Abstract
Group-based physiotherapy is a common and beneficial intervention for people with multiple sclerosis (MS). Most group interventions are not individually adapted to each participant's needs. Evidence on how individualization and group elements can be combined in a clinical setting is lacking. The objective of this study is to expand the knowledge base in neurological physiotherapy by investigating the nature of group dynamics in a group-based, individualized intervention for people with MS. This qualitative study included 13 nonparticipatory video observations (14 hr 38 min) of GroupCoreDIST exercise sessions complemented by 13 interviews (12 hr 37 min) with physiotherapists (PTs). The purposively sampled participants included 40 patients with MS (expanded disability scale of 1.0-6.5) and six PTs with expertise in neurological physiotherapy. Data were analysed using systematic text condensation in an enactive theoretical framework. Two main categories emerged from the material. (a) Individual systems affect group dynamics: Individual perceptions of success through adapted and embodied approaches positively affected the dynamics of the group. (b) Disease and exercise peer support: Social support was a substantial product of dynamic group processes and was enhanced through the PTs' strategic focus on experience sharing. The results revealed that group dynamics benefit from individualization and the PTs' focus on experience sharing. These findings are contrary to the prevailing view that individualization and group-based interventions are mutually exclusive and thus should be considered in group-based interventions for people with MS.
Highlights
Group-based exercise is a widespread physiotherapy intervention for people with multiple sclerosis (MS) (Rasova et al, 2016), and related effect studies indicate improvements in several vital health domains, such as strength, gait, balance, fatigue, exercise tolerance, and quality of life (Arntzen et al, 2019; Forsberg, von Koch, & Nilsagård, 2016; McCullagh, Fitzgerald, Murphy, & Cooke, 2008; Tarakci, Yeldan, Huseyinsinoglu, Zenginler, & Eraksoy, 2013; Taylor, Dodd, Prasad, & Denisenko, 2006)
The PTs' interaction strategies differed between the individual and the group, and a relationship was apparent between success at an individual level and how dynamic processes within the group evolved
Individual success and improvements through individualized and physical approaches positively affected group dynamics in a group-based intervention for people with MS. These findings contrast with the view that group-based and individualized interventions are mutually exclusive
Summary
Group-based exercise is a widespread physiotherapy intervention for people with multiple sclerosis (MS) (Rasova et al, 2016), and related effect studies indicate improvements in several vital health domains, such as strength, gait, balance, fatigue, exercise tolerance, and quality of life (Arntzen et al, 2019; Forsberg, von Koch, & Nilsagård, 2016; McCullagh, Fitzgerald, Murphy, & Cooke, 2008; Tarakci, Yeldan, Huseyinsinoglu, Zenginler, & Eraksoy, 2013; Taylor, Dodd, Prasad, & Denisenko, 2006). No studies have investigated how peer support processes occur in the clinical setting, reflecting the need for qualitative observational studies to develop group-based interventions for people with MS. According to Plow, Mathiowetz, and Lowe (2009), group-based therapy may not address patients' individual and complex needs and conflicts with the prevailing principle of individualization in MS rehabilitation (Amatya, Khan, & Galea, 2019; EMSP, 2012; Freeman & Gunn, 2018; National Institute for Health and Care Excellence, 2014). To explore how group dynamic processes take place in group-based and individualized physiotherapy interventions, qualitative investigations of GroupCoreDIST exercise sessions served as the basis for our study
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