Review Article

Determining the use and value of social support in Telerehabiliation Interventions for individuals with Multiple Sclerosis: A narrative synthesis review

Lucinda Pidgeon, Trudy Pelton* and Andrew Soundy

Published: 03 October, 2017 | Volume 1 - Issue 3 | Pages: 120-136

Background: Telerehabilitation has been identified as an effective treatment that promotes exercise rehabilitation in individuals with multiple sclerosis (MS). Social support is recognised as a core element of such interventions. However further research is needed to consider the role and value of different social support domains.

Aim: Review available literature to assess and synthesise the use and value of social support within telerehabilitation interventions for individuals with MS.

Method: A narrative synthesis was conducted. A systematic search of included articles was conducted. Electronic databases were searched from inception to January 2017. Other search methods were undertaken. Evaluation and synthesis of included articles utilised risk of bias assessment and a 4-stage synthesis process.

Main Results: A total of fourteen studies, involving 718 participants (505 female, 213 male; aggregated mean age 47.6 years) with MS, were included. Esteem support was the most frequently reported method of social support, followed by informational, emotional and tangible. It would appear social support can be beneficial in assisting participants to adhere to treatment interventions. Visual feedback may be directly beneficial to improve impaired balance in individuals with MS. A model for future interventions is provided.

Conclusions: Social support appears to increase the adherence of participants with MS to telerehabilitation interventions. Unique findings provide an indication for the direction and content of future interventions. Further research is necessary to ascertain the optimal types and frequencies of social support delivery and its effect on health outcomes for participants with MS.

Read Full Article HTML DOI: 10.29328/journal.jnpr.1001014 Cite this Article Read Full Article PDF


Telerehabilitation; Tele rehabilitation; Telemedicine; E-health; MS; Multiple sclerosis; Physiotherapy; Physical therapy; Rehabilitation


