Physiotherapy for people with progressive multiple sclerosis

Progressive Multiple Sclerosis (MS) is a degenerative neurological disease with no known cure. The overall aim of the research within this thesis was to investigate physiotherapy, an important part of the care, for people with progressive MS. This was done in three studies. A systematic review of the current literature for the effectiveness of physiotherapy for the rehabilitation of people with progressive MS; an online survey of people with progressive MS assessing levels of access to, and use of, clinical services across the United Kingdom; and a feasibility study of High Intensity Interval Training (HIIT) for people with progressive MS. The systematic search returned 15 studies, 482 participants in total, which investigated eight different interventions: exercise therapy, multi-disciplinary rehabilitation, functional electrical stimulation, botulinum toxin type A injections and manual stretches, inspiratory muscle training, therapeutic standing, acupuncture and body weight supported treadmill training. All studies, apart from one, produced a positive result, however, only one study was adequately powered. In conclusion, the review found that the evidence was positive for using physiotherapy for rehabilitation in people with progressive MS, but further adequately powered research, is required to strengthen this. In total 1298 people with progressive MS from across the United Kingdom completed the online survey in August to October 2015. Participants were asked regarding access and use of clinical services, delivery and opinion of physiotherapy, and use of complementary and alternative therapies. Access to MS Specialists was high (95%), as was access to a physiotherapist (87%). Seventy seven percent of physiotherapy was delivered by the National Health Service and 32% were currently receiving physiotherapy for their MS. Physiotherapy was very well perceived by people with progressive MS and the most common interventions received were independent (83%) and supervised exercise (71%). Five percent of respondents were currently using disease modifying therapies and 23% had previously taken them. Almost three quarters (74%) received a regular review but 37% received this review less than annually. It was recommended that service providers make steps to address this gap in service provision. Finally, eight weeks of twice weekly HIIT sessions were compared to twice weekly sessions of continuous moderate intensity training. Ten out of twelve participants completed the trial. The HIIT intervention was well tolerated with 93% adherence, 100% compliance with protocol and no adverse events. There were three adverse events in the continuous training group and compliance was 79%. In addition, those who received HIIT improved their maximal heart rate and mental processing speed while no changes were found in the continuous training group. A larger, fully powered trial is required to confirm these results. Overall the studies within this thesis demonstrate that physiotherapy has the potential to be beneficial in the rehabilitation of people with progressive MS, that people with progressive MS are engaging with physiotherapy, and that interventions such as HIIT may provide new avenues for eliciting health benefits from this patient group. However, despite these positive findings, more work is required to strengthen the evidence base and gaps in service provision should be addressed.