community healthcare in the two municipalities. The project team
included three individuals representing users from the Nordland
MS Association, along with an MS nurse and a neurologist from
the MS-outpatient clinic, and three physiotherapists/ researchers.
2.4 Research team and reﬂexivity
All researchers on the team are clinical specialists in
neurological physiotherapy. BN and ECA developed the
CoreDISTparticipation intervention, and SSHD contributed to
the development of the outdoor part.
The researchers ’ closeness to the intervention and the
clinical ﬁeld may have strengthened the depth and relevance
of their interpretations in this study ( 27), as it was easy to
understand what participan ts described and helped form
follow-up questions during the interviews. However, closeness
m a ya l s op r o d u c ear i s ko f“blind spots ”, as the researchers
may prejudice participants ’ experiences, omitting questions
where the answers are believed to be obvious ( 27). Thus,
throughout the process, trustworthiness and rigor were
enhanced by discussing the methodology, ﬁndings, and
interpretations with external res earchers (including specialists
in enactive theory), as well as user representatives. The
presented theoretical framework (enactive theory) enhanced
the distance to the material, as recommended in qualitative
research (28).
2.5 Recruitment and participants
Prior to recruitment, the study was introduced to individuals
with multiple sclerosis (pwMS) through a seminar hosted by the
Nordland MS Association. Additionally, seminars were
conducted for health professionals in community healthcare and
at the regional hospital. Written information about this study
(and the RCT) was sent from the MS clinic at the regional
hospital by post to all eligible individuals af ﬁliated with the
hospital. Individuals who wished to participate signed the
attached consent form and returned it in the pre-stamped
envelope. The inclusion criteria were as follows: had been
diagnosed with MS, had a score on the Expanded Disability
Status Scale (EDSS) (29)o f ≤3.5, was ≥18 years, was employed
(10%–100% of full-time) and residential address in the two
predeﬁned municipalities. The exclusion criteria were as follows:
pregnancy, exacerbation of symptoms within two weeks prior to
enrollment and other serious conditions compromising balance,
walking or work capacity. All participants in the intervention
group of the RCT (n = 15) were included (Table 3).
2.6 Data collection
The interview guide (Table 4) was developed based on literature
reviews, clinical experience and discussions within the research
group and with user representatives. Two test interviews were
conducted (with pwMS who were not part of the sample), and the
interview guide was then reﬁned around the following themes:
overall experience and re ﬂections from participation, content,
outdoor setting, the group, and the physiotherapists. Questions
were open-ended to capture rich, in-depth reﬂections regarding
participants’ experiences, following a phenomenological approach.
The interviewer asked for both negative and positive experiences
TABLE 4 Interview guide.
Theme Potential questions
Overall experiences and
reﬂections from participation
Generally, what are your main experiences of
participation?
What did you perceive as meaningful?
What did you perceive as negative?
Content How did you experience:
 The content of the sessions in general
 The high-intensity walking/running
 The speciﬁc exercises
 The combination of speciﬁc exercises and
intervals of running/walking
 The exercise intensity
How did you respond to the exercises? How did
you experience getting tired?
How do you perceive your speciﬁc movement
impairments (if any) being addressed?
Please elaborate on situations where you
experienced the feeling of mastery/failure.
If anything: What was challenging? What would
you prefer to have been done differently? What
did you enjoy?
What was the value of participating in the