  1. Kister I, Bacon TE, Chamot E, Salter AR, Cutter GR, et al. Natural History of Multiple Sclerosis Symptoms. Int J MS Care. 2013; 15: 146-158. Ref.: https://goo.gl/ApY1ZC  
  2. Motl RW, McAuley E, Snook EM. Physical activity and multiple sclerosis: a meta-analysis. Mult Scler. 2005; 11: 459-463. Ref.: https://goo.gl/snMzdV  
  3. Mostert S, Kesselring J. Effects of a short-term exercise training program on aerobic fitness, fatigue, health perception and activity level of subjects with multiple sclerosis. Mult Scler. 2002; 8: 161-168. Ref.: https://goo.gl/5DLo6K  
  4. Remington G, Rodriguez Y, Logan D, Williamson C, Treadaway K. Facilitating medication adherence in patients with multiple sclerosis. Int J MS Care. 2013; 15: 36-45. Ref.: https://goo.gl/12C1n8  
  5. Klauer T, Zettl UK. Compliance, adherence, and the treatment of multiple sclerosis. J Neurol. 2008; 255: 87-92. Ref.: https://goo.gl/AfuP4F  
  6. Rietberg MB, Brooks D, Uitdehaag BMJ, Kwakkel G. Exercise therapy for multiple sclerosis. Cochrane Database Syst Rev. 2005; Ref.: https://goo.gl/oWZpiR  
  7. Khan F, Turner-Stokes L, Ng L, Kilpatrick T, Amatya B. Multidisciplinary rehabilitation for adults with multiple sclerosis. Cochrane Database Syst Rev. 2007; 2: Ref.: https://goo.gl/728cr7  
  8. Campbell E, Coulter EH, Mattison PG, Miller L, McFadyen A, et al. Physiotherapy rehabilitation for people with progressive multiple sclerosis: a systematic review. Arch Phys Med Rehabil. 2016; 97: 141-151. Ref.: https://goo.gl/UgM5vs  
  9. Khan F, Amatya B, Kesselring J, Galea M. Telerehabilitation for persons with multiple sclerosis. Cochrane Database Syst Rev. 2015; 4: Ref.: https://goo.gl/Ua7suS   
  10. Brennan DM, Mawson S, Brownsell S. Telerehabilitation: enabling the remote delivery of healthcare, rehabilitation, and selfmanagement. Stud Health Technol Inform. 2009; 145: 231-248. Ref.: https://goo.gl/G3iQcA  
  11. Laver KE, Schoene D, Crotty M, George S, Lannin NA, et al. Telerehabilitation services for stroke. Cochrane Database Syst Rev. 2014; 12: Ref.: https://goo.gl/beYiHf  
  12. Prosperini L, Leonardi L, De Carli P, Mannocchi ML, Pozzilli C. Visuo-proprioceptive training reduces risk of falls in patients with multiple sclerosis. Mult Scler. 2010; 16: 491-499. Ref.:
  13. Rees T, Hardy L. An Investigation of the social support experiences of high-level sports performers. The Sport Psychologist. 2000; 14: 327-347. Ref.: https://goo.gl/unFYcc  
  14. Rees T, Smith B, Sparkes AC. The influence of social support on the lived experiences of spinal cord injured sportsmen. The Sport Psychologist. 2003; 17: 135-156. Ref.: https://goo.gl/uSPoHZ  
  15. McAuley E, Motl RW, Morris KS, Hu L, Doerksen SE, et al. Enhancing physical activity adherence and well-being in multiple sclerosis: a randomised controlled trial. Mult Scler. 2007; 13: 652-659. Ref.: https://goo.gl/UbrLUT  
  16. Ashford S, Edmunds J, French DP. What is the best way to change self‐efficacy to promote lifestyle and recreational physical activity? A systematic review with meta‐analysis. Br J Health Psychol. 2010; 15: 265-288. Ref.: https://goo.gl/MpxAMX  
  17. Skår ABR, Folkestad H, Smedal T, Grytten N. “I refer to them as my colleagues”: the experience of mutual recognition of self, identity and empowerment in multiple sclerosis. Disabil Rehabil. 2014; 36: 672-677. Ref.: https://goo.gl/xLu5Zu  
  18. Fakolade A, Finlayson M, Plow M. Using telerehabilitation to support people with multiple sclerosis: A qualitative analysis of interactions, processes, and issues across three interventions. British Journal of Occupational Therapy. 2017; 80: 259-268. Ref.: https://goo.gl/FvVALN  
  19. Ennis M, Thain J, Boggild M, Baker GA, Young CA. A randomized controlled trial of a health promotion education programme for people with multiple sclerosis. Clin Rehabil. 2006; 20: 783-793. Ref.: https://goo.gl/3ZxfKU  
  20. Malcomson KS, Lowe-Strong AS, Dunwoody L. What can we learn from the personal insights of individuals living and coping with multiple sclerosis? Disabil Rehabil. 2008; 30: 662-674. Ref.: https://goo.gl/Rt2VTN  
  21. Methley AM, Chew‐Graham C, Campbell S, Cheraghi‐Sohi S. Experiences of UK health‐care services for people with Multiple Sclerosis: a systematic narrative review. Health Expect. 2015; 18: 1844-1855. Ref.: https://goo.gl/PBHKXx  
  22. Motl RW, Snook EM, McAuley E, Scott JA, Douglass ML. Correlates of Physical Activity among Individuals with Multiple Sclerosis. Ann Behav Med. 2006; 32: 154-161. Ref.: https://goo.gl/FCreEs  
  23. Motl RW, Snook EM. Physical activity, self-efficacy, and quality of life in multiple sclerosis. Ann Behav Med. 2008; 35: 111. Ref.: https://goo.gl/qZjFVs  
  24. Rose A, Rosewilliam S, Soundy A. Shared decision making within goal setting in rehabilitation settings: A systematic review. Patient Educ Couns. 2017; 100: 65-75. Ref.: https://goo.gl/QYoJmn  
  25. Soundy A, Roskell C, Adams R, Elder T, Dawes H. Understanding health care professional interactions in multiple sclerosis: A systematic review and thematic synthesis, OJTR. 2016; 4: 187-217. Ref.: https://goo.gl/PXY5tK  
  26. Rieckmann P, Boyko A, Centonze D, Elovaara I, Giovannoni G, et al. Achieving patient engagement in multiple sclerosis: A perspective from multiple sclerosis in the 21st century steering group. Multiple Sclerosis and Related Disorders, 2015; 4: 202-218. Ref.: https://goo.gl/DFPbD7  
  27. Gross J, Vancampfort D, Stubbs B, Gorczynski P, Soundy A. A narrative synthesis investigating the use and value of social support to promote physical activity among individuals with schizophrenia. Disabil Rehabil. 2016; 38: 123-150. Ref.: https://goo.gl/qKWsny  
  28. Soundy A, Roskell C, Elder T, Collette J, Dawes H. The psychological processes of adaptation and hope in patients with multiple sclerosis: A thematic synthesis. OJTR. 2016; 4: 22-47. Ref.: https://goo.gl/cWZWUd  
  29. Rodgers M, Sowden A, Petticrew M, Arai L, Roberts H, Britten N, al e. Testing methodological guidance on the conduct of narrative synthesis in systematic reviews. Evaluation 2009; 15: 49-74.
  30. Cooke, A., Smith, D., Booth, A. (2012). Beyond PICO: the SPIDER tool for qualitative evidence synthesis. Qualitative Health Research, 22: 1435-1443.
  31. Yu CH, Mathiowetz V. Systematic review of occupational therapy-related interventions for people with multiple sclerosis: Part 1. Activity and participation. Am J Occup Ther. 2014; 68: 27-32. Ref.: https://goo.gl/Wv8gDc  
  32. Donzé C. Update on rehabilitation in multiple sclerosis. Presse Médicale, 2015; 44: 169-176. Ref.: https://goo.gl/Qobwys
  33. Brichetto G, Spallarossa P, de Carvalho MLL, Battaglia MA. The effect of Nintendo® Wii® on balance in people with multiple sclerosis: a pilot randomized control study. Mult Scler. 2013; 19: 1219-1221. Ref.: https://goo.gl/oDYVW8  
  34. Finkelstein J, Lapshin O, Castro H, Cha E, Provance PG. Home-based physical telerehabilitation in patients with multiple sclerosis: a pilot study. J Rehabil Res Dev. 2008; 45: 1361-1374. Ref.: https://goo.gl/Gh2aZg  
  35. Nilsagård YE, Forsberg AS, von Koch L. Balance exercise for persons with multiple sclerosis using Wii games: a randomised, controlled multi-centre study. Mult Scler. 2013; 19: 209-216. Ref.: https://goo.gl/yjtpY4  
  36. Ortiz-Gutiérrez R, Galán del Río F, Cano de la Cuerda R, Diego A, Isabel M, et al. A telerehabilitation program by virtual reality-video games improved balance and postural control in multiple sclerosis patients. NeuroRehabilitation. 2013; 33: 545-554. Ref.: https://goo.gl/vHSbME  
  37. Motl RW, Dlugonski D, Wójcicki TR, McAuley E, Mohr DC. Internet intervention for increasing physical activity in persons with multiple sclerosis. Mult Scler. 2011; 17: 116-128. Ref.: https://goo.gl/ZfEA5P  
  38. Huijgen BC, Vollenbroek-Hutten MM, Zampolini M, Opisso E, Bernabeu M, et al. Feasibility of a home-based telerehabilitation system compared to usual care: arm/hand function in patients with stroke, traumatic brain injury and multiple sclerosis. J Telemed Telecare. 2008; 14: 249-256. Ref.: https://goo.gl/4tjF68  
  39. Mercier HW, Ni P, Houlihan BV, Jette AM. Differential Impact and Use of a Telehealth Intervention by Persons with MS or SCI. Am J Phys Med Rehabil. 2015; 94: 987-999. Ref.: https://goo.gl/vk9aVL  
  40. Plow M, Finlayson M. Potential benefits of Nintendo Wii Fit among people with multiple sclerosis: a longitudinal pilot study. Int J MS Care. 2011; 13: 21-30. Ref.: https://goo.gl/jxfrmw  
  41. Turner AP, Hartoonian N, Sloan AP, Benich M, Kivlahan DR, et al. Improving fatigue and depression in individuals with multiple sclerosis using telephone-administered physical activity counseling. J Consult Clin Psychol. 2016; 84: 297-309. Ref.: https://goo.gl/pL5b22  
