Physiotherapist and participant perspectives from a randomized-controlled trial of physiotherapist-supported online vs. paper-based exercise programs for people with moderate to severe multiple sclerosis

Abstract

Purpose

There is a gap in research on how best to support exercise in moderate to severe MS. The objective of this study is to share perspectives of people living with MS and physiotherapists on their experiences in a randomized clinical trial of online physiotherapy vs. an active comparator.

Methods

Semi-structured exit interviews were conducted with volunteer participants from the online and comparator arms of the trial, and focus groups were held with study physiotherapists. Transcripts were analyzed using reflexive thematic analysis.

Results

Perspectives from participants with MS yielded three themes: usability of their program, utility of their program, and motivation to participate. Visual and dexterity impairments limited the usability of the online program. Having an opportunity “to be pushed” was valued by participants in both trial arms. Motivation to exercise was variable, and participants desired periodic face-to-face contact with their physiotherapists. Perspectives from trial physiotherapists yielded similar and complementary findings concerning usability and utility.

Conclusions

Participants with MS and physiotherapists found the online physiotherapy platform useful for supporting exercise, yet they identified some limitations. As the appeal of online platforms has increased since the pandemic, it will be important to consider the needs of people with moderate to severe MS.

Trial registration number

NCT03039400.

IMPLICATIONS FOR REHABILITATION

• People with moderate-to-severe MS and physiotherapists involved in a clinical trial found online physiotherapy useful for supporting exercise. Physiotherapists and participants using the online program desired improved platform accommodations for people living with MS with visual and dexterity impairments.

• Physiotherapists and people living with MS from both the online exercise program and comparator groups perceived a need for more face-to-face contact and opportunities to build therapeutic alliance.

• Perspectives from prescribing physiotherapists and people living with MS about supporting exercise online may have practice implications during and post-pandemic.

Keywords:

• Telerehabilitation
• multiple sclerosis (MS)
• physiotherapy
• exercise
• patient preference
• internet-based intervention

Acknowledgements

Thank you to the research team advisors, Patricia O’Donnell and Rob Loewen; study participants and study physiotherapists for their participation; and MS clinic staff for assistance with recruitment.

Disclosure statement

Lorna Paul is co-inventor of Web-Based Physio and now a director of the social enterprise Giraffe Healthcare. However, she was not involved with data collection. The other authors declare no conflicts of interest.

Additional information

Funding

The Saskatchewan Centre for Patient-Oriented Research supported this qualitative work. The original trial was funded by a Hermes Canada | Multiple Sclerosis Society of Canada Research Innovation Grant.