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.

Campus Diepenbeek Faculty of Rehabilitation Sciences REVAL Rehabilitation Research center REVAL BIOMED Hasselt University 3500 Hasselt Belgium

Competence Centre Department of Neurology and Department of Physiotherapy Haukeland University Hospital 5021 Bergen Norway

Department for Rehabilitation of Musculoskeletal Disorders Institute of Physical Medicine and Rehabilitation Faculty of Medicine Ss Cyril and Methodius University 1000 Skopje Macedonia

Department of Neurology 3rd Faculty of Medicine Charles University 100 34 Prague Czech Republic

Department of Neurology Referral Center for Autonomic Nervous System University Hospital Center Zagreb University of Zagreb School of Medicine Kispaticeva 10000 Zagreb Croatia

Department of Physical Therapy and Rehabilitation Faculty of Health Science Hacettepe University Ankara 06100 Turkey

Department of physiotherapy University of West Attica 12243 Athens Egaleo Greece

Department of Rehabilitation 3rd Faculty of Medicine Charles University Ruská 87 108 00 Prague Czech Republic

Department of Statistical Modelling Institute of Computer Science Czech Academy of Sciences 18207 Prague Czech Republic

Faculty of Health Medicine Dentistry and Human Sciences University of Plymouth Devon PL6 8BH UK

Faculty of Rehabilitation Sciences REVAL Rehabilitation Research Center REVAL BIOMED Hasselt University 3500 Hasselt Belgium

Fit Up Fitness and Physiotherapy Center Kontich Belgium

IRCCS Fondazione Don Carlo Gnocchi Larice Lab Milan P20148 Italy

Neurology Neuroimmunology Department and Neurorehabilitation Unit Multiple Sclerosis Centre of Catalonia Vall d'Hebron University Hospital 08035 Barcelona Spain

Nevrologgruppen Oslo 0159 Oslo Norway

Physiotherapy Masku Neurological Rehabilitation Centre 21250 Masku Finland

School of Health Sciences Health Research Unit Polytechnic Institute of Leiria Campus 2 Morro do Lena Alto do Vieiro 2411 901 Leiria Portugal

Specialist Practice in Neurology Regensburg 93059 Germany

Zobrazit více v PubMed

Feys P., Giovannoni G., Dijsselbloem N., Centonze D., Eelen P., Andersen S.L. The importance of a multi-disciplinary perspective and patient activation programmes in MS management. Mult. Scler. J. 2016;22:34–46. doi: 10.1177/1352458516650741. PubMed DOI

Montalban X., Gold R., Thompson A.J., Otero-Romero S., Amato M.P., Chandraratna D., Clanet M., Comi G., Derfuss T., Fazekas F., et al. ECTRIMS/EAN guideline on the pharmacological treatment of people with multiple sclerosis. Eur. J. Neurol. 2018;25:215–237. doi: 10.1111/ene.13536. PubMed DOI

Khan F., Amatya B. Rehabilitation in Multiple Sclerosis: A Systematic Review of Systematic Reviews. Arch. Phys. Med. Rehabil. 2017;98:353–367. doi: 10.1016/j.apmr.2016.04.016. PubMed DOI

Freeman J., Hendrie W., Jarrett L., Hawton A., Barton A., Dennett R., Marsden J., Rogers E., Zajicek J. Standing up in multiple sclerosis (SUMS): A multi-centre randomised controlled trial evaluating the clinical and cost effectiveness of a home-based self-management standing frame programme in people with progressive multiple sclerosis. Mul. Scler. J. 2019;24:869–870. doi: 10.1186/s12883-016-0581-8. PubMed DOI

Soelberg Sorensen P., Giovannoni G., Montalban X., Thalheim C., Zaratin P., Comi G. The Multiple Sclerosis Care Unit. Mul. Scler. 2018;25:627–636. doi: 10.1177/1352458518807082. PubMed DOI PMC

Rasova K., Freeman J., Martinkova P., Pavlikova M., Cattaneo D., Jonsdottir J., Henze T., Baert I., Van Asch P., Santoyo C., et al. The organisation of physiotherapy for people with multiple sclerosis across Europe: A multicentre questionnaire survey. BMC Heal. Serv. Res. 2016;16:552. doi: 10.1186/s12913-016-1750-6. PubMed DOI PMC

Martinková P., Freeman J., Drabinová A., Erosheva E., Cattaneo D., Jónsdóttir J., Baert I., Smedal T., Romberg A., Feys P., et al. Physiotherapeutic interventions in multiple sclerosis across Europe: Regions and other factors that matter. Mult. Scler. Relat. Disord. 2018;22:59–67. doi: 10.1016/j.msard.2018.03.005. PubMed DOI

European Multiple Sclerosis Platform. Code of Good Practice in MS & Consensus Papers. [(accessed on 30 January 2020)];2008 Available online: http://www.emsp.org/wp-content/uploads/2015/06/140824-Revised-Code-of-Good-Practice.pdf.

European Multiple Sclerosis Platform. Recommendation on Rehabilitation Services for Persons with Multipe Sclerosis in Europe Henze T, editor. [(accessed on 30 January 2020)];2012 Available online: https://www.eurims.org/News/recommendations-on-rehabilitation-services-for-persons-with-multiple-sclerosis-in-europe.html.

Nielsen G., Stone J., Matthews A., Brown M., Sparkes C., Farmer R., Masterton L., Duncan L., Winters A., Daniell L., et al. Physiotherapy for functional motor disorders: A consensus recommendation. J. Neurol. Neurosurg. Psychiatry. 2015;86:1113–1119. doi: 10.1136/jnnp-2014-309255. PubMed DOI PMC

Josephson I., Hedberg B., Bulow P. Problem-solving in physiotherapy--physiotherapists’ talk about encounters with patients with non-specific low back pain. Disabil. Rehabil. 2013;35:668–677. doi: 10.3109/09638288.2012.705221. PubMed DOI

Rasova K., Feys P., Henze T., Van Tongeren H., Cattaneo D., Jonsdottir J., Herbenova A. Emerging evidence-based physical rehabilitation for Multiple Sclerosis-Towards an inventory of current content across Europe. Heal. Qual. Life Outcomes. 2010;8:76. doi: 10.1186/1477-7525-8-76. PubMed DOI PMC

United Nations Statistics Dapartment Composition of Macro Geographical (Continental) Regions, Geographical Sub-Regions, and Selected Economic and Other Groupings. [(accessed on 30 January 2020)]; Available online: https://unstats.un.org/unsd/methodology/m49/

Hope A.C.A. A Simplified Monte Carlo Significance Test Procedure. J. R. Stat. Soc. Ser. B Methodol. 1968;30:582–598. doi: 10.1111/j.2517-6161.1968.tb00759.x. DOI

Benjamini Y., Hochberg Y. Controlling the False Discovery Rate: A Practical and Powerful Approach to Multiple Testing. J. R. Stat. Soc. Ser. B Stat. Methodol. 1995;57:289–300. doi: 10.1111/j.2517-6161.1995.tb02031.x. DOI

R Core Team RC . R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing; Vienna, Austria: 2017.

DeJong G., Horn S.D., Conroy B., Nichols D., Healton E.B. Opening the black box of post-stroke rehabilitation: Stroke rehabilitation patients, processes, and outcomes. Arch. Phys. Med. Rehabil. 2005;86(Suppl. S2):S1–S7. doi: 10.1016/j.apmr.2005.09.003. PubMed DOI

Wiles C. Physiotherapy and related activities in multiple sclerosis. Mult. Scler. J. 2008;14:863–871. doi: 10.1177/1352458507088155. PubMed DOI

Thompson A.J. The effectiveness of neurological rehabilitation in multiple sclerosis. J. Rehabil. Res. Dev. 2000;37:455–461. PubMed

Thompson A.J. Neurological rehabilitation: From mechanisms to management. J. Neurol. Neurosurg. Psychiatry. 2000;69:718–722. doi: 10.1136/jnnp.69.6.718. PubMed DOI PMC

Bode R.K., Heinemann A.W., Semik P., Mallinson T. Patterns of therapy activities across length of stay and impairment levels: Peering inside the “black box” of inpatient stroke rehabilitation. Arch. Phys. Med. Rehabil. 2004;85:1901–1908. doi: 10.1016/j.apmr.2004.02.023. PubMed DOI

Van Hedel H.J.A. Improvement in function after spinal cord injury: The black-box entitled rehabilitation. Swiss Med Wkly. 2012;142:w13673. PubMed

Ashburn A., Jones D., Plant R., Lovgreen B., Kinnear E., Handford F., Loader S. Physiotherapy for people with Parkinson’s disease in the UK: An exploration of practice. Int. J. Ther. Rehabil. 2004;11:160–167. doi: 10.12968/ijtr.2004.11.4.13371. DOI

