Understanding Engagement Decisions to Maximize Gait and Balance: Persons' with Multiple Sclerosis and Physical Therapists' Perspectives
Gait and balance limitations in persons with multiple sclerosis (PwMS) are common, occur early, contribute to the high prevalence of falls and healthcare costs, and create considerable negative effects on function and quality of life. Despite this, there is a paucity of information on what behaviors PwMS value and use to maximize gait and balance, what behaviors physical therapists (PTs) recommend to address gait and balance limitations, and the underlying decision making processes that lead to these behaviors and recommendations. A better understanding of the gait- and balance-enhancing behavioral decisions from the perspective of both PwMS and PT is critical to optimize MS care and outcomes.
To describe the behaviors and underlying processes used by PwMS and recommended by PT to maximize gait and balance following discharge from outpatient PT.
A multi-method case series of matched pairs (PwMS – PT) was used. PwMS completed a phone survey within four weeks of discharge, a follow-up interview four weeks later, and a set of standardized questionnaires at both time points. PTs completed an interview within six weeks of discharge. PT medical records were reviewed. Interviews were recorded and transcribed. Content and constant comparison analyses were used for thematic development and triangulation.
Seven matched pairs participated, n=12, with one PT participating three times [6/7 PwMS were female, 6/7 had relapsing remitting MS, and 4/7 had a Patient Determined Disease Steps score of 4; 4/5 PTs were female and 3/5 worked in a hospital based outpatient PT clinic associated with a MS center]. The overarching PwMS – PT theme was “keeping the lived world large”. The PwMS’s core decision making theme was “challenging self by pushing but respecting limits” through the supporting themes of 1) resolving uncertainty and 2) setting goals and building routines and resilience. The PT’s core theme was “finding the right fit” through the supporting themes of 1) seeing similarities and getting to know differences and 2) developing a partnership and plan for empowerment and self-management.
PwMS and PTs had the same aim for maximizing gait and balance and used similar but distinct behaviors and decision making processes towards it. This enhanced understanding of these decision making processes may aid in optimizing the PwMS – PT experience and ultimately gait and balance outcomes following PT.