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Sangelaji B.1, Smith C.M.1, Paul L.2, Treharne G.3, Hale L.1
1University of Otago, School of Physiotherapy, Dunedin, New Zealand, 2Institute of Health and Wellbeing, University of Glasgow, United Kingdom, 3University of Otago, Dept. of Psychology, Dunedin, New Zealand
Background: People with multiple sclerosis (pwMS) commonly present with both primary and secondary physical impairments, such as diffuse muscle weakness and poor cardiovascular fitness, which may worsen due to the progressive nature of MS pathology. These impairments, coupled with low exercise self-efficacy, fear of exercising, and high levels of fatigue, can lead to a progressively sedentary lifestyle and reduced quality of life. Controlled exercise and physical activity participation can increase muscle strength and cardiovascular fitness, decrease fatigue and improve the quality of life for pwMS. Whilst numerous studies have investigated such interventions in urban laboratories or hospital settings, few studies have explored how pwMS can engage and maintain engagement in exercise / physical activity in a rural home setting where there are limited physiotherapy services. We combined two physiotherapy approaches that enable pwMS to engage in exercise / physical activity, namely Web-Based Physio and Blue Prescription, with the purpose of increasing sustained physical activity engagement among pwMS living in a rural setting.
Purpose: To explore the feasibility and acceptability of a combined intervention approach and, the outcome measures used, for pwMS in rural settings.
Methods: We used a mix method case series design. We recruited four pwMS with moderate to severe disability who lived rurally. Quantitative outcomes measured at baseline, week 12 and week 24 included physical activity (using the SenseWear and Garmin monitors), the Godin Leisure-Time Exercise Questionnaire (GLTEQ), Multiple Sclerosis Impact Scale 29 V2 (MSIS-29), Modified Fatigue Impact Scale (MFIS), Hospital Anxiety and Depression Scale (HADS), and Exercise Self-efficacy Scale (EDSS). Participants were provided Web-Based Physio for 12 weeks and then Blue Prescription for 12 weeks. Qualitative in-depth interviews explored participants perceptions of the combined interventions and the outcome measurments at week 24.
Results: All four participants engaged in physical activity for 24 weeks. Three participants had improved GLTEQ scores (improved by 2, 9 and 15 units respectively) and two participants had improved MFIS physical subscale (8.3%, 41.6%) and MSIS-29 mental subscale (40.3%, 38.8%) scores. There were no discernible changes in other outcomes measured. All participants expressed problems using the activity monitors. Thematic analysis revealed that the combination of these two interventions was practical and acceptable, however old computer systems, low speed internet, lack of computer knowledge and low technology self-efficacy were articulated challenges.
Conclusion(s): For pwMS living rurally, initiating physical activity with the use of the Web-Based Physio followed by Blue Prescription to sustain engagement in physical activity was both feasible and acceptable, although there are challenges to using web-based interventions in this setting. The outcomes measures were appropriate and acceptable, except for the activity monitors which proved technically difficult for all four participants to use.
Implications: Telerehabilitation may be a solution to expanding rehabilitation services for people with a long term condition such as MS into rural settings, but technology may be a barrier to such implementation. Larger studies may be required to further clarify the usefulness of this approach.
Funding acknowledgements: School of Physiotherapy Research Fund GRANT-IN-AID 2015
Topic: Neurology
Ethics approval: University of Otago, Human Ethics Committees (Health), (H15-090)
All authors, affiliations and abstracts have been published as submitted.
