Impact of Usual-Care Physiotherapy on Physical Activity and Self-Efficacy in People With Multiple Sclerosis: An Observational Longitudinal Study

BACKGROUND: People with multiple sclerosis (MS) experience motor and nonmotor symptoms that affect daily life. Although regular physical activity (PA) may enhance the overall well-being of people with MS, they tend to have lower activity levels than healthy individuals. This study aims to investigate the impact of usual-care physiotherapy on PA and self-efficacy in people with MS and identify prerehabilitation factors that influence positive changes in PA with physiotherapy. METHODS: Forty-one people with MS undergoing physiotherapy with a median (IQR) age of 54.00 (17.00) years and an Expanded Disability Status Scale score of 6.00 (2.00) points were assessed on the first days (T0) and last days of their rehabilitation period (T1), and 6 weeks after it ended (T2). Instrumental assessment utilized Fitbit Versa trackers, measuring daily steps and moderate/vigorous PA engagement (MVPA). Self-efficacy, perceived fatigue, walking ability, and quality of life were measured using the Self-Efficacy in Multiple Sclerosis scale (SEMS), the Fatigue Severity Scale, the 10-Meter Walk Test, and the Short Form-12 Health Survey. RESULTS: Usual-care physiotherapy did not improve (P >.05) daily steps (T0: 4139 [3333]; T1: 4438 [2505] steps per day), MVPA (T0: 6.00 [15.6]; T1: 10.52 [16.30] minutes per day), or self-efficacy (SEMS: T0: 42.0 [10.8]; T1: 40.5 [8.7] points). Low perceived fatigue, better overall PA, and good physical health perception were identified as predictors of positive changes in PA after physiotherapy. CONCLUSIONS: Usual-care physiotherapy focusing on mobility did not result in significant improvements in PA or self-efficacy for people with MS. Perceived fatigue and overall PA before physiotherapy impacted PA levels after rehabilitation. Future interventions may benefit from integrating motivational strategies into the rehabilitation protocol to increase PA levels.