Your Invited Topical Review highlights the diverse and complex symptoms of multiple sclerosis. Which adults are most commonly affected? 

The latest reports show that over 37,000 Australians are living with multiple sclerosis (MS). 

The chronic, lifelong condition is commonly first diagnosed in adults aged 20–50 years old, with higher prevalence in temperate regions and among individuals of Northern European ancestry. 

Women are more frequently diagnosed than men and genetic predisposition can increase risk. 

Which people with MS are at greatest risk of faster progression or poorer outcomes? 

Those with progressive forms of MS, older age at onset, frequent early relapses and higher lesion burden on MRI are at greater risk. 

Comorbidities such as cardiovascular disease and social determinants of health such as socio-economic status, education and access to care substantially influence MS progression and quality of life. 

What assessments are recommended to evaluate disability and track progression over time? 

The Expanded Disability Status Scale remains the most widely used global measure of disability. 

Other recommended tools include MS Functional Composite for mobility, dexterity and cognition; timed 25-foot walk, timed 10-metre walk and six-minute walk tests for gait and endurance; and patient-reported measures such as the MS Impact Scale for quality of life. 

Remotely administered examples of these assessments have been validated and may be more accessible for physiotherapists with patients living in remote locations. 

Which assessments help physiotherapists determine the most appropriate management approach? 

The Topical Review looks at assessments commonly used by physiotherapists, including the Berg Balance Scale and the Timed Up and Go for balance and falls risk as well as the Fatigue Severity Scale for energy management. 

Behaviour change frameworks should be used to support patients and align interventions with patient priorities. 

What physiotherapy interventions have the strongest evidence for improving symptoms and function in MS? 

The Topical Review found the strongest evidence for resistance exercise and mind– body exercise (eg, balance, yoga, Pilates and exergaming) for managing fatigue. 

For improving aerobic capacity and walking ability, aerobic mind–body exercises are recommended. 

Balance can be effectively improved through aerobic, combined and mind–body exercise, while combined exercise is beneficial for depression and increasing physical activity levels. 

How can physiotherapists integrate fatigue management strategies into exercise programs without compromising functional gains? 

Fatigue management should be embedded into exercise prescription through energy conservation principles and graded activity planning. 

Strategies include: 

• scheduling training during times of the day when energy is highest
• combining aerobic, resistance, balance and flexibility work at a moderate intensity, which aligns with MS exercise guidelines and has strong evidence for improving function without exacerbating fatigue
• incorporating rest within the treatment session and rest days within the week
• using patient-reported scales (eg, the Fatigue Severity Scale) to monitor tolerance of physiotherapy strategies. 

What role can physiotherapists play in improving access to evidence-based MS care, especially in rural and remote Australian communities? 

Physiotherapists can lead telehealth initiatives and community-based programs to overcome geographical barriers. 

They can: 

• educate frontline MS healthcare providers (eg, neurologists and nurses) on the benefits and availability of MS-specific physiotherapy
• lead delivery of telerehabilitation and virtual exercise programs
• educate and support local healthcare providers in MS-specific physiotherapy
• advocate for NDIS support that integrates telehealth models. 

What are the most important priorities for future research to improve physiotherapy care for people with MS? 

Future research should prioritise standardising outcome measures and reporting to enable meaningful comparison across studies, while ensuring that underrepresented groups (those with paediatric onset or late onset, older adults, people with severe disability and people who have MS and other comorbidities) are included. 

Research must also examine real-world outcomes—including physical activity, mental health, social engagement and employment—alongside efforts to improve clinicians’ access to education and resources that promote physical activity and exercise in MS. 

Evaluating telehealth, remote assessment and digital interventions will be critical for enhancing access and adherence.

Investigating exercise’s neuroprotective effects and validating biomarkers through high-quality trials represents an important avenue of future study. 

Finally, developing strategies to enhance adherence, including behaviour change interventions and multidisciplinary care models, will be essential for translating evidence into sustained benefit. 

Physiotherapy is central to improving outcomes for people living with MS. 

By combining evidence-based interventions with personalised care, physiotherapists can help individuals maintain independence and quality of life. 

Continued research, particularly in digital health and integrated approaches, will ensure that physiotherapy remains at the forefront of MS care. 

>>Associate Professor Yvonne C Learmonth APAM is one of Australia’s leading MS exercise researchers, with 90 publications and international guideline influence. Her work at the University of New South Wales focuses on exercise interventions, implementation science and co-design with persons with lived experience to shape clinical practice and capacity building.