Changes in physiotherapy services and use of technology for people with multiple sclerosis during the COVID-19 pandemic

Published:January 25, 2023DOI:


      • Accessibility and perceived effectiveness of physiotherapy reduced during pandemic.
      • Physiotherapists advised PwMS to use web applications and television exercise programs.
      • Use of telerehabilitation or virtual reality technology did not increase.
      • Main concern in therapists’ use of remote technology was lack of physical assessment.



      The COVID-19 pandemic has led to reorganization or reduction of neurorehabilitation services for people with multiple sclerosis (PwMS). The aim of this study was to explore the changes in the organizational framework and technology usage in physiotherapy services for PwMS during the COVID-19 pandemic.


      This international cross-sectional survey study was designed, developed, and disseminated by RIMS European Network for Best Practice and Research in Multiple Sclerosis Rehabilitation. Physiotherapists from nine countries (Australia, Belgium, Czech Republic, Ireland, Israel, Italy, Norway, Spain, Turkey) who provided physiotherapy services to PwMS, were invited to complete an online survey to compare physiotherapy delivery to PwMS prior to and during the pandemic period.


      The survey was completed by 215 physiotherapists. Accessibility, the average number, length and perceived effectiveness of physiotherapy sessions provided to PwMS were significantly reduced during the COVID-19 pandemic (p=0.001). Physiotherapists increased the advice of mobile apps, recorded videos for rehabilitation and exercise websites during the pandemic (p<0.001) while the use of telerehabilitation and virtual reality technology did not change.


      There was of a reduction in the number, duration and perceived effectiveness of rehabilitation sessions for people with multiple sclerosis during the COVID-19 pandemic while use of remote technologies for physiotherapy did not change. To ensure the continuity of physiotherapy for PwMS with complex healthcare needs also during pandemics, the provision of guidelines and training in telehealth technologies in professional education becomes crucial.


