Physiotherapy interventions for non-ambulatory people with multiple sclerosis

This thesis is comprised of three papers that aim to examine the literature surrounding physiotherapy interventions in non-ambulatory people with Multiple Sclerosis (PwMS), to gather information from a pilot scheme of the Exercise Buddy system in community physiotherapy and to evaluate the system formally. Multiple Sclerosis (MS) is an inflammatory neurological disease that has a considerable physical and psychological impact on those affected. Approximately one quarter of PwMS are non-ambulatory, but the amount of physiotherapy received by this population is limited. An Exercise Buddy system is where professional carers are employed to conduct home exercise programmes with PwMS under the guidance of physiotherapists, and may augment the amount of physiotherapy currently received by a non-ambulatory subgroup. A systematic review on physical rehabilitation interventions in non-ambulatory PwMS was carried out that found very little high quality studies for this population. A series of semi-structured interviews were then carried out with the participants of a pilot scheme of the Exercise Buddy system. The system was found to have excellent potential to benefit PwMS and their carers both physically and psychologically, and that adequate communication and training of Exercise Buddies were crucial to the success of the system. A randomised crossover trial of 29 non-ambulatory PwMS and their carers was carried out which found significant improvements in the physical and psychological self-perceived impact of MS in PwMS. Disability levels in PwMS were maintained and large dropout rates in carers made it difficult to make definite conclusions about the effect of either intervention. The thesis concludes with a summary of the findings and a discussion of the implications of these papers for current practice and future research.