BACKGROUND: The COVID-19 pandemic has led to reorganization or reduction of neurorehabilitation services for people with multiple sclerosis (PwMS). The aim of this study was to explore the changes in the organizational framework and technology usage in physiotherapy services for PwMS during the COVID-19 pandemic. METHODS: This international cross-sectional survey study was designed, developed, and disseminated by RIMS European Network for Best Practice and Research in Multiple Sclerosis Rehabilitation. Physiotherapists from nine countries (Australia, Belgium, Czech Republic, Ireland, Israel, Italy, Norway, Spain, Turkey) who provided physiotherapy services to PwMS, were invited to complete an online survey to compare physiotherapy delivery to PwMS prior to and during the pandemic period. RESULTS: The survey was completed by 215 physiotherapists. Accessibility, the average number, length and perceived effectiveness of physiotherapy sessions provided to PwMS were significantly reduced during the COVID-19 pandemic (p=0.001). Physiotherapists increased the advice of mobile apps, recorded videos for rehabilitation and exercise websites during the pandemic (p<0.001) while the use of telerehabilitation and virtual reality technology did not change. CONCLUSION: There was of a reduction in the number, duration and perceived effectiveness of rehabilitation sessions for people with multiple sclerosis during the COVID-19 pandemic while use of remote technologies for physiotherapy did not change. To ensure the continuity of physiotherapy for PwMS with complex healthcare needs also during pandemics, the provision of guidelines and training in telehealth technologies in professional education becomes crucial.

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

CRRF Mons L Novarese Moncrivello 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 ; Department of Neurology Multiple Sclerosis Competence Centre Haukeland University Hospital Helse Bergen Bergen Norway

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

Department of Rehabilitation Sciences KU Leuven Leuven 1501 3001 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

IRCCS Fondazione Don Carlo Gnocchi ONLUS Milan Italy

Neurology Neuroimmunology Department and Neurorehabilitation Unit Multiple Sclerosis Centre of Catalonia Barcelona Spain; Department of Physiotherapy Faculty of Medicine and Health Sciences Universitat Internacional de Catalunya C Josep Trueta sn 08195 Sant Cugat del Vallès Barcelona Spain

Nord University Faculty of nursing and health sciences Bodø Norway

Physiotherapy Department St James's Hospital Dublin Ireland

Scientific Research Area Italian Multiple Sclerosis Foundation Genoa Italy

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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COVID-19 and multiple sclerosis: challenges and lessons for patient care