Physical therapy has been shown to benefit people with multiple sclerosis (pwMS) by strengthening muscles, increasing stamina, improving balance, improving coordination, improving cognition and alleviating muscle pain through targeted approaches. Starting physical therapy in the early stages of multiple sclerosis (MS) can help patients avoid exacerbating symptoms in the future. However, the lockdowns and restrictions imposed during the coronavirus disease 2019 (Covid-19) pandemic resulted in changes to the way physical therapists (PTs) have traditionally practised.
Two years after the start of the Covid-19 pandemic, little is still known about the impact that the pandemic is having on the delivery of physical therapy services, specifically in terms of the therapeutic items and approaches being used. The Special Interest Group for Mobility (SIG) for the European Network for Best Practice and Research in Multiple Sclerosis Rehabilitation (RIMS) conducted a multicentre study to address both this issue and the larger research question of how Covid-19 has changed the clinical and management aspects of MS rehabilitation.
GlobalData epidemiologists estimate that there will be 1.55 million diagnosed prevalent cases of MS in men and women in the seven major pharmaceutical markets (7MM: US, France, Germany, Italy, Spain, UK and Japan) by the end of this year. This number is set to increase to nearly 1.60 million by the end of 2028 (see Figure 1). It is important to understand the changes to the physical therapy landscape caused by the ongoing pandemic as it directly affects the health and wellbeing of pwMS. Figure 1 shows the number of people this could impact.
From December 2020 to July last year, a total of 215 PTs from nine countries (Australia, Belgium, the Czech Republic, Ireland, Israel, Italy, Norway, Spain and Turkey) completed an online survey conducted by SIG RIMS to assess changes in the regular use of therapeutic items from before the pandemic (2019) to during the pandemic (2020). Of the PTs who participated in the study, 38.7% worked in a hospital/rehabilitation centre during the pandemic (2020). Other workplaces included acute hospital centres, community centres, private clinics and others.
The study, which was published in Multiple Sclerosis and Related Disorders, found that 33.5% of PTs reported that aerobic training/conditioning exercises were either reduced or unavailable during the Covid-19 pandemic, making it the most impacted therapeutic item. Other therapeutic items that PTs reported lower or incomplete use of during the pandemic included bodyweight-supported walking (27.4%), computerised postural control training (23.3%), hydrotherapy (21.9%), practice with orthotic devices (21.8%), and biofeedback/electric stimulators (18.6%).
However, 14.9% of PTs reported an increase in relaxation/mind-body techniques, 14.4% reported an increase in fatigue management programmes, and 13% reported an increase in daily activities of daily living training. No significant differences were detected in therapeutic items used between PTs from different workplaces except for aerobic training. PTs in the private sector reported being ‘unable to use’ aerobic training more often than in hospital/rehabilitation centres.
The study by SIG RIMS contributes to the knowledge of how Covid-19 has shaped physical therapy services for pwMS. As the pandemic in this study was solely defined as the year 2020, further studies into other years of the pandemic could show whether lifting the majority of Covid-19 restrictions worldwide has again changed the way that PTs practice.