Implementation of functional training for people with multiple sclerosis – a first scientific follow-up

ABSTRACT

Background: People with multiple sclerosis (pwMS) benefit from regular physical exercise. There are positive effects in physical and cognitive performance and in dealing with activities of daily living. In addition, pwMS who exercise regularly prevent themselves from comorbidities such as diabetes, osteoporosis or chronic heart diseases and create biopositive effects in the neurodegenerative disease itself. The head organizations of German health insurances authorized the German Multiple Sclerosis (MS) Society in the state of Hesse providing the ambulant rehabilitation program “DMSG-Funktionstraining” for pwMS in 2019. “DMSG-Funktionstraining” (functional training) is an exercise training program developed for people with disabilities or people at risk of disability that takes place weekly and is led by a qualified therapist. It is prescribed by a doctor (duration between 12 and 24 months) and is part of outpatient medical rehabilitation. Methods: From the 1st of October 2019 until the 13th of March 2020 training groups were started throughout the state. In April 2020, 91 participants and 53 qualified coaches were evaluated via questionnaire. Participants and coaches evaluated the value of “DMSG-Funktionstraining,” the organizational strategies, the infrastructural conditions and the framework. Results: The return rate was about 86.8 % by “DMSG-Funktionstraining” participants and 56.6 % by “DMSG-Funktionstraining” coaches. Seventy-five questionnaires by the participants and 30 questionnaires by the coaches were included in descriptive analyses. The sample participant was 56.1 ± 7.1 years old, was diagnosed before 17.7 ± 9.9 years and had 2.1 ± 1.2 therapy units in total per week. The sample coach was 42.73 ± 10.2 years old. The respondents were sport therapists, physiotherapists, ergotherapists and yoga teachers. The big challenge for “DMSG-Funktionstraining” coaches was outlined in the heterogeneity of the group in one common training session. The disabilities were very different in regard to mobility and that meant a high level of training preparation and organization. Both the participants and the coaches evaluated the dynamic and the conversation possibilities in the training group as positive. The training contents were considered to be diversified and the coaches were assessed as competent. The distance between place of living and the training location was about 8.5 ± 8.4 kilometers and seemed to be attainable by the participants. In regard to accessibility, the responses varied. Considering the infrastructure, the organization strategies and the preparation, “Funktionstraining” was described as laborious by the coaches. Discussion: In conclusion, the difficulty with group training for people with a disease that combines highly varied symptomatic outcomes presents a big challenge. The results of this accompanying research in a preliminary project period can be described as auspicious in regard to the implementation of “DMSG-Funktionstraining” in the long term. There was a high level of satisfaction among “DMSG-Funktionstraining” participants. The critical point lies especially in the infrastructural implementation and needs further development. Based on the underlying results and the new circumstances due to the corona pandemic, the “DMSG-Funktionstraining” needed a new concept to transfer group training for pwMS to a virtual training room. Furthermore, the accompanying research turns out to have a high priority in order to gain a high-quality level in health care and self-help for pwMS, prospectively.