College of Science, Health, Engineering and Education, Murdoch University, Murdoch, WA, Australia.
Multiple Sclerosis Western Australia, Wilson, WA, Australia.
Disabil Rehabil. 2021 Dec;43(25):3623-3638. doi: 10.1080/09638288.2020.1743778. Epub 2020 May 12.
We undertook a qualitative study that explored exercise participation and exercise promotion in the multiple sclerosis (MS) community who live in regional or remote areas of Australia. By simultaneously gathering views from persons with MS, carers, healthcare providers and healthcare managers we aimed to gather unique perspectives which represented views from across socio-ecological levels of MS healthcare.
We used interpretive description methodology, and conducted semi-structured interviews or focus groups with people with MS ( = 28), carers ( = 8), healthcare providers ( = 12) and managers/supervisors of MS healthcare systems ( = 16). Data were analysed using thematic analysis.
We identified three themes with 10 subthemes. The first theme was "Factors associated with exercise engagement" for the people with MS, from individual, interpersonal, organisational and community/public policy perspectives. The second theme was "Factors influencing the MS community's promotion of exercise" focusing on carers, healthcare providers and healthcare systems. The third theme was "Motivators to increase exercise promotion" which should be delivered by the MS community across varying socio-ecological levels of healthcare to encourage exercise participation.
We identified new evidence on the factors which influence the MS community's promotion of exercise and we now better understand that training on exercise should be provided to the wider MS community, and exercise services should be considered locally and perhaps delivered via teleheath.IMPLICATIONS FOR REHABILITATIONCohesive healthcare campaigns, and clinical guidelines based on empirical evidence should be established for symptom management in MS with a focus on the role of exercise.Symptom management strategies should consider the whole MS community, including patients, carers, healthcare professional and healthcare co-ordinators.Internal factors (e.g., emotion and motivation) and broader factors (e.g., funding and location) must be considered when designing exercise interventions in persons with MS.
我们进行了一项定性研究，探讨了居住在澳大利亚偏远地区的多发性硬化症（MS）患者的运动参与和运动促进情况。通过同时收集 MS 患者、照顾者、医疗保健提供者和医疗保健管理人员的意见，我们旨在收集独特的观点，代表 MS 医疗保健各个社会生态层面的观点。
我们使用解释性描述方法，对 28 名 MS 患者、8 名照顾者、12 名医疗保健提供者和 16 名 MS 医疗保健系统的管理人员/主管进行了半结构式访谈或焦点小组讨论。使用主题分析对数据进行分析。
我们确定了三个主题，包括 10 个子主题。第一个主题是“与运动参与相关的因素”，针对 MS 患者，从个人、人际、组织和社区/公共政策角度进行了探讨。第二个主题是“影响 MS 社区促进运动的因素”，重点关注照顾者、医疗保健提供者和医疗保健系统。第三个主题是“增加运动促进的动力”，应该由 MS 社区在不同的社会生态层面的医疗保健中提供，以鼓励运动参与。
我们确定了影响 MS 社区促进运动的新证据，我们现在更好地了解到，应该向更广泛的 MS 社区提供有关运动的培训，并且应该在当地考虑运动服务，也许可以通过远程医疗提供。
应该为 MS 制定基于循证医学的关于症状管理的综合医疗保健运动和临床指南，重点关注运动的作用。症状管理策略应考虑整个 MS 社区，包括患者、照顾者、医疗保健专业人员和医疗保健协调员。在为 MS 患者设计运动干预措施时，必须考虑内部因素（例如情绪和动机）和更广泛的因素（例如资金和位置）。
