Multiple Sclerosis Physiotherapy by Video: What to Expect

What can physiotherapy discuss for MS?

A physiotherapy discussion may start with the activity the person wants to talk about, such as moving around the home, using a mobility aid, or managing a daily routine. Ask what has changed, what the person has already discussed with their MS team, and what support is available. The clinician should consider the person's own goals rather than assume one target or programme fits everyone [1][2].

NICE recommends encouraging people with MS to exercise and advises that regular exercise may have beneficial effects and does not have harmful effects on MS. This is general guidance, not an individual exercise prescription. The person should discuss their own symptoms, restrictions, fatigue and current care advice with their treating team before changing activity [1].

What may a video appointment include?

The clinician may ask about goals, recent changes, falls, mobility aids, fatigue, support and the home environment. A video call can support a conversation and may allow selected movement to be observed when the clinician and person agree that it is safe. The person can decline a movement or stop at any time; there is no need to rearrange furniture, remove a mobility aid or attempt a balance task for the camera.

The call quality, camera view, communication needs and available support can limit what is seen. Share those limits at the start. A helper should join only if the person wants them there and should not perform a lift or test. The purpose is to decide what can be discussed remotely, not to prove that every part of a physiotherapy assessment can be done by video [4][5].

Before joining, choose a private place and put the device on a stable surface. The person can ask why a movement is being discussed, decline it or pause the call. There is no need to change clothing, remove a support or move furniture just to create a camera view.

How does a clinician check whether video is suitable?

The clinician should ask what the person hopes to discuss, what has changed recently, what support is available, and whether the call can take place in a safe and private setting. The person should be able to decline any movement observation. A support person may join only if invited by the person receiving care.

Video cannot show every relevant detail. If the clinician cannot assess a concern safely, they should explain the limitation and recommend another route, such as an in-person appointment or contact with the person's MS team. The person should not attempt a challenging balance task, transfer or walk simply to demonstrate it on camera.

NICE recommends activity and fatigue-related support in defined circumstances; that does not set one exercise prescription for every person. Telerehabilitation evidence includes varied programmes and does not establish that a particular video format is suitable for everyone [1][3].

What does video not replace?

Physiotherapy by video does not diagnose MS or determine whether a new symptom is a relapse. It does not replace neurological review, medication decisions, equipment fitting or an examination that requires physical contact. A clinician may recommend an in-person assessment or suggest that the person contact their MS team when a video conversation cannot answer the question safely [1][4].

The Cochrane review describes low-quality, varied evidence and does not establish one overall conclusion for every person or intervention [3]. A later review identified 10 exercise-based studies with different formats and measures; five reported significant improvements in the intervention group. Its authors describe results as comparable in most assessed aspects, but these findings are not a promise of benefit or proof that remote care suits every goal [4].

How should fatigue and pacing be discussed?

Fatigue can affect daily activity, but it varies between people and may have more than one contributing factor. A clinician can ask when it occurs, which activities are affected and what the person's MS team has advised. NICE gives specific recommendations for defined situations; for example, for people with MS and moderately impaired mobility (EDSS 4 or above), it says to consider supervised aerobic and moderate progressive resistance activity together with cognitive behavioural techniques. This is not a universal prescription, and the person's clinician must determine what applies [1].

If fatigue or another symptom changes, discuss it with the treating team rather than assuming the cause. Rehabilitation evidence spans different interventions and outcomes, so a review result does not predict an individual's response [2][4]. The person can ask whether a goal is suitable for remote discussion and what information would help the clinician decide.

Video and in-person care have different limits

The clinician should explain what can be discussed in each format and recommend a suitable next step for the person's goals and safety.

• Video may support discussion of goals, daily routines, fatigue questions and home context.
• In-person review may be needed for hands-on examination, equipment fitting or a safety assessment that cannot be done remotely.
• New or rapidly changing symptoms need medical advice rather than a routine physiotherapy request.

When to seek medical advice

Contact the person's MS team or an appropriate local medical service for new or worsening symptoms. Do not use a routine physiotherapy request to determine whether a change is a relapse. This page is not a diagnostic or triage tool; use local emergency services if the situation may be an emergency.

What to prepare for a video session

• The person's main goal and the daily task they want to discuss.
• Current advice from their neurologist or MS team and any relevant restrictions.
• A list of recent falls, mobility aids and support available at home.
• A clear area for the call; do not move furniture or attempt a difficult task just for the video.
• A support person only if the person wants them to attend.