Rapid Conversion Evidence Summary (RaCES) Internship with the Person-Centred Complex Care (PCCC) theme

Background: Physical activity benefits health and wellbeing and is a key component of the management of people with multiple sclerosis (PwMS) identified in the NICE MS Quality Standards (National Institute for Health and Care Excellence, 2016). However, although new UK physical activity guidelines have an increased focus on strengthening activity, there exists a low awareness and understanding of this amongst PwMS, whose physical activity is more often aerobic than strengthening. The NICE Guidelines on the Management of MS in Adults (National Institute for Health and Care Excellence, 2014) recommend that supervised exercise programmes involving strength training are utilised to treat people with MS. Previous research has reported favourable responses to face-to-face exercise groups specifically for PwMS, with the social role of the group of greatest importance by providing motivation and support from others with shared experiences. A gap in service provision was identified regarding strength training for PwMS and previous research and service efficiency priorities indicated that this could be delivered in a group session.

Research aims and objectives:
1) to complete a RaCES publication to explore the evidence underpinning strength training guidelines for PwMS
2) to plan the implementation of a supervised group strength training programme for PwMS within a neurological out-patient physiotherapy service.

Methods: This internship had 2 distinct components:
1) The RaCES project involved:
• carrying out a literature search and identifying appropriate systematic reviews to include,
• assessing the quality of the included reviews,
• summarising the findings from the reviews and evaluating the findings within the context of current guideline recommendations.
2) The development of the implementation plan was supported by completion of the Improving Clinical Care Through Implementation Science MSc module.

Reviews were identified via a PubMed search using a variety of terms for multiple sclerosis and strengthening exercise. The reviews were assessed for methodological quality using the Joanna Briggs Institute (JBI) critical appraisal tool. The findings of the reviews were collated in text and tables.
Data collection did not take place as part of implementation planning

Patient and public involvement: A single 1:1 service user session was completed remotely which provided valuable feedback about barriers and facilitators to exercise, the proposed intervention and implementation plan.

Findings: Four systematic reviews were summarised for this RaCES. The literature focused on mild to moderate MS and identified that strength training improved muscle strength, but that its impact on other functional outcomes was unclear. Guidelines for strength training for PwMS were found to be broadly supported by research evidence at individual study level and systematic review/meta-analysis level. These guidelines provide a basis for the parameters of exercise but do not provide a clear method of delivery or a clearly defined strength activity intervention. The implementation planning included use of the Consolidated Framework for Implementation Research (CFIR) to understand context and select implementation strategies and the Health Inequalities Assessment Tool to identify inequalities. The Plan, Do, Study, Act (PDSA) cycle was identified as a means for implementation.

Potential impact: The RaCES publication identified the evidence underpinning the current guidelines and summarised the guidelines in an accessible format for clinicians. The RaCES publication was also developed into a lay infographic and shared with local clinical and academic teams.
Due to service limitations the implementation plan has not been able to be actioned. From a personal development perspective, the internship work completed supported an application for a research role at UCLan and has contributed towards a Masters qualification.

Links:
• ARC Fest Presentation (December 2021)
• ARC NWC Internship Poster
• Publication – Strength training for people with multiple sclerosis and the current recommendations

For more information, contact hjgooch@uclan.ac.uk