The Actionability of Physical Activity Guidelines for Multiple Sclerosis Care: A Systematic Review and AACTT Framework Analysis

Abstract

Objective: This study aimed to conduct a systematic review of clinical guidelines, guidance documents and consensus statements regarding physical activity (PA) promotion by health care providers (HCPs) to people with multiple sclerosis (MS) and to assess the methodological quality, and actionability of the recommendations. The protocol was registered with Prospero (CRD42023495137).

Data sources: Clinical guidelines, guidance documents and consensus statements (hereafter guidelines) published in English between 2013 and 2023 were identified through extensive gray and scientific literature searches, and through contacting relevant HCP organizations in English speaking countries.

Study selection: Two researchers independently screened titles and abstracts of the 939 identified records and included 19 guidelines, which were developed for PA promotion as part of MS clinical management and for which the target user was HCPs.

Data extraction: Two researchers independently extracted data and appraised the methodological quality using the Appraisal of Guidelines for Research and Evaluation (AGREE-II). Behavioral actionability was analyzed using the Actor, Action, Context, Target and Time (AACTT) framework.

Data synthesis: Seventy-eight recommendations from 19 guidelines were identified. Two guidelines had high methodological quality. Actor, Action, Context, Target and Time were clearly specified in 57 (73%), 45 (58%), 0 (0%), 51 (65%), and 24 (31%) of the 78 recommendations, respectively. Guidelines with the highest methodological quality did not always score well on actionability, and vice-versa.

Conclusions: Our comprehensive analysis of guidelines for PA promotion in MS reveals the need for more actionable recommendations and better reporting of guideline development, which has the potential to improve the translation of evidence into practice. <END ABSTRACT>.

Keywords: Clinical guidelines; Evidence translation; Exercise; Implementation science; Multiple sclerosis; Physical activity; Rehabilitation; systematic review.