BACKGROUND: The impact of the COVID-19 pandemic on physical therapy services for people with multiple sclerosis (pwMS) is unknown. Therefore, the Special Interest Group for Mobility (SIG Mobility) of the European Network for Best Practice and Research in Multiple Sclerosis Rehabilitation (RIMS) has undertaken the initiative to examine the impact of the COVID-19 outbreak on physical therapy services and physical activity participation in pwMS across Europe, Israel and Australia. OBJECTIVE: To describe the impact of the COVID-19 outbreak on physical therapy practice from the perspective of the therapist. METHODS: An online survey was developed and conducted from December 2020 to July 2021. The survey (50 questions), included multiple-choice questions and open-ended responses. RESULTS: In total, 215 physical therapists (PT's) from 9 countries (Australia, Belgium, the Czech Republic, Ireland, Israel, Italy, Norway, Spain, and Turkey) participated in the study. The therapy most affected during the pandemic was aerobic training/conditioning exercises; 33.5% reported that these activities were either reduced or unavailable. In contrast, 15% of the PTs reported increased use of relaxation/mind body techniques and/or fatigue management programs during the pandemic. PTs reported a mixture of positive and negative feelings about the therapeutic sessions offered during the pandemic. Most reported positive feelings included "positive" (26.5%), and "optimistic" (24.7%). Negative feelings most frequently reported included "worried" (30.7%), and "hesitant" (20.9%). The PTs reported a 10% decrease in the use of hands-on techniques and a 10% increase in the use of oral instructions when treating moderately and severely pwMS during as compared to before the pandemic. CONCLUSION: The COVID-19 pandemic has affected physical therapy services in pwMS internationally in terms of content, frequency of use and format.

Centre d'Esclerosi Múltiple de Catalunya Neurology Neuroimmunology Department and Neurorehabilitation Unit Hospital Universitari Vall d'Hebron Universitat Autònoma de Barcelona Barcelona Spain; Department of Physiotherapy Faculty of Medicine and Health Sciences Universitat Internacional de Catalunya Barcelona Spain

Department of Experimental Medicine Section of Human Physiology University of Genoa Genoa Italy; Italian Multiple Sclerosis Foundation Scientific Research Area Genoa Italy

Department of Physical Therapy School of Health Professions Sackler Faculty of Medicine and Sagol School of Neuroscience Tel Aviv University Israel; Multiple Sclerosis Center Sheba Medical Center Tel Hashomer Israel

Department of Physiotherapy and Rehabilitation Faculty of Health Sciences Izmir Katip Celebi University Izmir Turkey

Department of Physiotherapy Haukeland University Hospital Helse Bergen Bergen Norway; The Norwegian Multiple Sclerosis Competence Centre Department of Neurology Haukeland University Hospital Bergen Norway

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

Department of Rehabilitation Sciences KU Leuven Leuven Belgium; National MS Center Melsbroek Belgium

Discipline of Exercise Science Murdoch University Murdoch Australia; Centre for Molecular Medicine and Innovative Therapeutics Centre for Healthy Ageing Health Futures Institute Murdoch University Murdoch Australia; Perron Institute for Neurological and Translational Science Nedlands Australia

Faculty of Nursing and Health Science Nord University Bodø Norway; Department of Health and Work Nordland Hospital Trust Bodø Norway

IRCCS Fondazione Don Carlo Gnocchi ONLUS Milan Italy

Physiotherapy Department St James's Hospital Dublin Ireland

School of Allied Health and Centre of Physical Activity for Health Health Research Institute University of Limerick Limerick Ireland; Multiple Sclerosis Society of Ireland Limerick Ireland

Scientific Research Area Italian Multiple Sclerosis Foundation Genova Italy

UMSC Hasselt Pelt Belgium; REVAL Rehabilitation Research Center Faculty of Rehabilitation Sciences Hasselt University Hasselt Belgium; IPEM Institute of Psychoacoustics and Electronic Music Faculty of Arts and Philosophy Ghent University Ghent Belgium

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