2 Materials and methods
2.1 Design
Individual in-depth interviews using a phenomenological-
inspired approach were chosen, as this is suitable for exploring
the meaning and signi ﬁcance of pwMS ’s experiences and
reﬂections (23, 24).
2.2 Ethical considerations
The study was conducted according to the Declaration of
Helsinki and approved by the Regional Committee for Medical
Research Ethics in North Norway (REK North: 174837). Written
informed consent was obtained prior to the intervention and
conﬁrmed verbally when arranging the interviews. Participation
was voluntary and anonymous, and the participants were
informed about the opportunity to withdraw from the study. The
Consolidated Criteria for Reporting Qualitative Research (COREQ)
(25) were used to optimize the conduct and reporting of the study.
2.3 Study context
This interview study was nested within a randomized
controlled trial (RCT) comparing the CoreDISTparticipation
intervention to usual care ( 26) and conducted at a regional
hospital MS-outpatient clinic (Nordland Hospital Trust) and in
two afﬁliated municipalities in the northern Norway. The current
study investigates participants in the intervention group ’s
experiences of the four-week outdoor group, which was part of
this new intervention ( Table 2 ). The outdoor sessions were
conducted by three trained physiotherapists working in the
TABLE 2 Description of the outdoor group.
Content Purpose
Warm-up and recording one’s own balance
Exercises for detailed sensorimotor
activation, larger muscle groups, muscle
length and balance while standing.
Preparation.
Experience one’s own balance and
record eventual changes.
Dual task: motor (using spiky balls and
medicine balls individually, in pairs and
in the group) and cognitive (singing,
rhymes and counting).
Main part
(1) High-intensity training (85%–95%
maxHR/min 16 RPE) × 4 min: Running
or walking with long strides and large
arm movements. Participants chose their
own route, marking it with a cone, and
picked up a bean bag for each new lap to
count how many laps for each interval.
Improve stamina.
Experience one’s own opportunities for
high-intensity physical activity.
Improve sensorimotor control and
balance as prerequisites for walking and
running.
(2) Moderate-intensity detailed exercises
(approx. 70% maxHR) × 3 min.
CoreDIST exercises while standing
approximately (10 repetitions × 2 set).
Examples of exercises: squat, one legged
stance, rise on toes, reaching, turning and
rolling down to touch the ground in
standing.
Progressions was individually tailored
(during both running/walking and the
detailed exercises) through instructions,
demonstration and hands-on facilitations
by the physiotherapists. Quality and
efﬁciency of movement were addressed
by the physiotherapists. Optimalization
of trunk control during movement were
emphasised.
A combination of high-intensity and
CoreDIST exercises was repeated 3–4
times during one session.
Cool-down and recording one’s own balance
Hold/relax muscle contraction. Experience one ’s own balance and
record eventual changes.Balance on one leg.
TABLE 1 Overview of the CoreDISTparticipation intervention.
Week 1: MS outpatient
clinic
Consultation with the MS nurse(20 min) to address work-related issues based on a structured guide comprising the following themes: knowledge
of MS at the workplace, experienced work-related challenges due to MS, potential needs and facilitators.
Physiotherapy assessment(60 min) to explore the potential for changes in balance and walking aiming to turn focus toward possibilities and thus,
motivate the patient.
Based on these assessments the MS nurse and the physiotherapist indicated the aspects of importance on a standardized form to inform the
municipal physiotherapist.
Standardized testing (baseline, for the RCT).
Week 2–5: Municipality Physiotherapy assessment (60–90 min) to explore the patient’s impairments and potential for improvements in a clinical examination prior to
group-training.