title: The organisation of physiotherapy for people with multiple sclerosis across Europe: a multicentre questionnaire survey.
abstract: Understanding the organisational set-up of physiotherapy services across different countries is increasingly important as clinicians around the world use evidence to improve their practice. This also has to be taken into consideration when multi-centre international clinical trials are conducted. This survey aimed to systematically describe organisational aspects of physiotherapy services for people with multiple sclerosis (MS) across Europe.
  
  
  
  Representatives from 72 rehabilitation facilities within 23 European countries completed an online web-based questionnaire survey between 2013 and 2014. Countries were categorised according to four European regions (defined by United Nations Statistics). Similarities and differences between regions were examined.
  
  
  
  Most participating centres specialized in rehabilitation (82 %) and neurology (60 %), with only 38 % specialising in MS. Of these, the Western based Specialist MS centres were predominately based on outpatient services (median MS inpatient ratio 0.14), whilst the Eastern based European services were mostly inpatient in nature (median MS inpatient ratio 0.5). In almost all participating countries, medical doctors - specialists in neurology (60 %) and in rehabilitation (64 %) - were responsible for referral to/prescription of physiotherapy. The most frequent reason for referral to/prescription of physiotherapy was the worsening of symptoms (78 % of centres). Physiotherapists were the most common members of the rehabilitation team; comprising 49 % of the team in Eastern countries compared to approximately 30 % in the rest of Europe. Teamwork was commonly adopted; 86 % of centres based in Western countries utilised the interdisciplinary model, whilst the multidisciplinary model was utilised in Eastern based countries (p = 0.046).
  
  
  
