The effects of and experiences from participation in GroupCoreDIST- a new, individualized, group-based, physiotherapy intervention for ambulant individuals with multiple sclerosis. A mixed methods study including a randomized controlled trial and a qualitative interview study

Abstract

<p><i>Introduction: </i>Balance and walking deviations are common in individuals with multiple sclerosis (MS). Individualized physiotherapy is common, however, participation in individualized group physiotherapy is questioned, and needs to be explored in terms of balance and walking-status, effects and user-experiences. <p><i>Methods: </i>This parallel QUAN+QUAL mixed method study included a randomized controlled trial (RCT) and a qualitative interview study. The RCT included 80 individuals with MS (European Disability Status Scale 1-6.5, mean 2.36) allocated to GroupCoreDIST (n=40) for 60-minuttes, three times per week, for six weeks (18 sessions), or standard care (n=40). Assessments at baseline, week 7, 18 and 30 included standardized outcome measures assessing trunk control, balance and walking. A repeated-measures mixed models analysis in IBM-SPSS was conducted. From the GroupCoreDIST, 13 participants were interviewed twice, at week 7 and 30. The interviews were systematised using NVivo11.0/12.0 (QSR International, 2016), and analysed by Malterud´s systematic text condensation, with dynamic systems theory and a phenomenological pattern theory of self as analytical frameworks. The findings were integrated through a systematic analysis. <p><i>Results: </i>The integrated findings provided three new categories: 1) Detecting deviations, challenges and possibilities: revealed measured and experienced deviations in balance and walking, even if disability was low. Various assessments are needed to detect deviations, and may provide meaningful insights. 2) Short-term effects and insights from nesting individual and group elements: revealed short-term effects in balance and walking and experiences of improvements, feelings of control and ownership to own body, and reflections of new activity opportunities. The GroupCoreDIST-integration of individual and group elements was meaningful. 3) Long-term changes, affordances and maintenance: revealed long-term effects on balance and walking and feelings of new affordances and autonomy. <p><i>Conclusion: </i>Balance and walking deviations should be detected even in individuals with low disability. Detailed physiotherapy should be implemented in the follow-up of individuals with MS also when disability is low.