Kym Wansbrough

Introduction: Persons with MS have indicated that healthcare professionals are their preferred source of information on exercise.

Objectives/Aims: Using implementation study design we aimed to determine the effect of an online theoretical and experiential education programme on practitioners’ attitudes towards prescribing exercise to persons with multiple sclerosis (MS).

Methods: Physiotherapists and exercise physiologists participated. They received online training and support to deliver a 16-week programme to persons with MS. Data on practitioners’ self-confidence (PSC) and professional quality of life (ProQOL) were collected at baseline (week 0) and post-programme (weeks 1, 17, 52). Implementation data were collected post-programme using a TDF-based questionnaire and questions on behaviour change strategies and programme satisfaction. PSC, ProQOL, and TDF data were analysed using an imputation model for missing data. Effect-size estimates from generalised linear mixed models determined the magnitude of change for each outcome measure.

Results: Of 40 practitioners (20 physiotherapy and 20 exercise physiology) who provided baseline data, 24 completed the theoretical programme, and 16 completed the experiential programme. Self-confidence improved significantly (|βs| ⩾ 1.208, SEs ⩾ 0.223, |ts| ⩾ 5.403, ps < 0.001), with large effect sizes (percentage 234.5%-511.0%). Some TDF-based domains improved, such as beliefs about skills to prescribe. The 15 practitioners who completed all surveys expressed high satisfaction after the programme. The number of practitioners implementing behaviour change strategies increased from 11 to 15.

Conclusion: An online education programme for MS care improved practitioners' self-confidence and beliefs about physical activity, but high attrition suggests healthcare system barriers.

Multiple sclerosis (MS) is the most prevalent neurological disorder in young adults, characterised by physical, psychological and cognitive dysfunction. Exercise training is a safe management strategy. Healthcare providers (HCPs) acknowledge deficiencies in awareness, counselling strategies, and resources that prevent them from promoting and prescribing this effective treatment. We implemented an online evidence-based educational programme and evaluated the effect, acceptability, appropriateness, and feasibility of the programme in improving HCP confidence, knowledge, and attitudes towards remote exercise prescription to persons with MS.
: Physiotherapists and exercise physiologists were recruited and received the educational programme (online theory and 16-week experience of prescribing to persons with MS). Participants' confidence, knowledge and attitudes towards exercise prescription, as well as their professional quality of life, were our primary outcomes-baseline (T1), immediately post-online theoretical learning (T2), post-application with clients (T3; approximately 16 weeks after T2), and at 12-month follow-up (T4). We gathered participants' acceptability, appropriateness, and feasibility evaluation at T2, T3 and T4. We analysed the effect on primary outcomes using generalised linear mixed models, with secondary and evaluative outcomes analysed as counts and qualitative themes.
: Of 40 participants who provided baseline data, 24 completed the theoretical programme, and 16 completed the experiential programme. Self-confidence improved significantly (|βs| ≥ 1.27, SEs ≤ 0.31, |zs| ≥ 5.28, ps < 0.001), with large effect sizes (percentage change: 256.8-479.4%). Some theoretical domains framework-based domains have improved, such as beliefs about skills to prescribe evidence-based principles. Participants expressed high satisfaction with the programme and showed increased delivery of implementation behaviour change strategies.
: An online evidence-based education programme for MS care improved HCPs' self-confidence, perceived skills and delivery of evidence-based exercise behaviour-based prescription.

