Mscares: Therapy Protocol for Persons with Multiple Sclerosis

Background: Rehabilitation for persons with multiple sclerosis (MS) can be challenging to implement due to demyelination in the brain and spinal cord causing a multitude of symptoms dependent on the area of insult. These symptoms can vary per individual as well as change over time. Identifying invisible symptoms, determining optimal treatment approaches, and keeping up with recent updates to MS management causes a decrease in confidence in treatment of MS. Other chronic diseases have had success with an exercise protocol and functional components with a certain diagnosis that may be used and modified throughout the continuum of care. This protocol is taught through continuing education and online courses. This allows for more confidence with treatment and better therapy outcomes. To date, a specific protocol has not been developed for the MS population and evidence based research is extremely limited as to treatment approaches for persons with MS.

Objectives: 1)To determine the level of comfort and knowledge base of Occupational and Physical Therapists in delivery of therapy to persons with MS throughout the United States.2)To determine the interest in a therapy protocol called “MSCARES: Movement, Strength, Cognition, Agility, Resources, Exercise, & Stretching” for treatment approaches specifically designed to address symptoms associated with multiple sclerosis. The protocol will be developed to allow the therapist to determine deficits and underlying issues through specific treatment approaches that can be graded throughout the continuum of care. Instruction for the protocol is delivered in continuing education and online courses 3)To determine the interest level in a certification for delivery of treatment specific to MS. 

Methods: Survey developed and sent via survey monkey to gauge interest in the United States. Survey was sent to PT and OT Associations, social media, and Universities with OT/PT programs. 

Results: 100 responses received as of December 2, 2015. 95% treat 0-15 persons with MS per year, 4% 16-30 persons, and 1% 31-55 persons. 3% feel knowledgeable treating MS, 27% somewhat, and 70% not at all. 50% want more education, 38% maybe, and 12% not interested. 18% would like a certification to deliver the protocol, 52% would not, and 30% may not want the certification.

Conclusions: OTs and PTs reported significant lack of confidence and knowledge in the treatment of the MS population. The number of actual persons with MS being seen per year may indicate another issue, that persons with MS are significantly undertreated by both OT and PT. With an increase in confidence and knowledge on the treatment of MS, an increase in the number of persons being seen by therapists may substantially improve.  As an indirect effect, education on the benefits of therapy for healthcare professionals may increase referrals for therapy services.