  This survey is the first to provide data about organisational aspects of physiotherapy for people with MS across Europe. Overall, care in key organisational aspects of service provision is broadly similar across regions, although some variations, for example the models of teamwork utilised, are apparent. Organisational framework specifics should be considered anytime a multi-centre study is conducted and results from such studies are applied.
authors.affiliation: Department of rehabilitation, Third Faculty of Medicine, Charles University in Prague, Ruska 87, Prague 10, 100 00, Czech Republic. kamila.rasova@gmail.com.|Third Faculty of Medicine, Charles University in Prague, Ruska 87, Prague 10, 100 00, Czech Republic. kamila.rasova@gmail.com.
authors.forename: Kamila
authors.initials: K
authors.lastname: Rasova
authors.affiliation: Faculty of Health and Human Science, Plymouth University, Playmouth, PL6 8BH, England.
authors.forename: Jenny
authors.initials: J
authors.lastname: Freeman
authors.affiliation: Institute of Computer Science, Academy of Sciences of the Czech Republic, Pod Vodarenskou vezi 2, Prague 8, 182 07, Czech Republic.
authors.forename: Patricia
authors.initials: P
authors.lastname: Martinkova
authors.affiliation: Third Faculty of Medicine, Charles University in Prague, Ruska 87, Prague 10, 100 00, Czech Republic.
authors.forename: Marketa
authors.initials: M
authors.lastname: Pavlikova
authors.affiliation: Don Gnocchi Foundation, Larice Lab, Santa Maria Nascente, Via Capecelatro 66, 20148, Milan, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Cattaneo
authors.affiliation: Neurorehabilitation at the Don Gnocchi Foundation, Larice Lab, Santa Maria Nascente, Via Capecelatro 66, 20148, Milan, Italy.
authors.forename: Johanna
authors.initials: J
authors.lastname: Jonsdottir
authors.affiliation: PASSAUER WOLF Reha-Zentrum Nittenau, Rehabilitations klinik für Neurologie-Geriatrie-Urologie, Eichendorffstr. 21, D-93149, Nittenau, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Henze
authors.affiliation: Hasselt University, Campus Diepenbeek, REVAL Rehabilitation Research Institute (BIOMED), Agoralaan building A, B-3590, Diepenbeek, Belgium.
authors.forename: Ilse
authors.initials: I
authors.lastname: Baert
authors.affiliation: Fit Up, Fitness- and Physiotherapy Center, Mechelsesteen weg 192a, 2550, Kontich, Belgium.
authors.forename: Paul
authors.initials: P
authors.lastname: Van Asch
authors.affiliation: Cemcat, Neurorehabilitation Unit, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
authors.forename: Carme
authors.initials: C
authors.lastname: Santoyo
authors.affiliation: Department of Neurology, Norwegian Multiple Sclerosis Competence Centre, Haukeland University Hospital, P.O. Box 1400, 5021, Bergen, Norway.|Department of Physiotherapy, Haukeland University Hospital, P.O. Box 1400, 5021, Bergen, Norway.
authors.forename: Tori
authors.initials: T
authors.lastname: Smedal
authors.affiliation: MS-Senteret Hakadal AS, Blomsterbakken 33, 1487, Hakadal, Norway.
authors.forename: Antonie Giæver
authors.initials: AG
authors.lastname: Beiske
authors.affiliation: MS Rehabilitation Centre, Szpitalna 5, 78-449, Borne Sulinowo, Poland.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Stachowiak
authors.affiliation: MS Rehabilitation Centre, Szpitalna 5, 78-449, Borne Sulinowo, Poland.
authors.forename: Mariusz
authors.initials: M
authors.lastname: Kovalewski
authors.affiliation: Clinic for physical medicine and rehabilitation, Clinical Center of Serbia, Pasterova 2, 11000, Belgrade, Serbia.
authors.forename: Una
authors.initials: U
authors.lastname: Nedeljkovic
authors.affiliation: Technological Educational Institute of Athens, 24, Mitrodorou street, Ak. Pratonos, 10441, Athens, Greece.
authors.forename: Daphne
authors.initials: D
authors.lastname: Bakalidou
authors.affiliation: School of Health Sciences, Health Research Unit, Polytechnic Institute of Leiria, Campus 2 - Morro do Lena - Alto do Vieiro, 2411-901, Leiria, Portugal.
authors.forename: José Manuel Alves
authors.initials: JM
authors.lastname: Guerreiro
authors.affiliation: Faculty of Medicine and Health, Örebro University Region, SE- 701 82, Örebro, Sweden.
authors.forename: Ylva
authors.initials: Y
authors.lastname: Nilsagård
authors.affiliation: Institute of Physical Medicine and Rehabilitation, Faculty of Medicine, "Ss Cyril and Methodius" University, Elisie Popovski 28, 1000, Skopje, Macedonia, Republic of The former Yugoslav.
authors.forename: Erieta Nikolikj
authors.initials: EN
authors.lastname: Dimitrova
authors.affiliation: Referral Center for Demyelinating Diseases of the Central Nervous System University Department of Neurology Zagreb School of Medicine and University Hospital Center, Kispaticeva 12, HR-10000, Zagreb, Croatia.
authors.forename: Mario
authors.initials: M
authors.lastname: Habek
authors.affiliation: Physical Therapy and Rehabilitation departmant of Health Science Faculty, Hacettepe University, Ankara, Turkey.
authors.forename: Kadriye
authors.initials: K
authors.lastname: Armutlu
authors.affiliation: Groupe Hospitalier de l'institut Catholique de Lille, Department of physical Medicine and Rehabilitation hospital Saint Philibert, Faculté Libre de Médecine, Univ Nord de France, F-59000, Lille, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Donzé
authors.affiliation: St. James's Hospital, St. James's street, Dublin 8, Ireland.
authors.forename: Elaine
authors.initials: E
authors.lastname: Ross
authors.affiliation: "Elias" University Emergency Hospital, 17 Marasti Bulevard, Bucharest, 01146, Romania.
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Ilie
authors.affiliation: Divison of Neurology, Neurorehabilitation unit, University Medical Centre Ljubljana, Zaloška 2, 1000, Ljubljana, Slovenia.
authors.forename: Andrej
authors.initials: A
authors.lastname: Martić
authors.affiliation: Masku Neurological Rehabilitation Centre, Physiotherapy, Vaihemäentie 10, PO Box 15, 21251, Masku, Finland.
authors.forename: Anders
authors.initials: A
authors.lastname: Romberg
authors.affiliation: Hasselt University, Campus Diepenbeek, REVAL Rehabilitation Research Institute (BIOMED), Agoralaan building A, B-3590, Diepenbeek, Belgium.
authors.forename: Peter
authors.initials: P
authors.lastname: Feys
mesh_terms: D000553:Ambulatory Care / Q000706:statistics & numerical data; D005060:Europe; D006801:Humans; D007297:Inpatients; D009103:Multiple Sclerosis / Q000628:therapy*; D010348:Patient Care Team / Q000458:organization & administration; D026741:Physical Therapy Modalities / Q000458:organization & administration*; D055656:Prescriptions; D012017:Referral and Consultation / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires