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.

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

Department of Statistical Modelling Institute of Computer Science of the Czech Academy of Sciences 182 07 Prague Czech Republic

Faculty of Health University of Plymouth Devon PL6 8BH UK

IRCCS Fondazione Don Carlo Gnocchi Larice Lab 20148 Milan Italy

Neurology Hospital Doctor Sótero del Rio Santiago 8320000 Chile

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

Neurology Pontificia Universidad Católica de Chile Santiago 3580000 Chile

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

Physiotherapy Masku Neurological Rehabilitation Centre 21250 Masku Finland

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

Specialist Practice in Neurology 93059 Regensburg Germany

See more in PubMed

Holper L., Coenen M., Weise A., Stucki G., Cieza A., Kesselring J. Characterization of functioning in multiple sclerosis using the ICF. J. Neurol. 2010;257:103–113. doi: 10.1007/s00415-009-5282-4. 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. Health Qual. Life Outcomes. 2010;8:76. doi: 10.1186/1477-7525-8-76. PubMed DOI PMC

Henze T., Rieckmann P., Toyka K.V. Symptomatic treatment of multiple sclerosis. Multiple Sclerosis Therapy Consensus Group (MSTCG) of the German Multiple Sclerosis Society. Eur. Neurol. 2006;56:78–105. doi: 10.1159/000095699. PubMed DOI

Martinková P., Freeman J., Drabinová A., Erosheva E., Cattaneo D., Jonsdottir 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

Kesselring J., Coenen M., Cieza A., Thompson A., Kostanjsek N., Stucki G. Developing the ICF Core Sets for multiple sclerosis to specify functioning. Mult. Scler. 2008;14:252–254. doi: 10.1177/1352458507082615. PubMed DOI

Khan F., Pallant J.F. Use of the International Classification of Functioning, Disability and Health (ICF) to identify preliminary comprehensive and brief core sets for multiple sclerosis. Disabil. Rehabil. 2007;29:205–213. doi: 10.1080/09638280600756141. PubMed DOI

Rasova K., Havrdova E., Brandejsky P., Zalisova M., Foubikova B., Martinkova P. Comparison of the influence of different rehabilitation programmes on clinical, spirometric and spiroergometric parameters in patients with multiple sclerosis. Mult. Scler. 2006;12:227–234. doi: 10.1191/135248506ms1248oa. PubMed DOI

Khan F., Pallant J.F., Zhang N., Turner-Stokes L. Clinical practice improvement approach in multiple sclerosis rehabilitation: A pilot study. Int. J. Rehabil. Res. 2010;33:238–247. doi: 10.1097/MRR.0b013e328338b05f. PubMed DOI

Peiris C.L., Taylor N.F., Shields N. Extra physical therapy reduces patient length of stay and improves functional outcomes and quality of life in people with acute or subacute conditions: A systematic review. Arch. Phys. Med. Rehabil. 2011;92:1490–1500. doi: 10.1016/j.apmr.2011.04.005. PubMed DOI

Cieza A. Rehabilitation the Health Strategy of the 21st Century, Really? Arch. Phys. Med. Rehabil. 2019;100:2212–2214. doi: 10.1016/j.apmr.2019.05.019. PubMed DOI

Coenen M., Cieza A., Freeman J., Khan F., Miller D., Weise A., Kesselring J. The members of the Consensus Conference. The development of ICF Core Sets for multiple sclerosis: Results of the International Consensus Conference. J. Neurol. 2011;258:1477–1488. doi: 10.1007/s00415-011-5963-7. PubMed DOI

Baert I., Freeman J., Smedal T., Dalgas U., Romberg A., Kalron A., Conyers H., Elorriaga I., Gebara B., Gumse J., et al. Responsiveness and Clinically Meaningful Improvement, According to Disability Level, of Five Walking Measures After Rehabilitation in Multiple Sclerosis: A European Multicenter Study. Neurorehabilit. Neural Repair. 2014;28:621–631. doi: 10.1177/1545968314521010. PubMed DOI

Lamers I., Kelchtermans S., Baert I., Feys P. Upper limb assessment in multiple sclerosis: A systematic review of outcome measures and their psychometric properties. Arch. Phys. Med. Rehabil. 2014;95:1184–1200. doi: 10.1016/j.apmr.2014.02.023. PubMed DOI

Amatya B., Khan F., Galea M. Rehabilitation for people with multiple sclerosis: An overview of Cochrane Reviews. Cochrane Database Syst. Rev. 2019:1. doi: 10.1002/14651858.CD012732.pub2. PubMed DOI PMC

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

Gimigliano F., Negrini S. The World Health Organization “Rehabilitation 2030: A call for action”. Eur. J. Phys. Rehabil. Med. 2017;53:155–168. PubMed

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 Health Serv. Res. 2016;16:552. doi: 10.1186/s12913-016-1750-6. PubMed DOI PMC

Řasová K., Freeman J., Cattaneo D., Jonsdottir J., Baert I., Smedal T., Romberg A., Feys P., Alves-Guerreiro J., Habek M., et al. Content and Delivery of Physical Therapy in Multiple Sclerosis across Europe: A Survey. Int. J. Env. Res. Pub. Health. 2020;17:886. doi: 10.3390/ijerph17030886. PubMed DOI PMC

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

Bovend’Eerdt T.J., Botell R.E., Wade D.T. Writing SMART rehabilitation goals and achieving goal attainment scaling: A practical guide. Clin. Rehabil. 2009;23:352. doi: 10.1177/0269215508101741. PubMed DOI

U.N. Statistics Division Composition of macro geographical (continental) regions, geographical sub-regions, and selected economic and other groupings. United Nations. [(accessed on 3 November 2010)]; Available online: http://millenniumindicators.un.org/unsd/methods/m49/m49regin.htm.

Venables W.N., Ripley B.D. Modern Applied Statistics with S. Springer; New York, NY, USA: 2002.

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

Wade D.T., de Jong B.A. Recent advances in rehabilitation. BMJ Br. Med. J. 2000;320:1385–1388. doi: 10.1136/bmj.320.7246.1385. PubMed DOI PMC

Stevenson V.L., Playford E.D. Rehabilitation and MS. Int. MS J. 2007;14:85–92. PubMed

Smith D.L. Goal attainment scaling as an adjunct to counseling. J. Couns. Psychol. 1976;23:22–27. doi: 10.1037/0022-0167.23.1.22. DOI

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

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

Haigh R., Tennant A., Biering-Sorensen F., Grimby G., Marincek C., Phillips S., Ring H., Tesio L., Thonnard J.-L. The use of outcome measures in physical medicine and rehabilitation within Europe. J. Rehabil. Med. 2001;33:273–278. PubMed

Paltamaa J., Sarasoja T., Leskinen E., Wikstrom J., Malkia E. Measuring deterioration in international classification of functioning domains of people with multiple sclerosis who are ambulatory. Phys. Ther. 2008;88:176–190. doi: 10.2522/ptj.20070064. PubMed DOI

Rasova K., Martinkova P., Vyskotova J., Sedova M. Assessment set for evaluation of clinical outcomes in multiple sclerosis: Psychometric properties. Patient Relat. Outcome Meas. 2012;3:59–70. doi: 10.2147/PROM.S32241. PubMed DOI PMC

Paul L., Coote S., Crosbie J., Dixon D., Hale L., Holloway E., McCrone P., Miller L., Saxton J., Sincock C., et al. Core outcome measures for exercise studies in people with multiple sclerosis: Recommendations from a multidisciplinary consensus meeting. Mult. Scler. 2014;20:1641–1650. doi: 10.1177/1352458514526944. PubMed DOI

Dalgas U., Hvid L.G., Kwakkel G., Motl R.W., de Groot V., Feys P., Eijnde B.O., Coote S., Beckerman H., Pfeifer K., et al. Moving exercise research in multiple sclerosis forward (the MoXFo initiative): Developing consensus statements for research. Mult. Scler. 2020 doi: 10.1177/1352458520910360. PubMed DOI

Baert I., Smedal T., Kalron A., Rasova K., Heric-Mansrud A., Ehling R., Minguez I.E., Nedeljkovic U., Tacchino A., Hellinckx P., et al. Responsiveness and meaningful improvement of mobility measures following MS rehabilitation. Neurology. 2018;91:e1880–e1892. doi: 10.1212/WNL.0000000000006532. PubMed DOI

Kalron A., Achiron A., Dvir Z. Muscular and gait abnormalities in persons with early onset multiple sclerosis. J. Neurol. Phys. Ther. 2011;35:164–169. doi: 10.1097/NPT.0b013e31823801f4. PubMed DOI

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

COMIRESTROKE-A clinical study protocol for monitoring clinical effect and molecular biological readouts of COMprehensive Intensive REhabilitation program after STROKE: A four-arm parallel-group randomized double blinded controlled trial with a longitudinal design