Yvonne C Learmonth

Purpose
Conduct a systematic review aimed to identify and synthesise evidence describing how walking impairment impacts the way persons with multiple sclerosis (MS) participate in activities within their homes and communities. Further, we assessed the sensitivity of the International Classification of Functioning, Disability and Health (ICF) framework to the lived walking experience for persons with MS.

Methods
Seven electronic databases were searched for peer-reviewed articles on the walking experience of persons with MS. Qualitative articles were included if they included quotes from persons with MS regarding community walking. Qualitative data were synthesised using a hybrid inductive and deductive thematic analysis, guided by the ICF framework and quality was appraised using the CASP tool.

Results
We included 90 eligible studies (214 quotes, 1813 participants). Study quality was high in 54% of studies. Four themes were identified: (1) adapting to physical barriers; (2) navigating society; (3) emotion and mindset; and (4) personal relationships.

Conclusions
The impact of walking impairment on community participation is perceived by persons with MS as negative and the cause of disconnect from those around them. Barriers are largely perceived as extrinsic to the self. Caution should be exercised when conceptualising walking experiences with MS using the ICF framework alone.

Implications for rehabilitation
This study reinforces the understanding of walking with multiple sclerosis (MS) as dynamic and multifaceted, shaped by physical, societal, relational, and psychological factors.

There is a need for enhanced advocacy efforts that extend beyond infrastructure, targeting the immediate social networks and broader communities of individuals with MS.

Consumer and community co-designed research is pivotal in recognising emotion and mindset as central, not peripheral, to the walking experience for persons with MS.

When conducting a walking-related needs analysis for persons with MS, we recommend that clinicians integrate psychological and physical outcomes.

Background
To improve the quality and standard of care, considerable resources are invested to produce clinical guidelines for multiple sclerosis (MS) management. We aimed to investigate MS clinicians’ use of guidelines and factors that influence use.

Methods
Interview guides were developed using Fisher’s framework to assess factors that influence guideline application (categorized as personal, guideline related, and external). Nurses and neurologists experienced in MS health care were recruited through convenience sampling. Semistructured online interviews were conducted from June 2023 to October 2023, and data were analyzed using inductive and deductive methods.

Results
We interviewed 16 MS clinicians (10 nurses, 6 neurologists). Despite most clinicians believing that guidelines can improve consistency, safety, and quality of care, the application of guidelines was highly variable. Participants reported that clinical decision-making in MS management involves integrating guideline recommendations with clinical reasoning while considering patients’ circumstances and preferences, the complex nature of MS, and resource constraints. Personal barriers to guideline application included low awareness and familiarity. Guideline-related barriers included evidence, plausibility, accessibility, layout, and complexity. External barriers included a lack of resources. Facilitators were mostly guideline related, including relevance to local protocols, covering complex treatment or unfamiliar topics, and when guidelines were up to date and credible. Participants suggested various strategies to overcome barriers to guideline use.

Conclusions
Australian MS clinicians reported low awareness and high variability in the application of national and/or international MS guidelines. Clinical practice guidelines should be adaptable to local contexts, accessible, and regularly updated. Multifaceted strategies to better distribute and champion guidelines should be employed.

Background
This study aimed to determine the self-reported impacts of COVID-19 on healthcare disruption for persons with multiple sclerosis (MS) in Australia and the personal characteristics and service factors associated with disruption.

Methods
We used 2020 data from the Australian MS Longitudinal Study survey. We used univariate and backward-stepwise regression to explore the disease-related and demographic predictors of: i) the self-perceived influence of COVID-19 on medical care; and ii) the impact of reduced access to health services on health. We also quantified the cumulative impact reduced access to each health service had on the cohort, incorporating the volume and severity of the impact on health.

Results
Of the 1484 participants who provided data, 548 (36.9 %) participants reported the pandemic influenced their medical care. Participants who reported the pandemic influenced their medical care had a younger age, more comorbidities and more disability. 454 (30.6 %) participants reported that reduced access to health services impacted their health. Reduced access was most commonly reported for general practice (311, 21 %), neurology (246, 16.6 %) and physiotherapy (214, 14.4 %). Reduced access to physiotherapy had the greatest cumulative impact on health. The cumulative personal impact of reduced access across all health services was associated with several factors, including younger age, female sex and disability.

Conclusions
One-third of Australians with MS experienced healthcare disruptions during the first year of the COVID-19 pandemic, with the reduced access to physiotherapy most significantly impacting health. The study underscores the importance of continuity of healthcare services during future crises and underscores the need for robust strategies such as hybrid healthcare models and telehealth frameworks to guard against risks to service delivery in the future.

