Models and materials for exercise promotion in comprehensive multiple sclerosis care: completion of the ‘exercise <i>in</i> medicine’ development process

Health care providers have highlighted the need for tools and resources that support promotion of exercise behavior within comprehensive multiple sclerosis (MS) care. This study involved a final quality improvement evaluation of exercise promotion models and materials for inclusion within this setting. Our research team distributed a paper-based survey containing Likert scales, open answer questions, and copies of the models for editing. We distributed this survey among health care providers across the United States. We conducted a novel mixed-methods analysis evaluating quantitative, qualitative, and creative data. We received completed surveys from 13 health care providers who strongly rated the clarity and applicability of the models and materials, and reported that no major improvements were necessary. The minor improvements were specific per comprehensive MS care center. The feedback indicated that the “Exercise <i>in</i> Medicine” models and materials are <i>guides</i> such that the processes should be integrated into real world practice by amending roles and responsibilities with the team members and structure per comprehensive MS care center. This paper presents finalized models and materials for exercise promotion within comprehensive MS care that are ready to be tested for feasibility and efficacy in a clinical trial.IMPLICATIONS FOR REHABILITATIONHealth care providers require support to promote exercise within the context of comprehensive MS care.The practice models in this article provide guides regarding how to promote exercise in this context.Implementing these exercise promotion guides can reduce the burden of neurologists, and ensure patients receive exercise support from appropriate providers.These guides should be implemented within the context of each individual care center, and not as an explicit step by step guide as each care center is unique. Health care providers require support to promote exercise within the context of comprehensive MS care. The practice models in this article provide guides regarding how to promote exercise in this context. Implementing these exercise promotion guides can reduce the burden of neurologists, and ensure patients receive exercise support from appropriate providers. These guides should be implemented within the context of each individual care center, and not as an explicit step by step guide as each care center is unique.医疗保健从业者已明确提出，在综合性多发性硬化症（multiple sclerosis, MS）照护框架内，亟需能够支持锻炼行为推广的工具与资源。本研究针对适用于该场景的锻炼推广模型与材料，开展了最终质量改进评估。研究团队发放了包含李克特量表（Likert scales）、开放式问题以及供编辑使用的模型副本的纸质调查问卷，调查对象覆盖全美范围内的医疗保健从业者。本研究采用创新性混合方法分析，对定量数据、定性数据与创意类数据进行评估。最终共回收13份有效问卷，受访者高度认可相关模型与材料的清晰度与适用性，并表示无需进行重大改进。所提出的小幅优化方案均针对各综合性MS照护中心的具体情况制定。反馈结果显示，"Exercise in Medicine（临床诊疗中的锻炼）"相关模型与材料可作为实践指南，即需结合各综合性MS照护中心的团队成员职责与架构，将相关流程融入实际临床工作。本文呈现了适用于综合性MS照护场景的最终定稿锻炼推广模型与材料，已可在临床试验中开展可行性与有效性验证。 康复实践启示 医疗保健从业者在综合性MS照护场景中开展锻炼推广工作时，亟需相关支持。本文所述实践模型可为该场景下的锻炼推广提供行动指南。落实此类锻炼推广指南可减轻神经内科医师的工作负担，并确保患者能够从适配的医疗从业者处获得专业的锻炼支持。由于各照护中心均具有独特性，此类指南应结合各中心的具体场景落地实施，而非作为僵化的逐步骤操作手册。