Consultative, Proactive Physical Therapy in Early Multiple Sclerosis

Exercise training may be the most effective nonpharmacological symptomatic treatment for patients with multiple sclerosis (MS). Physical therapy (PT) can facilitate increased exercise through education, individualized exercise routines, goal setting, and supportive resources. However, traditional PT focuses on function restoration rather than proactive measures to prevent the advancement of morbidity. We present the application of a proactive physical therapy (PAPT) approach for individuals with MS.

Neurologists referred patients to PT shortly after their MS diagnosis. Patients completed a shared decision-making-based evaluation of their current functional level, received education on exercise guidelines and goal-setting support, and established an exercise routine of an appropriate intensity. The patient and physical therapist communicated via email and telephone at 1 and 3 months. Assessments included physical function, Fatigue Severity Scale (FSS), and self-reported exercise at 6 months.

Three patients were referred directly to PAPT, and 1 transitioned from restorative PT. At 6 months, 3 patients reported regular aerobic, strengthening, and flexibility participation that met or exceeded established exercise recommendations. Two of 3 patients demonstrated clinically meaningful changes in functional outcome measures (eg, 10-meter Walk Test), a third patient remained stable in all functional outcome measures. Three patients reported significant improvements on the FSS at 6 months. The fourth patient did not complete the 6-month follow-up due to pregnancy complications but reported meeting guidelines at 3 months.

A PAPT model of care is feasible and effective for patients who have been newly diagnosed with MS. With minimal PT visits, patients met established exercise guidelines and maintained or improved physical function.