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.

Context
The double-leg Landing Error Scoring System (LESS) identifies noncontact ACL injury risk. However, its intersession reliability has been examined in only one study. As such injuries often occur during single-leg landings, research on the single-leg LESS (SLESS) in field settings remains lacking. Therefore, our study investigated the intersession, intrarater, and interrater reliability of single- and double-leg jump-landing tasks using SLESS and LESS.

Methods
Thirty-five team-sports players (age: 26.4 [6.7] years, n = 28 males and 7 females) performed 3 jump-landing variations (single-leg dominant and nondominant and double leg) across 3 sessions. We conducted sessions 1 and 2 on the same day, with session 3 one week later. Three assessors rated video footage to determine SLESS and LESS total scores. Reliability was assessed using the intraclass correlation coefficient (ICC), standard error of measurement, and coefficient of variation (CV) with 95% CIs.

Results
Intersession reliability for the SLESS and LESS scores showed good to excellent ICCs (dominant leg: .89, nondominant leg: .91, double leg: .79) with moderate CVs (dominant leg: 6.5%, nondominant leg: 6.6%, double leg: 7.9%). Intrarater reliability for the SLESS and LESS scores also demonstrated good to excellent ICCs (dominant leg: .94, nondominant leg: 0.92, double leg: .88) with moderate CVs (dominant leg: 5.0%, nondominant leg: 6.0%, double leg: 5.6%). Interrater reliability for the SLESS and LESS scores exhibited good ICCs (dominant leg: .82, nondominant leg: .83, double leg: .79) but poor CVs (dominant leg: 10.5%, nondominant leg: 11.5%, double leg: 11.5%). Single-leg LESS and LESS scores exhibited small standard error of measurement values between 1.05 and 1.11 for all reliability measures.

Conclusions
The SLESS and LESS are reliable field-based tools for assessing jump-landing tasks among team-sports players, facilitating confidence in sports and exercise science research.

Summary of: Lopez-Brull A, Perez-Dominguez B, Plaza-Carrasco M, Blasco-Ortiz C, Navarro-Ribera B, Casaña J, et al. Online graded motor imagery is effective in women diagnosed with pelvic pain: a randomized controlled trial. Phys Ther. 2025:105:pzae164.

Question: Does an online graded motor imagery (GMI) program reduce pain intensity and improve sexual function in women diagnosed with genito-pelvic pain/penetration disorder compared with no treatment? Design: Parallel-group, randomised, controlled trial with concealed allocation and blinded assessors. Setting: Physiotherapy clinics specialised in pelvic floor disorders in Valencia, Spain. Participants: Eligible participants were women aged >18 years who experienced pain with vaginal penetration during sexual intercourse for ≥ 6 months and who scored > 6 points on the Chronic Pelvic Pain questionnaire (0 to 27 scale). Key exclusion criteria were other medical conditions that could explain pain with vaginal penetration during sexual intercourse. One-to-one randomisation of 87 participants allocated 43 to the GMI group and 44 to a control group. Interventions: Participants in the GMI group received a tailored online program for pelvic pain, aligning with principles of neuroplasticity. It consisted of three 2-week phases over 6 weeks. In phase 1 (implicit motor imagery exercise), participants viewed pain-related images of the abdominoperineal area and judged left/right perspectives via an app. In phase 2 (explicit motor imagery exercise), participants listened to six audio recordings and imagined several exercises, with the recordings representing a gradual progression of potential painful activities. In phase 3, participants followed a graded exposure exercise program, starting with genital exploration and ending in intercourse. Researchers contacted participants over the 6 weeks to ensure adherence and address queries. The control group received no intervention during the study period. Outcome measures: The primary outcomes were pain intensity assessed using a visual analogue scale (0 to 10 cm) and sexual function assessed using the short form Female Sexual Function Index (FSFI-6, 2 to 30) at 6 weeks. Results: Eighty-three participants (96%) completed the 6-week follow-up. The GMI program resulted in a small but significant reduction in pain intensity (between-group MD –2.0, 95% CI –2.6 to –1.4) but did not result in improved sexual function (between-group MD in FSFI scores 1.1, 95% CI –0.7 to 2.9) when compared with no treatment. Conclusion: In adult women with genito-pelvic pain/penetration disorder, a 6-week online GMI program improved pain intensity but not sexual function compared with no treatment. [95% CIs calculated by the CAP Editor.]

Provenance: Invited. Not peer reviewed.