The meaningfulness of exploring one's own limits through interactions and enjoyment in outdoor high-intensity physiotherapy for people with multiple sclerosis: a qualitative study.
Stine Susanne Haakonsen Dahl, Ellen Christin Arntzen, Britt Normann
PMID 38566621WHAT IT FOUND
People with MS described the outdoor sessions in a multi-component physiotherapy programme as meaningful.
They valued pushing limits with running/walking, detailed exercises, group support, outdoors and tailored physiotherapist interaction.
Key findings
01Participants reported strong positive experiences of being supported and pushed to explore their physical limits, including improved performance, higher training intensity, balance gains or running again.
02The outdoor group's meaning was linked to the engaging group setting, the natural outdoor environment, and tailored physiotherapist interaction, including hands-on correction and running or walking with participants.
03Some participants reported negative experiences, including soft-tissue injury in two people, increased dizziness in one, negative feelings about not reaching high intensity in three, and leg tiredness from standing exercises.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
This is a qualitative interview study of 15 people from the intervention group only, with no comparison group, so it reports experiences, not treatment effects. Participants were employed adults with relapsing remitting MS and EDSS 3.5 or lower, self-referred, and were motivated for physical activity, so findings may not apply to people with higher disability, non-relapsing forms, unemployed people, or other regions. Ethnicity and socio-economic class were not recorded, and the sample came from northern Norway, which limits transferability. The intervention included nurse consultation, physiotherapy assessment, indoor group training, digital videos, a multidisciplinary work meeting, outdoor group training and SMS reminders, so the contribution of the outdoor component alone cannot be separated. Researchers developed the intervention and were neurological physiotherapists, which may introduce blind spots, although external researchers and user representatives were involved. Attendance was not complete: mean outdoor participation was 4.6 sessions, with total mean attendance 57.3%, so experiences reflect partial exposure. No objective outcomes from the nested RCT are reported here.
Declared interests
The CoreDISTparticipation intervention and the parent RCT were funded by the Northern Norway Health Authority, and this interview study was funded by Nord University PhD salary. The authors declare financial support for research, authorship and publication.
The easy way to misread this
Do not conclude that outdoor high-intensity physiotherapy improves walking, balance or physical activity in people with MS. This study reports experiences from 15 participants in a multi-component programme, without a control group, and the contribution of the outdoor sessions alone cannot be separated. Do not assume high-intensity running is safe without assessment; two participants had soft-tissue injuries and one had increased dizziness.