Kalron A., Feys P., Dalgas U., Smedal T., Freeman J., Romberg A., Conyers H., Elorriaga I., Gebara B., Merilainen J., et al. Searching for the “Active Ingredients” in Physical Rehabilitation Programs Across Europe, Necessary to Improve Mobility in People With Multiple Sclerosis: A Multicenter Study. Neurorehabil. Neural Repair. 2019;33:260–270. doi: 10.1177/1545968319834893. PubMed DOI

McCallum C.A., Mosher P.D., Jacobson P.J., Gallivan S.P., Giuffre S.M. Quality in Physical Therapist Clinical Education: A Systematic Review. Phys. Ther. 2013;93:1298–1311. doi: 10.2522/ptj.20120410. PubMed DOI

Rasova K., Martinkova P., Pavlikoma M., Cattaneo D., Jonsdottir J., Henze T., Baert I., Van Asch P., Santovo C., Smedal T., et al. Physical therapy provision in multiple sclerosis across Europe: A regional lottery? Eur. J. Phys. Rehabil. Med. 2015;51:850–852. PubMed

Pavlikova M., Cattaneo D., Jonsdottir J., Štětkářová I., Angelová G., Markova M., Prochazkova M., Prokopiusová T., Hruskova N., Reznickova J., et al. The Impact of Balance Specific Physiotherapy, Intensity of Therapy and Disability on Static and Dynamic Balance in People with Multiple Sclerosis: A Multi-Centre Prospective Study. [(accessed on 30 January 2020)]; Available online: https://www.msard-journal.com/article/S2211-0348(20)30050-X/fulltext. PubMed

Asova K., Martinkova P., Cattaneo D., Jonsdottir J., Henze T., Baert I., Van Asch P., Santoyo C., Smedal T., Gorzata S.M., et al. Physical therapy in multiple sclerosis differs across Europe: Information regarding an ongoing study. J. Int. Med Res. 2014;42:1185–1187. PubMed

Kobelt G., Thompson A., Berg J., Gannedahl M., Eriksson J. New insights into the burden and costs of multiple sclerosis in Europe. Mult. Scler. J. 2017;23:1123–1136. doi: 10.1177/1352458517694432. PubMed DOI PMC

Rieckmann P., Centonze D., Elovaara I., Giovannoni G., Havrdová E., Kesselring J., Kobelt G., Langdon D., Morrow S.A., Oreja-Guevara C., et al. Unmet needs, burden of treatment, and patient engagement in multiple sclerosis: A combined perspective from the MS in the 21st Century Steering Group. Mult. Scler. Relat. Disord. 2018;19:153–160. doi: 10.1016/j.msard.2017.11.013. PubMed DOI

Marziniak M., Brichetto G., Feys P., Meyding-Lamade U., Vernon K., Meuth S.G. The Use of Digital and Remote Communication Technologies as a Tool for Multiple Sclerosis Management: Narrative Review. JMIR Rehabil. Assist. Technol. 2018;5:e5. doi: 10.2196/rehab.7805. PubMed DOI PMC

Straudi S., Basaglia N. Neuroplasticity-Based Technologies and Interventions for Restoring Motor Functions in Multiple Sclerosis. Adv. Exp. Med. Biol. 2017;958:171–185. PubMed

Craig P., Dieppe P., MacIntyre S., Michie S., Nazareth I., Petticrew M. Developing and evaluating complex interventions: The new Medical Research Council guidance. BMJ. 2008;337:a1655. doi: 10.1136/bmj.a1655. PubMed DOI PMC

Jette D.U., Bacon K., Batty C., Carlson M., Ferland A., Hemingway R.D., Hill J.C., Ogilvie L., Volk D. Evidence-Based Practice: Beliefs, Attitudes, Knowledge, and Behaviors of Physical Therapists. Phys. Ther. 2003;83:786–805. doi: 10.1093/ptj/83.9.786. PubMed DOI

Boesen F., Nørgaard M., Trénel P., Rasmussen P.V., Petersen T., Løvendahl B., Sørensen J. Longer term effectiveness of inpatient multidisciplinary rehabilitation on health-related quality of life in MS patients: A pragmatic randomized controlled trial–The Danish MS Hospitals Rehabilitation Study. Mult. Scler. J. 2017;24:340–349. doi: 10.1177/1352458517735188. PubMed DOI PMC

Khan F., Amatya B., Kesselring J., Galea M.P. Telerehabilitation for persons with multiple sclerosis. A Cochrane review. Eur. J. Phys. Rehabil. Med. 2015;51:311–325. PubMed

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

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