Effects of in-Person, Telehealth, and Combined Wellness Programs on Functional Outcomes in Individuals with MS: A Retrospective Cohort Study Protocol

Background: Since Multiple Sclerosis (MS) is a chronic neurological condition with a variable presentation, long-term group wellness programs have been established to address ongoing wellness needs for individuals with MS. Telerehabilitation alleviates participation barriers (time, location, and cost), however, research comparing the effectiveness of tele- versus in-person wellness is limited. This project, therefore, expands on previous behavioral studies that suggest group telewellness programs to be feasible, safe, and effective over time.

Objectives: To retrospectively examine the effects of in-person, telehealth only, and combined wellness exercise programs on fatigue, balance, walking ability, quality of life, and functional status in individuals with MS.

Methods: This study utilizes a retrospective cohort design. Records of 8 individuals with MS participating in an in-person group wellness program, 12 in a tele-based program, and 4 in a combined (tele and in-person) group will be extracted. Each wellness group is supervised and includes progressive, recommended aerobic, strength, and balance exercises. Records from individuals with MS who have completed a series of self-reported functional outcome measures as part of usual clinical care at baseline and after 13-weeks of participation will be included and compared across groups. Self-reported assessments will include fatigue using the Modified Fatigue Impact Scale (MFIS), balance confidence by Activities-specific Balance Confidence scale (ABC), walking ability by the 12- item MS walking scale (MSWS-12), quality of life by the Multiple Sclerosis Quality of Life- 54 (MSQOL-54) questionnaire, and functional status by the computer-adaptive test via Focus on Therapeutic Outcomes (FOTO) Inc. Demographic data will be reported using descriptive statistics and between-group differences by analysis of variance for each outcome.

Results: Participants in the 13-weeks in-person and combined groups will perform better (p<0.05) than those in the tele-based program on all self-reported outcomes.

Conclusions: As compared to tele-based programs, the in-person and combined group wellness programs can provide greater improvements in self-reported functional outcomes in individuals with MS. This study will be one of the first to provide useful preliminary and comparative data on 3 different modes of administration of group-based exercise and wellness programs in individuals with MS.