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Dybesland A.R.1, Normann B.2
1University Hospital of Northern Norway, Physiotherapy Section, Tromsø, Norway, 2UiT The Arctic University of Norway, Faculty of Health and Care Sciences, Tromso, Norway
Background: Individualization is a prevailing principle in physiotherapy for individuals with MS, as is enhancement of movement quality to promote functional recovery. Less is known regarding how physiotherapists capture these principles in group settings, and how the content of the session is structured when the exercises are targeting core-stability and balance.
Purpose: The purpose of this study was to elucidate physiotherapy practice in a group setting for individuals with MS, aiming to provide new clinical insights, based on the following research question: What characterize group-based physiotherapy practice focusing on core-stability and balance training in ambulatory persons with MS regarding individualization and focus on movement quality, and how can we understand the PT's actions and interactions with the participants?
Methods: Three qualitative non-participating observations with videotaping were conducted during a new five-week group-based intervention for three ambulatory individuals with secondary progressive MS. Content analysis using integrated perspectives from phenomenology, natural- and social sciences was undertaken, resulting in two main themes each complemented by two sub-themes.
Results: Individual tailoring of common exercises is possible in groups of three individuals, and necessary to enhance movement quality as opposed to compensatory strategies. The physiotherapists continuous online movement analysis is, combined with a dynamic hands-on/hands-off interplay, vital for nonverbal guidance and to adapt the exercises. The group setting is important for reinforcement of positive feedback, but some limitations to hands-on interaction are seen. Systematic movement sequencing with knowledgeable explanations allows for exercise progression and the participants understanding of abstract exercises influence on ADL. Over time, prerequisites for postural control are enhanced, which may enable the participants to exhibit positive movement quality changes in walking.
Conclusion(s): Individually tailored core-stability and balance exercises in a five-week group intervention reduce compensatory movement strategies, seem to influence aspects of movement quality in walking, and may promote functional recovery.
Implications: - The findings indicate that high level of movement analysis-, manual handling-, and task deconstruction skills are needed to continuously differentiate and individually tailor exercises in a group of three participants. The importance of educational programs and courses to facilitate such expertise within the field is highlighted.
- Hands-on interaction seems feasible to utilize in group settings, but warrants reflection to its use.
- Movement quality in walking may be enhanced through the potential carry-over effect from upright and weight-bearing exercises.
Funding acknowledgements: The Norwegian Fund for Post-Graduate Training in Physiotherapy funded the writing of the article from the study, Study-id: 69255.
Topic: Neurology: multiple sclerosis
Ethics approval: The study was approved by the Norwegian Social Science Data Services with project number 34530.
All authors, affiliations and abstracts have been published as submitted.