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        • Bartolo M
        • Intiso D
        • Lentino C
        • et al.
        Urgent measures for the containment of the coronavirus (Covid-19) epidemic in the neurorehabilitation/rehabilitation departments in the phase of maximum expansion of the epidemic.
        Front. Neurol. 2020; 11: 423
        • Bettger JP
        • Thoumi A
        • Marquevich V.
        • et al.
        COVID-19: Maintaining essential rehabilitation services across the care continuum.
        BMJ Glob. Heal. 2020; 5e002670
        • Bezuidenhout L
        • Joseph C
        • Thurston C
        • Rhoda A
        • English C
        • Conradsson DM
        Telerehabilitation during the COVID-19 pandemic in Sweden: a survey of use and perceptions among physiotherapists treating people with neurological diseases or older adults.
        BMC Health Serv. Res. 2022; 22: 555
        • Brigo E
        • Rintala A
        • Kossi O
        • Verwaest F
        • Vanhoof O
        • Feys P
        • Bonnechère B.
        Using telehealth to guarantee the continuity of rehabilitation during the COVID-19 pandemic: a systematic review.
        Int. J. Environ. Res. Public Health. 2022; 19: 10325
        • Bourne E.
        • Short K.
        • McAllister L.
        • Nagarajan S.V.
        The quantitative impact of placements on allied health time use and productivity in healthcare facilities: a systematic review with meta-analysis.
        Focus Health Professional Educ.: Multi-Professional J. 2019; 20: 8-40
        • Brichetto G
        • Tachhino A
        • Leocani L
        • Kos D.
        Impact of Covid-19 emergency on rehabilitation services for multiple sclerosis: an international RIMS survey.
        Mult. Scler. Relat. Disord. 2022; 67104179
        • Buckingham S
        • Anil K
        • Demain S
        • Gunn H
        • Jones RB
        • Kent B
        • Logan A
        • Marsden J
        • Playford ED
        • Freeman J.
        Telerehabilitation for people with physical disabilities and movement impairment: development and evaluation of an online toolkit for practitioners and patients.
        Disabil. Rehabil. 2022; (May 22): 1-8
        • Bloem BR
        • Dorsey ER
        • Okun MS.
        The Coronavirus disease 2019 crisis as catalyst for telemedicine for chronic neurological disorders.
        JAMA Neurol. 2020; 77: 927-928
        • Calabrò RS
        • Fiorente N.
        Innovative rehabilitation technologies in the COVID-19 era: two sides of the same coin.
        Innov. Clin. Neurosci. 2022; 19 (PMCID: PMC9341311): 8-9
        • Campbell E
        • Coulter E
        • Mattison P
        • McFadyen A
        • Miller L
        • Paul L.
        Access, delivery and perceived efficacy of physiotherapy and use of complementary and alternative therapies by people with progressive multiple sclerosis in the United Kingdom: an online survey.
        Mult. Scler. Relat. Disord. 2017; 12 (Feb): 64-69
        • Centonze D
        • Leocani L
        • Feys P.
        Advances in physical rehabilitation of multiple sclerosis.
        Curr. Opin. Neurol. 2020; 33 (Jun): 255-261
        • Colais P
        • Cascini S
        • Balducci M
        • Agabiti N
        • Davoli M
        • Fusco D
        • Calandrini E
        • Bargagli AM.
        Impact of the COVID-19 pandemic on access to healthcare services amongst patients with multiple sclerosis in the Lazio region, Italy.
        Eur. J. Neurol. 2021; 28 (Oct): 3403-3410
        • Dalgas U
        • Langeskov-Christensen M
        • Stenager E
        • et al.
        Exercise as medicine in multiple sclerosis-time for a paradigm shift: preventive, symptomatic, and disease-modifying aspects and perspectives.
        Curr. Neurol. Neurosci. Rep. 2019; 19 (88.10)
        • Dario A
        • Simic M.
        Innovative physiotherapy clinical education in response to the COVID-19 pandemic with a clinical research placement model.
        J. Physiother. 2021; 67 (Oct): 235-237
        • Duncan PW
        • Bernhardt J.
        Telerehabilitation: has its time come?.
        Stroke. 2021; 52 (Aug): 2694-2696
        • Eysenbach G.
        Improving the quality of Web surveys: The checklist for reporting results of internet E-surveys (CHERRIES) [published correction appears in doi:10.2196/jmir.2042].
        J. Med. Internet Res. 2004; 6: e34
        • Farokh Atashzar S.
        • Jay Carriere
        • Mahdi Tavakoli
        Review: how can intelligent robots and smart mechatronic modules facilitate remote assessment, assistance, and rehabilitation for isolated adults with neuro-musculoskeletal conditions?.
        Front. Robot. AI. 2021; (DOI=10.3389/frobt.2021.610529 ISSN=2296-9144)
        • Fernemark H
        • Skagerström J
        • Seing I
        • et al.
        Working conditions in primary healthcare during the COVID- 19 pandemic: an interview study with physicians in Sweden.
        BMJ Open. 2022; 12e055035
        • Fortunato R
        • van der Maas NA
        • Biland-Thommen U
        • Kaufmann M
        • Sieber C
        • Kamm CP
        • Zecca C
        • Gobbi C
        • Chan A
        • Calabrese P
        • Kesselring J
        • von Wyl V
        Swiss multiple sclerosis registry. Physiotherapy use and access-barriers in persons with multiple sclerosis: a cross-sectional analysis.
        Mult. Scler. Relat. Disord. 2021; 48 (Feb)102710
        • Griffin N.
        • Kehoe M.
        A questionnaire study to explore the views of people with multiple sclerosis of using smartphone technology for health care purposes.
        Disabil. Rehabil. 2018; 40: 1434-1442
        • Hellstén T
        • Arokoski J
        • Sjögren T
        • Jäppinen AM
        • Kettunen J.
        The current state of remote physiotherapy in finland: cross-sectional web-based questionnaire study.
        JMIR Rehabil. Assist. Technol. 2022; 9: e35569
        • Jongen PJ
        • Kremer IE
        • Hristodorova E
        • Evers SM
        • Kool A
        • Van Noort EM
        • Hiligsmann M
        • Haase R
        • Lavorgna L.
        Adherence to web-based self-assessments in long-term direct-to-patient research: two-year study of multiple sclerosis patients.
        J. Med. Internet Res. 2017; 19 (e249)
        • Jonsdottir J
        • Baglio F
        • Gindri P
        • Isernia S
        • Castiglioni C
        • Gramigna C
        • Palumbo G
        • Pagliari C
        • Di Tella S
        • Perini G
        • Bowman T
        • Salza M
        • Molteni F
        Virtual reality for motor and cognitive rehabilitation from clinic to home: a pilot feasibility and efficacy study for persons with chronic stroke.
        Front. Neurol. 2021; 12601131
        • Kahraman T
        • Rasova K
        • Jonsdottir J
        • Medina CS
        • Kos D
        • Coote S
        • Tacchino A
        • Smedal T
        • Arntzen EC
        • Quinn G
        • Learmonth Y
        • Pedulla L
        • Moumdjian L
        • Kalron A.
        The impact of the COVID-19 pandemic on physical therapy practice for people with multiple sclerosis: A multicenter survey study of the RIMS network.
        Mult. Scler. Relat. Disord. 2022; 62 (Jun)103799
        • Khan F
        • Amatya B
        • Kesselring J
        • Galea MPG.
        Telerehabilitation for persons with multiple sclerosis. A Cochrane review.
        Eur. J. Phys. Rehabil. Med. 2015; 51: 311-325
        • Learmonth YC
        • Motl RW.
        Physical activity and exercise training in multiple sclerosis: a review and content analysis of qualitative research identifying perceived determinants and consequences.
        Disabil. Rehabil. 2016; 38: 1227-1242
        • Maguire R
        • Hynes S
        • Seebacher B
        • et al.
        Research interrupted: The impact of the COVID-19 pandemic on multiple sclerosis research in the field of rehabilitation and quality of life.
        Mult. Scler. J.- Exp., Transl. Clin. 2021; 7
      1. Marck CH, Hunter A, Heritage B, Gibbs L, Kermode AG, Walker DI, Learmonth YC. The effect of the Australian bushfires and the COVID-19 pandemic on health behaviours in people with multiple sclerosis. PII: S2211-0348(21)00309-6. 10.1016/j.msard.2021.103042.

