Physiotherapy and confirmed disability improvement in people with multiple sclerosis.

BACKGROUND

Confirmed disability improvement (CDI) is an emerging outcome in disease-modifying treatment (DMT) trials in people with multiple sclerosis (pwMS). Physiotherapy (PT) can significantly influence walking speed and therefore CDI occurrence, but is rarely incorporated into trial analysis.

OBJECTIVES

Evaluate CDI occurrence in relation to exposure to PT.

METHODS

PwMS in the German MS Registry (exported Sep. 2025) receiving continuous PT ≥6 months were matched to those without PT. CDI was defined by tiers of Expanded Disability Status Scale (EDSS) improvement confirmed after ≥3 months. Mean cumulative function (MCF) estimation for recurrent events assessed CDI occurrence related to, and independent from, PT.

RESULTS

From 45949 pwMS records, 1430 patients qualified; 362 undergoing PT were matched to 362 without. PT was associated with a higher CDI incidence (16.3% vs. 11.1%; p = 0.040) over up to 8 years of follow-up. Subgroup analyses revealed higher CDI occurrence in pwMS with EDSS scores ≥4 (p = 0.006) and with older age (p = 0.031).

CONCLUSIONS

This study demonstrates the determinants of CDI in pwMS and the impact of PT on CDI occurrence, particularly for pwMS with higher EDSS scores and older age.