The impact of the COVID-19 pandemic on physiotherapy services for people with multiple sclerosis: a multicentre survey study of the RIMS network

ABSTRACT

Introduction: The COVID-19 pandemic has placed a strain on healthcare services worldwide with a highly heterogeneous impact. Therefore, the Special Interest Group for Mobility (SIG Mobility) of the European Network for Best Practice and Research in Multiple Sclerosis Rehabilitation (RIMS) decided to examine the impact of the COVID-19 outbreak on physiotherapy services in people with multiple sclerosis (pwMS). Objective(s) To describe the impact of the pandemic on physiotherapy practice from the perspective of physiotherapists (PTs) by investigating changes in rehabilitation methods, organizational framework, and technology usage. Method(s) An online survey was developed by RIMS SIG Mobility and distributed to PTs in 9 countries (Australia, Belgium, Czech Republic, Ireland, Israel, Italy, Norway, Spain, and Turkey) from December 2020 to July 2021. Result(s) 215 PTs participated in the study. The therapy most affected during the pandemic was aerobic training/conditioning exercises;33.5% reported that these activities were either reduced or unavailable. In contrast, 15% reported increased use of relaxation/ mind-body techniques and/or fatigue management programs. Frequency, total number, and duration of sessions decreased significantly during the pandemic compared to before the pandemic (p<0.001). Physiotherapy service delivery (accessibility) and effectiveness for pwMS were significantly decreased (p<0.001). There was a 10% decrease in the use of hands-on techniques and a 10% increase in the use of oral instructions when treating pwMS having moderate or severe disability during the pandemic compared to before. PTs increased use of telerehabilitation applications during the pandemic (p<0.001) app usage increased significantly from 37% to 56%, use of recorded videos from 38% to 55%, use of physiotherapy exercise websites from 33% to 52%, and use of exercise classes on TV from 7% to 20%. The top 4 challenges faced in telerehabilitation were limitations of assessment (54%), difficulties with equipment (43%), difficulties with understanding the patient's body language (35%), and not being able to use proprioceptive cues (35%). Conclusion(s) The COVID-19 pandemic has notably affected physiotherapy services for pwMS internationally in terms of content, frequency of use, format, accessibility, and effectiveness. The long-term consequences of these changes should be investigated.