Content and Delivery of Physical Therapy in Multiple Sclerosis across Europe: A Survey

Abstract

Background: Guidelines and general recommendations are available for multiple sclerosis rehabilitation, but no specific guidance exists for physical therapists. Describing aspects of physical therapy content and delivery in multiple sclerosis and its determinants and analysing whether general recommendations connected with physical therapy are implemented in practice is important for interpreting clinical and research evidence. Methods: An online cross-sectional survey of physical therapists specialized in multiple sclerosis (212 specialists from 26 European countries) was used. Results: There was distinct diversity in service delivery and content across Europe. Perceived accessibility of physical therapy varied from most accessible in the Western region, and least in the Southern region. Sixty-four physical therapists adjusted their approach according to different disability levels, less so in the Eastern region. Duration, frequency and dose of sessions differed between regions, being highest in Southern and Western regions. “Hands on treatment” was the most commonly used therapeutic approach in all apart from the Northern regions, where “word instruction” (providing advice and information) prevailed. Conclusions: The content and delivery of physical therapy differs across Europe. Recommendations concerning access to treatment and adjustment according to disability do not appear to be widely implemented in clinical practice.

Effectiveness of Dry Needling versus Placebo on Gait Performance, Spasticity, Electromyographic Activity, Pain, Range-of-Movement and Quality of Life in Patients with Multiple Sclerosis: A Randomized Controlled Trial Protocol

“…However, the evidence for most approaches is still limited for the management of aspects such as walking capability [ 12 ], spasticity level [ 14 ], and self-reported pain intensity [ 15 , 16 ]. In addition, the recommendations about the necessity of improving the access to treatment for pwMS, to adapt the interventions to the individual disability level, and to use up-to-date evidence-based approaches do not seem to be properly implemented in the clinical setting [ 17 , 18 ].…”

Construction of a User-Led Resource for People Transitioning to Secondary Progressive Multiple Sclerosis: Results of an International Nominal Group Study

“…In Germany, physiotherapy is available for a large number of patients, with some having one to two sessions of 20 min/week, but this format seems not to match pwSPMS needs. A recently published online survey of 212 MS physical therapists from 26 European countries shows that approaches differ largely between therapists, and except for northern regions, the general attitude is more "hands-on treatment" than "hands-off treatment" (providing advice and information) (25).…”

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

“…A descriptive, cross-sectional survey of physical therapists (PTs) who work with MS patients using convenience sampling was undertaken. The survey was part of the COPHYREQUEST project, of which other results are reported elsewhere [ 4 , 17 , 18 , 19 ].…”

“…European regions were defined according to the United Nations Statistics Department [ 21 ]. To test differences between regions, we employed the Pearson Chi-square test with a simulated p -value [ 18 ], due to very small counts in some cells. To compare the use of goals and assessment in the same ICF domain, we used paired t-tests.…”