Implementing Co-innovation to Develop an Accessible, Web-Based Exercise Program for People with Multiple Sclerosis

Abstract

Objective

To apply a patient-centered co-innovation framework to develop and preliminarily evaluate a web-based exercise program for people with multiple sclerosis (MS).

Design

Exploratory sequential mixed methods study implimenting focus groups to identify needs and preferences, followed by a 6-week pilot intervention to generate further feedback while assessing safety and feasibility.

Setting

Ambulatory rehabilitation clinic with home-based, on-demand exercise delivery.

Participants

Adults with MS (N=31; focus groups: n=16; pilot testing: n=15).

Interventions

A 6-week tele-exercise program (3 sessions/wk; 20-45 min) delivered via instructional videos aligned with evidence-based guidelines, including aerobic and resistance options with modifications for varying mobility levels, plus weekly 20-minute one-on-one virtual coaching.

Main Outcome Measures

Focus group themes identified by Reflexive Thematic Analysis; postintervention user experience (1-5 Likert items and free response); feasibility (adherence); safety (adverse events); mobility outcomes (Six-Minute Walk Test [6MWT], Five Times Sit to Stand [5×STS], timed Up and Go [TUG], Timed 25-Foot Walk [T25FW]).

Results

Focus groups identified actionable needs spanning exercise type, instructional style, safety cues, modification options, scheduling/accountability, and delivery preferences, which directly informed program design (table 1). In pilot testing, no adverse events were reported. Adherence to assigned sessions averaged 75%±11% in Wave 1 and 56%±11% in Wave 2; among participants who completed ≥1 session, adherence was 93.8%±12.5% and 75.8%±30.4%, respectively. Mobility improved from baseline: 6MWT +20.4% (+188 ft), P=.001; 5×STS −16.6% (−3.54 s), P=.042; TUG −14.9% (−2.19 s), P=.048; Timed 25-Foot Walk −9.1% (−0.59 s), P=.365. User experience ratings indicated high usability and convenience.

Conclusions

Co-innovation strategies that systematically engage people with MS, clinicians, and researchers in an iterative design process can generate insights that inform the development of evidence-aligned, web-based exercise programs that address the complex and diverse needs of people with MS. Findings support further evaluation in larger, diverse cohorts and the exploration of social support features to enhance engagement.