goals regarding leisure and work) and outcome measures used (e.g., the Berg Balance Scale was more frequently used in Northern regions). Quality of life was not routinely assessed, despite being viewed as an important therapy goal. Discrepancies existed both in goal setting and assessment across European regions. ICF assists in understanding these discrepancies and in guiding improved health-care for the future.</jats:p

Physiotherapeutic interventions in multiple sclerosis across Europe: Regions and other factors that matter.

BACKGROUND: A wide variety of interventions exists in physical therapy (PT), but knowledge about their use across different geographical regions is limited. This study investigated the use of PT interventions in people with multiple sclerosis (MS) across Europe. It aimed to determine whether regions differ in applying interventions, and explore whether factors other than regions play a role in their use. METHODS: In an online cross-sectional survey, 212 respondents from 115 European workplaces providing PT services to people with MS representing 26 countries (four European regions) participated. Cluster analysis, Pearson Chi-squared test and a Poisson regression model were used to analyze the data. RESULTS: Thirteen of 45 listed PT interventions were used by more than 75% of centers, while nine interventions were used by less than 25%. For 12 interventions, regions differed markedly in their use. Cluster analysis of centers identified four clusters similar in their intervention use. Cluster assignment did not fully align with regions. While center region was important, center size, number and gender of physical therapists working in the center, and time since qualification also played a role. Cluster analysis exploring the use of the interventions provided the basis for a categorization of PT interventions in line with their primary focus: 1. Physical activity (fitness/endurance/resistance) training; 2. Neuroproprioceptive "facilitation/inhibition"; 3. Motor/skill acquisition (individualized therapy led); 4. Technology based interventions. CONCLUSIONS: To our knowledge this is the first study that has explored this topic in MS. The results broaden our understanding of the different PT interventions used in MS, as well as the context of their use

Searching for the “Active Ingredients” in Physical Rehabilitation Programs Across Europe, Necessary to Improve Mobility in People With Multiple Sclerosis: A Multicenter Study

Background. Physical rehabilitation programs can lead to improvements in mobility in people with multiple sclerosis (PwMS). Objective: Identify which rehabilitation program elements are employed in real life and how they might impact mobility improvement in PwMS. Methods. Participants were divided into improved and non-improved mobility groups based on changes observed in the Multiple Sclerosis Walking Scale-12 following multimodal physical rehabilitation programs. Analyses were performed at group and subgroup (mild and moderate-severe disability) levels. Rehabilitation program elements included: setting; number of weeks; number of sessions; total duration, therapy format (individual, group, autonomous), therapy goals and therapeutic approaches. Results. The study comprised 279 PwMS from 17 European centers. PwMS in the improved group received more sessions of individual therapy in both subgroups. In the mildly disabled group, 60.9% of the improved received resistance training, whereas, 68.5% of the non-improved, received self-stretching. In the moderatelyseverely disabled group, 31.4% of the improved, received aerobic training, while 50.4% of the non-improved, received passive mobilization/stretching. Conclusions. We believe that our findings are an important step in opening the black-box of physical rehabilitation, imparting guidance and assisting future research in defining characteristics of effective physical rehabilitation

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. Therefore, 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

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.

Objective 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

The use of botulinum toxin A in children with cerebral palsy, with a focus on the lower limb

Purpose The purpose of this review is to clarify the role of botulinum toxin serotype A (BTX-A) in the treatment of children with cerebral palsy (CP), with a special focus on the lower limb. Background The treatment of spasticity is central in the clinical management of children with CP. BTX-A blocks the release of acetylcholine at the motor end plate, causing a temporary muscular denervation and, in an indirect way, a reduced spasticity. Children with increased tone develop secondary problems over time, such as muscle contractures and bony deformities, which impair their function and which need orthopaedic surgery. However in these younger children, delaying surgery is crucial because the results of early surgical interventions are less predictable and have a higher risk of failure and relapse. As BTX-A treatment reduces tone in a selective way, it allows a better motor control and muscle balance across joints, resulting in an improved range of motion and potential to strengthen antagonist muscles, when started at a young age. The effects are even more obvious when the correct BTX-A application is combined with other conservative therapies, such as physiotherapy, orthotic management and casts. There is now clear evidence that the consequences of persistent increased muscle tone can be limited by applying an integrated multi-level BTX-A treatment approach. Nevertheless, important challenges such as patient selection, defining appropriate individual goals, timing, dosing and dilution, accuracy of injection technique and how to measure outcomes will be questioned. Therefore, ‘‘reflection is more important than injection’’ remains an actual statement.status: publishe