Background & Aims

Multiple sclerosis (MS) is characterized by various symptoms, including pain, which significantly affects patients’ quality of life and psychological well-being (1). This qualitative study explores how these symptoms influence the practice and engagement in home-based exercises in individuals with MS. Despite not initially focusing on pain, it emerged prominently in participant narratives. As practices evolve towards greater patient autonomy in managing their treatment, gaining an understanding of the relationship between pain and home-based exercises programs is informative for healthcare professionals. This knowledge aids in the development of more effective, patient-tailored exercise regimens. This research aims to shed light on the challenges patients face in adhering to prescribed home exercises and identifies strategies implemented to overcome these obstacles.

Methods

A total of 36 semi-structured interviews were conducted with 18 individuals (13 women & 5 men; age: 53±11 years; 10 live with a partner, while the others live alone; 6 in part-time employment, with the remaining 12 unemployed), each interviewed twice: initially two weeks after proposing a home-based balance exercise program (2) and again three months later. In collaboration with each patient, each physiotherapist involved in the study selected four or five exercises appropriate for the patient. The first interview focused on initial reactions and experiences with the exercises. The follow-up interview delved into factors related to adherence, long-term effects, and revisited obstacles and facilitators to exercises. The interviews, transcribed verbatim, were analyzed using thematic analysis to identify key patterns and themes in the data.

Results

Interestingly, although this research not initially focused on it, pain was frequently mentioned, underscoring its significance in MS. In the patients’ histories, pain was not only a common symptom but also often a triggering factor for seeking medical consultation, which ultimately led to the diagnosis of MS in seven patients. All patients but one reported current pain, mainly located in the back and legs (10 each), head and arms (3 each), and diffuse (n=5), with some experiencing symptoms like tingling (n=3), sometimes also as medication side effects. Fear of movement due to potential pain or injury was a recurrent theme, with many patients expressing apprehension about exercising, often leading to avoidance. Despite this, some participants identified exercises that alleviated pain, indicating a nuanced relationship between physical activity and symptom management. The patients’ narratives also highlighted the role of physiotherapy in adapting treatments to individual pain profiles.

Conclusions

The study underscores pain as a central aspect of the MS experience, influencing home exercise practices. Participants reported a dichotomy where fear of pain led to exercise avoidance, yet certain exercises could alleviate pain, suggesting that tailored exercise is crucial. The findings advocate for a personalized approach in physiotherapy that emphasize the adaptation of exercises to manage pain and enhance adherence. These insights call for healthcare providers to carefully consider pain management as part of exercise therapy for patients with MS, which can potentially improve quality of life and treatment outcomes. Further research may explore the development of structured, patient-specific home exercise programs that account for the complex interplay between pain, fear, and physical activity in MS.

References

(1)Finlayson M. Multiple sclerosis rehabilitation. From impairment to participation. Boca Raton, USA: CRC Press; 2013. 603 p.
(2)Sattelmayer KM, Chevalley O, Kool J, Wiskerke E, Denkinger LN, Giacomino K, Opsommer E, and Hilfiker R. Development of an exercise programme for balance abilities in people with multiple sclerosis: a development of concept study using Rasch analysis. Archives of Physiotherapy. 2021;11(1):29.

Presenting Author

Opsommer Emmanuelle

Poster Authors

Emmanuelle Opsommer

PhD

HESAV

Lead Author

Carla Ribeiro

PhD

School of Health Sciences, University of Applied Sciences and Arts - Western Switzerland, Lausanne

Lead Author

Josiane Mbarga

PhD

School of Health Sciences, University of Applied Sciences and Arts - Western Switzerland, Lausanne

Lead Author

Topics

  • Lifestyle Issues: Sleep/Diet/Exercise/Social Interactions