        • Milivojević I
        • Adamec I
        • Habek M.
        Utilization of physical rehabilitation among people with multiple sclerosis.
        Ir. J. Med. Sci. 2013; 182 (Sep): 429-432
        • Morrison EH
        • Michtich K
        • Hersh CM.
        How the COVID-19 Pandemic has changed multiple sclerosis clinical practice: results of a nationwide provider survey.
        Mult. Scler. Relat. Disord. 2021; 51102913
        • Moumdjian L
        • Smedal T
        • Arntzen EC
        • van der Linden ML
        • Learmonth Y
        • Pedullà L
        • Tacchino A
        • Novotna K
        • Kalron A
        • Yazgan YZ
        • Nedeljkovic U
        • Kos D
        • Jonsdottir J
        • Santoyo-Medina C
        • Coote S.
        Impact of the COVID-19 pandemic on physical activity and associated technology use in persons with multiple sclerosis: an international RIMS-SIG mobility survey study.
        Arch. Phys. Med. Rehabil. 2022; (Jun 26:S0003-9993(22)00478-6)
        • Maggio M.G.
        • Russo M.
        • Cuzzola M.F.
        • Destro M.
        • La Rosa G.
        • Molonia F.
        • Bramanti P.
        • Lombardo G.
        • de Luca R.
        • Calabrò R.S.
        Virtual reality in multiple sclerosis rehabilitation: A review on cognitive and motor outcomes.
        J. Clin. Neurosci. 2019; 65: 106-111
        • Matysiak M
        • Siger M
        • Walczak A
        • Ciach A
        • Jonakowski M
        • Stasiołek M.
        The influence of COVID-19 pandemic lockdown on the physical activity of people with multiple sclerosis. The role of online training.
        Mult. Scler. Relat. Disord. 2022; 6103843
        • Morrison EH
        • Michtich K
        • Hershc CM.
        How the COVID-19 Pandemic has changed multiple sclerosis clinical practice: results of a nationwide provider survey.
        Mult. Scler. Relat. Disord. 2021; 51102913
        • Monaghesh E
        • Hajizadeh A.
        The role of telehealth during COVID-19 outbreak: a systematic review based on current evidence.
        BMC Public Health. 2020; 20 (Aug 01): 1193
        • Momsen AH
        • Ørtenblad L
        • Maribo T.
        Effective rehabilitation interventions and participation among people with multiple sclerosis: an overview of reviews.
        Ann. Phys. Rehabil. Med. 2022; 65 (Jan 25)101529
        • Pagliari C
        • Di Tella S
        • Jonsdottir J
        • et al.
        Effects of home-based virtual reality telerehabilitation system in people with multiple sclerosis: A randomized controlled trial.
        J. Telemed. Telecare. 2021; 0×211054839
        • Palacios-Ceña D
        • Fernández-de-Las-Peñas C
        • Florencio LL
        • Palacios-Ceña M
        • de-la-Llave-Rincón AI.
        Future challenges for physical therapy during and after the COVID-19 pandemic: a qualitative study on the experience of physical therapists in Spain.
        Int. J. Environ. Res. Public Health. 2021; 18: 8368
        • Rockwell KL
        • Gilroy AS.
        Incorporating telemedicine as part of COVID-19 outbreak response systems.
        Am. J. Manag. Care. 2020; 26 (Apr): 147-148
        • Reynolds A
        • Nasir A
        • Gallagher P.
        Physiotherapists’ perspective of telehealth during the Covid-19 pandemic.
        Int. J. Med. Informatics. 2021; 156104613
        • Rabanifar N
        • Abdi K.
        Letter to Editor: telerehabilitation: a useful and appropriate approach for people with disability in Covid-19 pandemic.
        Med. J. Islam Repub. Iran. 2021; 35 (Feb 4): 18
        • Tiwari D
        • Naidoo K
        • Chatiwala N
        • Bartlo PL
        • Triola A
        • Ong B
        • Gore S.
        Exploratory analysis of physical therapy process of care and psychosocial impact of the COVID-19 pandemic on physical therapists.
        Phys. Ther. 2021; 101 (Jun 1pzab088)
      2. World Health Organization, 2022. Strategic preparedness, readiness and response plan to end the global COVID-19 emergency in 2022. Geneva: World Health Organization; 2022 (WHO/WHE/ SPP/2022.01). Licence: CC BY-NC-SA 3.0 IGO.

        • Yeroushalmi S
        • Maloni H
        • Costello K
        • Wallin MT.
        Telemedicine and multiple sclerosis: a comprehensive literature review.
        J. Telemed. Telecare. 2019; 26: 400-413×19840097