Feasibility, Safety, and Patient and Provider Perceptions of a Telewellness Program in MS during COVID-19

Background: Individuals with Multiple Sclerosis (MS) frequently report decreased social support and low physical activity due to barriers of transportation, time, finances, and access to services. This can be overcome with online interventions, but the utility of a comprehensive online group exercise program in individuals with MS has not been examined yet.

Objectives: The purpose, therefore, was twofold: (1) to investigate the feasibility, safety, and initial outcomes and (2) to identify patient and provider perceptions of a 13-week group telewellness program in individuals with MS.

Methods: Retrospective records from seventeen individuals with MS (mean [SD] age = 53.5 [12.3] years, BMI = 28.2 [7.1] kg/m2, disease severity = 29.7% severe or above) who completed the pre- and post-functional status questionnaires (via FOTO) during a 13-week group telewellness program were extracted. The program included aerobic, resistance, balance, and flexibility exercises. Feasibility, safety, and training-related changes were determined by adherence to the prescribed daily dose, number of adverse events, and within-group differences. Participant and provider perceptions from a program feedback interview form were extracted. Qualitative data was coded and triangulated using thematic analysis.

Results: Participants were adherent (79%), reported minimal adverse effects, and demonstrated significant changes (p<0.05) in self-reported functional status post-training [effect size=0.62]. All program participants achieved the predicted functional status (p>0.05) at the end of the program. Nine themes emerged from thematic analysis. Patient themes highlighted the: (1) physical and social benefits, (2) limitations, and (3) suggested improvements for the program. Provider themes suggested challenges with: (1) initial implementation, (2) clinical factors, (3) technology, and (4) safety. Additionally, they suggested (5) solutions and (6) benefits of telehealth.

Conclusions: A 13-week group telewellness exercise program is feasible, safe, and well-received by patients and providers. A telewellness group program not only increases physical activity but also enhances social wellness in people with MS. Findings suggest that group telewellness programs may be successful alternatives or supplements to in-clinic wellness. Future studies should investigate the utility of telewellness programs with large randomized trials, and design telehealth-specific clinical staff training.