Yvonne C Learmonth

Introduction: People with multiple sclerosis (MS) are at higher risk of experiencing violence (including abuse, neglect and exploitation). It is not known whether clinicians feel prepared to identify and support patients experiencing violence. Objectives/Aims: To assess MS clinicians’ accounts of and preparedness to identify and manage experiences of violence in their patients with MS. Methods: Australian MS clinicians are currently recruited for online interviews through online advertisement, newsletters or email lists of relevant professional organisations. We use an inductive iterative thematic analysis using NVivo, concurrently to data collection, to derive meaning and identify themes from the data without preconceptions. Results: Our initial data from four MS clinicians reveal five themes; 1) Current practices, 2) Reports of violence, 3) Risk factors for violence, 4) Clinician challenges, and 5) Increasing clinician preparedness. Clinicians report that assessing patients for exposure to violence is an important part of their role. Currently clinicians look for verbal/physical cues of violence, build rapport, provide a safe space to talk and refer to services. Reported types of violence in patients comprise physical, emotional, verbal, and sexual violence, financial abuse, coercive control, social isolation, and withholding of basic care. Risk factors perceived by clinicians include new diagnosis, more severe disability, cognitive impairment, isolation, financial dependence, pregnancy, and needing care. Major challenges to assess and support patients experiencing violence include lack of clinician training, especially guidance on screening, mandatory reporting requirements (which may impact on trust), and referral pathways. Further challenges include perpetrator presence in the clinic, cultural and language barriers, and emotional toll on the clinician. Suggested strategies to increase clinician preparedness include screening tools which encompass guidelines and decision-trees, as well as training on identifying violence, initiating conversations and referral options. Further, collaborations between MS and domestic violence and legal services, dedicated time for team case discussions, emotional support for clinicians, and cultural competency training would support clinicians. Conclusion: Preliminary results show that clinicians frequently identify experiences of violence in their patients with MS and that they require more support to do this in the form of education, tools, referral pathways, and support.

Introduction: Persons with multiple sclerosis (MS) frequently experience symptoms of anxiety. There is an unmet need for effective and accessible interventions to reduce anxiety in this population.

Objectives/Aims: To conduct a systematic review and metaanalysis on the effect of exercise on anxiety in MS, exploring participant and intervention characteristics.

Methods: We searched eight databases until November 2024 for randomised controlled exercise trials with an inactive control group in adults with MS. Trial quality was assessed using the Cochrane Risk-of-Bias Tool 2.0. Intervention development was assessed based on the Medical Research Council’s (MRC) framework for developing interventions. We pooled standardised mean difference (SMD) effect sizes (Hedge’s g) and their 95% confidence intervals for continuous data in a pairwise meta-analysis.

Results: From 6096 records, 18 trials (n=709 participants) were included. Sixteen exercise interventions, demonstrated improvements in anxiety symptoms compared to inactive control, reflected as a small positive effect (SMD: 0.26, 95% CI: 0.04, 0.48). Risk of bias was high, due to self-reported measures. Few trials were pre-registered, and none focussed on anxiety as the main outcome. Authors infrequently reported detailed intervention design; only two trials reported co-design collaboration with both patient and clinician stakeholders.

Conclusion: Exercise interventions may improve symptoms of anxiety in people with MS. Studies should be designed using the MRC framework, pre-register protocols, reduce risk of bias in their outcome measurement, and assess anxiety as a primary outcome in participants with clinical levels of anxiety.

Introduction: Persons with MS have indicated that healthcare professionals are their preferred source of information on exercise.

Objectives/Aims: Using implementation study design we aimed to determine the effect of an online theoretical and experiential education programme on practitioners’ attitudes towards prescribing exercise to persons with multiple sclerosis (MS).

Methods: Physiotherapists and exercise physiologists participated. They received online training and support to deliver a 16-week programme to persons with MS. Data on practitioners’ self-confidence (PSC) and professional quality of life (ProQOL) were collected at baseline (week 0) and post-programme (weeks 1, 17, 52). Implementation data were collected post-programme using a TDF-based questionnaire and questions on behaviour change strategies and programme satisfaction. PSC, ProQOL, and TDF data were analysed using an imputation model for missing data. Effect-size estimates from generalised linear mixed models determined the magnitude of change for each outcome measure.