Individuals who face difficulties with voluntary movement experience considerable challenges in performing everyday tasks, significantly compromising their sense of autonomy. Transcranial alternating current stimulation (tACS) holds promise in modulating sensorimotor beta oscillations, which underscore voluntary movement. However, the exact effect of beta tACS on oscillatory power is still largely elusive. This study aimed to examine the effect of different intensities of beta tACS (20 Hz) on both resting-state and event-related sensorimotor oscillations. Twenty-one healthy young adults (13 female; mean age 24.30 ± 4.84 years) received four separate 20 min sessions of tACS at different intensities (sham, 0.5 mA, 1.0 mA, or 1.5 mA, peak-to-peak), targeting the left primary motor cortex during rest. Electroencephalography (EEG) was recorded before and after stimulation, during both resting state and a self-paced right index finger button press task. Changes in sensorimotor beta power (13–30 Hz) were analyzed. For the resting-state, none of the real stimulation intensities induced significant changes in beta power relative to sham. For event-related activity, we observed intensity-dependent changes in bilateral broadband power (4–90 Hz): during movement preparation, 1.0 mA stimulation increased power; during movement termination, 0.5 mA stimulation decreased power while 1.0 mA and 1.5 mA stimulation induced comparable increases in power. While none of the stimulation intensities induced changes in broadband power during movement execution, 1.0 mA stimulation shifted participants’ peak beta frequency toward the tACS frequency. Interestingly, changes in power during movement preparation and execution following 1.0 mA stimulation were negatively associated with participants’ pre-tACS peak beta frequency. Together, these findings contribute to our understanding of the sensorimotor response to beta tACS, as well as the effect of stimulation intensity on tACS-induced neuromodulation, which has important implications for research and clinical settings.

Transcranial electrical stimulation (tES) has garnered significant attention as a non-invasive neuromodulation technique with promising therapeutic potential for various neurological and neuropsychiatric conditions. However, considerable variability in response to tES both between and within-individuals is a prevailing issue. This review explored recent advancements in optimising tES through individualised protocols that consider individual head anatomy, neural oscillatory activities and dynamic changes in the neurophysiology of the stimulated brain. Real-time monitoring and closed-loop systems allow adaptive adjustments of stimulation parameters in response to ongoing brain activity, which holds promise for enhancing tES effectiveness and overcoming the challenge of inter-session response variability. Overall, the reviewed literature highlights the emerging trend towards individualised tES protocols as a means to unlock the full potential of tES in research and clinical use. While promising, further research is warranted to establish standardised methodologies and validate the efficacy of individually tailored tES protocols to realise its full potential.

Due to the interconnected nature of the brain, changes in one region are likely to affect other structurally and functionally connected regions. Emerging evidence indicates that single-site transcranial alternating current stimulation (tACS) can modulate functional connectivity between stimulated and interconnected unstimulated brain regions. However, our understanding of the network response to tACS is incomplete. Here, we investigated the effect of beta tACS of different intensities on phase-based connectivity between the left and right primary motor cortices in 21 healthy young adults (13 female; mean age 24.30 ± 4.84 years). Participants underwent four sessions of 20 min of 20 Hz tACS of varying intensities (sham, 0.5 mA, 1.0 mA, or 1.5 mA) applied to the left primary motor cortex at rest. We recorded resting-state and event-related electroencephalography (EEG) before and after tACS, analyzing changes in sensorimotor beta (13–30 Hz) imaginary coherence (ImCoh), an index of functional connectivity. Event-related EEG captured movement-related beta activity as participants performed self-paced button presses using their right index finger. For resting-state connectivity, we observed intensity-dependent changes in beta ImCoh: sham and 0.5 mA stimulation resulted in an increase in beta ImCoh, while 1.0 mA and 1.5 mA stimulation decreased beta ImCoh. For event-related connectivity, 1.5 mA stimulation decreased broadband ImCoh (4–90 Hz) during movement execution. None of the other stimulation intensities significantly modulated event-related ImCoh during movement preparation, execution, or termination. Interestingly, changes in ImCoh during movement preparation following 1.0 mA and 1.5 mA stimulation were significantly associated with participants’ pre-tACS peak beta frequency, suggesting that the alignment of stimulation frequency and peak beta frequency affected the extent of neuromodulation. Collectively, these results suggest that beta tACS applied to a single site influences connectivity within the motor network in a manner that depends on the intensity and frequency of stimulation. These findings have significant implications for both research and clinical applications.