  42. Saposnik G, Mamdani M, Bayley M, Thorpe KE, Hall J, et al. Effectiveness of Virtual Reality Exercises in STroke Rehabilitation (EVREST): rationale, design, and protocol of a pilot randomized clinical trial assessing the Wii gaming system. Int J Stroke. 2010; 5: 47-51. Ref.: https://goo.gl/23efWm  
  43. Gulick EE. Social support among persons with multiple sclerosis. Research in Nursing & Health. 1994; 17: 195-206. Ref.: https://goo.gl/DdmuiB  
  44. Hwang JE, Cvitanovich DC, Doroski EK, Vajarakitipongse JG. Correlations between quality of life and adaptation factors among people with multiple sclerosis. Am J Occup Ther. 2011; 65: 661-669. Ref.: https://goo.gl/rdNfiw  
  45. Campbell D, Stanley JC. Experimental and quasi-experimental designs for research, Chicago: Rand McNally College Publishing. 1963.
  46. Rodgers M, Sowden A, Petticrew M, Arai L, Roberts H, et al. Testing methodological guidance on the conduct of narrative synthesis in systematic reviews: effectiveness of interventions to promote smoke alarm ownership and function. Evaluation. 2009; 15: 49-73. Ref.: https://goo.gl/DJdZ8b  
  47. Mackenzie IS, Morant SV, Bloomfield GA, MacDonald TM, O’riordan J. Incidence and prevalence of multiple sclerosis in the UK 1990–2010: a descriptive study in the General Practice Research Database. J Neurol Neurosurg Psychiatry. 2014; 85: 76-84. Ref.: https://goo.gl/JA4FB9   
  48. Langer-Gould A, Brara SM, Beaber BE, Zhang JL. Incidence of multiple sclerosis in multiple racial and ethnic groups. Neurology. 2013; 80: 1734-1739. Ref.: https://goo.gl/Jh3pCk   
  49. Marrie RA, Cohen J, Stuve O, Trojano M, Sørensen PS, et al. A Systematic review of the incidence and prevalence of comorbidity in multiple sclerosis: Overview. Mult Scler. 2015; 21: 263-281. Ref.: https://goo.gl/yh8y8E  
  50. Edwards J, Kaimal G. Using meta-synthesis to support application of qualitative methods findings in practice: A discussion of meta-ethnography, narrative synthesis, and critical interpretive synthesis. The Arts in Psychotherapy, 2016; 51: 30-35. Ref.: https://goo.gl/AEwXDM  
  51. Bombardier CH, Cunniffe M, Wadhwani R, Gibbons LE, Blake KD, et al. The efficacy of telephone counseling for health promotion in people with multiple sclerosis: a randomized controlled trial. Arch Phys Med Rehabil. 2008; 89: 1849-1856. Ref.: https://goo.gl/1jx63V   
  52. Dlugonski D, Motl RW, Mohr DC, Sandroff BM. Internet-delivered behavioral intervention to increase physical activity in persons with multiple sclerosis: sustainability and secondary outcomes. Psychol Health Med. 2012; 17: 636-651. Ref.: https://goo.gl/nh7X99  
  53. Pilutti LA, Dlugonski D, Sandroff BM, Klaren R, Motl RW. Randomized controlled trial of a behavioral intervention targeting symptoms and physical activity in multiple sclerosis. Mult Scler. 2014; 20: 594-601. Ref.: https://goo.gl/jZX5Yd
  54. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred Reporting Items for Systematic Reviews and Meta- Analyses: The PRISMA Statement. PLoS Med. 2009; 6: e1000097. Ref.: https://goo.gl/b8q97y
  55. Coulter A. Patient engagement--What works? J Ambul Care Manage. 2012; 35: 80-89. Ref.: https://goo.gl/KirR6X  
  56. Levack WMM, Weatherall M, Hay-Smith EJC, Dean SG, McPherson K, et al. Goal setting strategies to enhance goal pursuit in adult rehabilitation: summary of a cochrane systematic review and meta-anlaysis. Eur J Phys Rehabil Med. 2016; 52: 400-416. Ref.: https://goo.gl/yA4TJx  
  57. Multiple Sclerosis Society UK. MS in the UK. Obtained from the World Wide Web 13/06/2017. 2016; 1-3. Ref.: https://goo.gl/D2rX97  
  58. Soundy A, Elder T. Developing and applying the theory of psychological adapation needs in patients with multiple sclerosis. In R. R. Watson & Killgore, W. D. S. Nutrition and lifestyle in neurological autoimmune diseases: multiple sclerosis. Academic Press. 2017.
  59. Stennett A, De Souza L, Norris M. Physical activity and exercise priorities in community dwelling people with multiple sclerosis: A delphi study. Disabil Rehabil. 2017; 1-8. Ref.: https://goo.gl/UpFfeQ
  60. Six PA. Mechanisms linking social ties and support to physical and mental health. J Health Soc Behav. 2011; 52: 145-161. Ref.: https://goo.gl/3UBeU9


Figure 1

Figure 1

Figure 1

Figure 2

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More

Help ?