The Benefits of PT for Patients with MS

The Benefits of PT for Patients with MS

Jessica Reynolds, SPT

Background 
During a recent outpatient neurology PT rotation, several physical therapists noted that patients with Multiple Sclerosis (MS) often were not referred for PT until they experienced significant functional impairments.  This is a problem, as PT intervention can help to improve gait speed,¹ which could lead to greater independence and community participation throughout the disease process.

I chose to address this problem by presenting to a group of UNC neurology residents, explaining the value of physical therapy for patients with MS.  I chose to educate this audience about physical therapy and its benefits at all stages of MS in hopes that their current and future patients would benefit from earlier referrals.  I also decided to share handouts from the presentation more broadly with several neurology clinics in the area so that they could also recognize the benefits of earlier physical therapy intervention for patients with MS.

The Products
The presentation took place during the residents’ rounds during the middle of presumably long shifts.  I worked to keep the presentation succinct, interactive and focused on the benefits of PT for patients at all stages with MS, using many visual aids and limited text.  I encouraged questions throughout the presentation to further engage the audience.  I presented a PowerPoint with handouts containing key takeaways, a timeline for suggested referral, steps for referring a patient to PT within the UNC system, and a resource for patients to find a Neurologic Clinical Specialist (NCS) outside of the Triangle.  In order to ensure that learning objectives were met, I used this brief exit slip to assess participants’ knowledge.  The residents’ responses indicated an understanding of the importance of referring patients for physical therapy after diagnosis of MS.

Part of the presentation to the neurology students included research data about the effectiveness of dafampridine paired with physical therapy on gait in patients with MS.   Whitney Huryta and I have been assisting with Dr. Plummer’s research in this area.  While research is still being conducted, the current data suggests that when physical therapy intervention is combined with dalfampridine, there appears to be an enhanced impact on gait speed greater than the sum of the two interventions alone.  I was excited to share this information with the neurologists, and they were very interested in the findings as well.  Neurologists commonly prescribe dalfampridine for patients with MS to improve gait.  The drug effectively increases gait speed in about 1/3 of patients with MS.²  If PT has the ability to enhance its benefits, then perhaps more individuals could show a gain with PT and dalfampridine than with dalfampridine alone.  I had previously performed a Critically Appraised Topic examining the impact of dalfampridine versus aerobic exercise on gait speed for patients with MS, and also included that handout for the neurologists.

We also shared our research findings in a poster presentation at the Human Movement Science and Biomechanics Research Symposium.  We are still performing interventions and collecting data with additional subjects, but the poster shares the information we’ve collected so far.  When making the poster, we worked to limit the text and use graphs, diagrams, and photographs to tell as much of the story as possible since most individuals only had time to spend a few minutes at each poster.  At the conference, we enjoyed discussing our findings with the other attendees and learning about exciting research from other presenters.

Self-Reflection
During this Capstone, I became an even greater advocate for the importance of interdisciplinary communication.  I was admittedly nervous to speak to a room of neurology residents and then to a variety of individuals at the conference, but it was clear in doing so that across our disciplines, we all want the best outcomes possible for patients.  Everyone I spoke to throughout this process was kind, curious, and committed to excellent work.  Our training makes us experts in our own individual areas, but we have so much to learn about other disciplines and how they can impact patient care.  For example, several residents indicated that they had limited knowledge about physical therapy at the beginning of the presentation.  After learning about PT and its benefits, they all indicated that they planned to prescribe PT early and suggest that colleagues do the same.  In speaking with others about the importance of PT intervention for patients with MS, I became even more inspired about our profession and about collaborating with colleagues.

Acknowledgements
I am especially grateful to Dr. Prue Plummer, PhD, PT, for her guidance and mentorship with this Capstone and for allowing me to assist with her research.  I am also grateful to Dr.  Silva Markovic-Plese, MD, PhD, MS, for her collaboration and for arranging the opportunity to speak to the residents.  Special thanks to Corinne Bohling, DPT, for her guidance on my committee, and to Catherine Jacobs, DPT, for her assistance in planning the presentation to the residents.

References

1. Plummer P. Critical Appraisal of Evidence for Improving Gait Speed in People with Multiple Sclerosis. Int J MS Care. 2016;18(3):105-115. doi:10.7224/1537-2073.2014-114.
2. Goodman AD, Brown TR, Krupp LB, et al. Sustained-release oral fampridine in multiple sclerosis: a randomised, double-blind, controlled trial. Lancet. 2009;373(9665):732-738. doi:10.1016/S0140-6736(09)60442-6.