From the Guidelines
Physiotherapy is indicated in multiple sclerosis (MS) as it improves functional impairment and quality of life for patients. Although the provided study 1 primarily focuses on systemic lupus erythematosus and systemic sclerosis, it mentions that physiotherapy was found to improve functional impairment in a quasi-experimental study (LoE: 4; CA: robust), which can be applied to the management of MS symptoms.
Key aspects of physiotherapy in MS
- Improving strength, flexibility, balance, and coordination to counteract muscle weakness and spasticity
- Specific interventions such as stretching exercises, resistance training, balance training, and aerobic exercises
- Gait training and recommendation of assistive devices like canes, walkers, or ankle-foot orthoses when appropriate
Physiotherapy approach
- Tailoring the frequency and intensity of physiotherapy to the individual's symptoms, disease stage, and energy levels
- Sessions typically occurring 2-3 times weekly during active rehabilitation phases
- Promoting neuroplasticity, maintaining muscle function, improving circulation, and teaching energy conservation techniques
- Starting physiotherapy early in the disease course and continuing regularly, with programs adjusted as the condition progresses or during periods of relapse and remission.
From the Research
Physiotherapy in Multiple Sclerosis (MS)
- Physiotherapy plays a key role in managing gait impairment in MS, with people with MS prioritizing gait as the most valuable function to be affected by MS 2.
- A systematic review and meta-analysis found that Robot-Assisted Gait Training (RAGT) improved performance on the 6-minute walk test, 10-metre walk test, fatigue severity scale, and Berg Balance Scale in people with severe MS 2.
- Physiotherapy interventions are feasible for mobility in severe MS, with some evidence for the effectiveness of RAGT 2.
Comparison with Occupational Therapy
- Occupational therapy interventions have also been studied in MS, with a meta-analysis suggesting that occupational therapy-related treatments were effective in treating deficits associated with MS, particularly for outcomes in capacity and ability, and task and activity levels 3.
- A scoping review found that occupational therapy can improve occupational and other outcomes in people with MS, with evidence for the effectiveness of fatigue management programs and upper-limb rehabilitation 4.
- Occupational therapy practice guidelines for adults with MS have been developed, providing clinical recommendations for occupational therapy practitioners and highlighting the importance of addressing occupational performance and participation needs in people with MS and their caregivers 5.
Limitations and Gaps in Evidence
- There is a need for more rigorous research to fully understand the effectiveness of physiotherapy and occupational therapy interventions in MS 6, 3.
- Gaps in the evidence exist, particularly in relation to the effectiveness of occupational therapy interventions in improving outcomes for people with MS 4, 5.