Maximizing gait and balance: behaviors and decision-making processes of persons with multiple sclerosis and physical therapists

Abstract

Purpose: To describe the behavioral decisions used by persons with multiple sclerosis (MS) and physical therapists to maximize gait and balance following outpatient physical therapy.

Methods: A multi-method case series with seven matched pairs (persons with MS–physical therapists). Quota sampling maximized variability among persons with MS (disease steps score range 3–6). Three of the four physical therapists were MS or neurology certified. Persons with MS completed a phone survey, follow-up interview, and standardized questionnaires. Physical therapists completed an interview. Data were collected 2–8 weeks following discharge. Content and constant comparison analyses were used for thematic development and triangulation.

Results: Core themes arose exemplifying the decision-making processes and actions of persons with MS (challenging self by pushing but respecting limits) and physical therapists (finding the right fit). One overarching theme, keeping their lived world large, or participation in valued life roles, emerged integrating both perspectives driving decision-making.

Conclusions: Participants have a shared goal of maximizing gait and balance so persons with MS can participate in valued life roles. Understanding the differences in the behavioral decisions and optimizing skill sets in shared decision-making and self-management may enhance the therapeutic partnership and engagement in gait- and balance-enhancing behaviors.

Implications for Rehabilitation

• Persons with MS and physical therapists have a shared goal of maximizing gait and balance so persons with MS can participate in valued activities and life roles, or more poetically, keep their lived world large.

• Knowledge that persons with MS aim to challenge themselves by pushing but respecting limits can provide physical therapists with greater insight in helping persons with MS resolve uncertainty, set meaningful goals, and build the routines and resilience needed for engagement in gait- and balance-enhancing behaviors.

• Enriching skill sets in shared decision-making, behavior change and self-management may optimize the physical therapist toolbox.

Keywords:

• Engagement
• adherence
• patient participation
• exercise
• discharge planning
• qualitative research

Acknowledgements

We would like to thank all the persons with MS and physical therapists who participated in this study, as well as the clinics (Mercy Therapy Services of St. Louis, Washington, and Springfield, Missouri; Rehabilitation Institute of St. Louis; OMNI Physical Therapy), the MS Center of St. Louis, and the Gateway Area Chapter of the National Multiple Sclerosis Society, for their support with recruitment and making this study possible.

Disclosure statement

The authors have no declarations of conflicts of interest. Joanne M Wagner is an employee and stock holder of Acorda Therapeutics, Inc. This project was self-funded by the first author. No external funding was sought or received.

Additional information

Funding

This project was self-funded by the first author. No external funding was sought or received.