Results: Of 40 practitioners (20 physiotherapy and 20 exercise physiology) who provided baseline data, 24 completed the theoretical programme, and 16 completed the experiential programme. Self-confidence improved significantly (|βs| ⩾ 1.208, SEs ⩾ 0.223, |ts| ⩾ 5.403, ps < 0.001), with large effect sizes (percentage 234.5%-511.0%). Some TDF-based domains improved, such as beliefs about skills to prescribe. The 15 practitioners who completed all surveys expressed high satisfaction after the programme. The number of practitioners implementing behaviour change strategies increased from 11 to 15.

Conclusion: An online education programme for MS care improved practitioners' self-confidence and beliefs about physical activity, but high attrition suggests healthcare system barriers.

Background: We investigated how commonly telehealth is used by people with MS, their satisfaction with telehealth during the COVID-19 period, and recommendations to improve their experiences with telehealth.

Methods: In October-December 2020 we surveyed Australians with MS. We collected demographic, disease- related and social health determinant data, data on telehealth use and experiences during the COVID-19 pandemic, and recommendations on telehealth improvements. We conducted univariate analysis to compare factors associated with telehealth use versus no use, established frequencies of experiences and suggestions for improvement, and conducted thematic analysis on free-text suggestions for improvement.

Results: Of the 1485 participants, 69.7% had used telehealth since the start of the COVID-19 pandemic, there were small differences in demographical, disease and social health determinants to explain telehealth use.Most participants who used telehealth had good or very good experiences (74.3%). Most common
suggestions to improve telehealth experiences was “guidance on preparing for telehealth sessions” (n = 545, 60%). Themes of expansion in telehealth availability and expansion to physical test and physical treatments were wanted by participants.

Conclusion: Persons with MS in Australia commonly used telehealth during the COVID-19 pandemic and were generally satisfied with their experiences. Implementing the suggested improvements will further optimise the use of telehealth.

Exercise is effective for multiple sclerosis (MS) symptom and disease management and can be digitally-delivered. How Australian healthcare professionals (HCP; physiotherapists (PT), exercise physiologists (EP), occupational therapists (OT) prescribe or deliver exercise to MS clients remains unclear. We determined current HCP practices, confidence, and preferences on exercise prescription, and personal educational preferences on telehealth exercise for MS.

Australian neurological HCP completed online surveys. Logistic regression and ANOVA compared responses between HCP, stratified to profession. Four focus groups and thematic analyses were conducted on needs and preferences towards designing educational programs on telehealth exercise delivery for MS.

Fifty-eight HCP responded (34 PT; 14 EP; 10 OT). Differences existed in the familiarity of different professions with current exercise guidelines for MS (EP: 85.7%; PT: 67.6%; OT: 40%). Profession differences existed on confidence to prescribe telehealth exercise (EP 85%; PT 80%; OT 35%; p<0.001). HCP were interested in education on telehealth exercise for MS (EP 100%; PT 91.2%; OT 70%). However, OT (60%) preferred focusing on behavior change, while EP (78.6%) and PT (73.5%) preferred delivering both exercise and behavior change. HCP (N=15) of all professions participated in the focus groups. Main facilitators towards education on telehealth exercise and behaviour change were to increase reach to clients who: live remotely, lack time, and/or face financial restrictions, and increasing professional skills in exercise delivery in MS care. Barriers and concerns included lack of time for education and suitability with current practice. Training resources should address HCP needs to improve exercise delivery in MS care.

Background:
We investigated how commonly telehealth is used by people with MS, their satisfaction with telehealth during the COVID-19 period, and recommendations to improve their experiences with telehealth.

Methods:
In October-December 2020 we surveyed Australians with MS. We collected demographic, disease-related and social health determinant data, data on telehealth use and experiences during the COVID-19 pandemic, and recommendations on telehealth improvements. We conducted univariate analysis to compare factors associated with telehealth use versus no use, established frequencies of experiences and suggestions for improvement, and conducted thematic analysis on free-text suggestions for improvement.

Results:
Of the 1485 participants, 69.7% had used telehealth since the start of the COVID-19 pandemic, there were small differences in demographical, disease and social health determinants to explain telehealth use . Most participants who used telehealth had good or very good experiences (74.3%). Most common suggestions to improve telehealth experiences was “guidance on preparing for telehealth sessions” (n = 545, 60%). Themes of expansion in telehealth availability and expansion to physical tests and physical treatments were wanted by participants.

Conclusion:
Persons with MS in Australia commonly used telehealth during the COVID-19 pandemic and were generally satisfied with their experiences. Implementing the suggested improvements will further optimise the use of telehealth.