#CMSC16 – MS Patients, Physical Therapists Have Distinct Decision-Making Processes for Improving Gait, Balance

Understanding and combining decision-making processes of both patients with multiple sclerosis (MS) and physical therapists to improve balance and gait — the movement of the lower limbs for locomotion — may help optimize patient outcomes. The findings were recently shown in an oral presentation titled “Understanding Engagement Decisions to Maximize Gait and Balance: Perspectives of Persons with Multiple Sclerosis and Physical Therapists,” at the June 1-4 Consortium of Multiple Sclerosis Centers (CMSC) 2016 Annual Meeting in National Harbor, Maryland.

MS patients commonly experience balance and gait limitations, which contribute to a high number of falls, increased healthcare costs, and have a negative impact on the patients’ physical function and quality of life. But little is known about the behaviors that both patients and physical therapists value to improve gait and balance, and the decision-making processes underlying these recommendations. A better understanding of the behavioral decisions for gait and balance improvement from the perspective of both patients and therapists is critical to optimize MS care and therapy outcomes.

Researchers at Saint Louis University, Missouri, along with their collaborators at Rocky Mountain University of Health Professions in Utah and Queen’s University in Ontario, Canada, aimed at describing the behaviors and underlying processes used by patients and recommended by physical therapists to improve gait and balance following discharge from outpatient physical therapy.

Seven patients and five physical therapists were included in the study, and each patient was matched with a physical therapist; one physical therapist participated three times. Patients completed a phone survey four weeks after being discharged, a follow-up interview four weeks later, and a set of standardized questionnaires at both time points. Physical therapists were interviewed six weeks after discharge.

The investigators analyzed the theme by which patients and physical therapists were ruled to employ their specific behaviors or recommendations. Whereas the patient-physical therapist underlying theme was “keep the lived world large,” patients’ core decision-making theme was “challenging self by pushing but respecting limits.”

In fact, patients’ behaviors were aimed at resolving uncertainty, setting goals, and building routines and resilience. Physical therapists, however, made recommendations based on the core theme “finding the right fit,” based on seeing similarities and getting to know differences among patients, and developing a partnership and plan for patients’ self-management and empowerment.

The results suggested that although patients and physical therapists have the same aims for improving gait and balance, the differences in their decision-making processes induces distinct behaviors, which should be revised to help optimize the patient-physical therapist interaction, and ultimately improve gait and balance outcomes in MS patients.