Comprehensive Rehabilitation Programme in People With Multiple Sclerosis: The RECONNECT-MS Study

Change in MS-specific health impact (Multiple Sclerosis Impact Scale, MSIS-29 total score)

The MSIS-29 is a 29-item patient-reported outcome assessing the physical (20 items) and psychological (9 items) impact of multiple sclerosis on daily life over the past 2 weeks. Each item is rated on a 5-point scale; the total score is transformed to a 0-100 metric (higher scores indicate greater impact of MS). MSIS-29 was selected as the primary outcome because it captures the comprehensive impact of MS on the participant's life and is the most representative measure of the study's primary aim. Also assessed at T0 (2 months before T1) to characterise within-subject stability during the no-intervention control period. Sample size (n=45) was not determined on MSIS-29, but conservatively on MFIS, the only pilot-study outcome non-significant at n=20 (MCID 4, SD 8.6, α=0.05, 1-β=0.8); MSIS-29 was significant in the pilot at n=20.

Change in dynamic balance and stepping (Four Square Step Test, FSST)

Time (in seconds) required to step over four canes arranged in a square pattern in clockwise and counter-clockwise direction. Higher times indicate worse dynamic balance. Also assessed at T0 to characterise within-subject stability.

Change in walking endurance (Two-Minute Walk Test, 2MWT)

Distance (in meters) walked at a self-selected fast pace during 2 minutes. Higher distance indicates better walking capacity and endurance. Also assessed at T0.

Change in upper limb fine motor function (Nine Hole Peg Test, NHPT)

Time (in seconds) required to insert and remove 9 pegs from a board, performed separately with the dominant and non-dominant hand. Higher times indicate worse fine motor function. Also assessed at T0.

Change in upper limb tremor dominant frequency (inertial sensors)

Frequency (in Hz) for which the smoothed power spectral density is maximal (fmax), derived from the frequency characteristics of upper limb tremor measured using inertial sensors (a 3-axis accelerometer and a 3-axis gyroscope). A ring-shaped sensor is placed on the index finger of the upper limb in a defined posture; measured separately for each limb with the eyes open and closed. Also assessed at T0.

Change in functioning, disability, and health profile (ICF Brief Core Set for Multiple Sclerosis)

Functioning, disability, and contextual factors assessed using the WHO International Classification of Functioning, Disability and Health (ICF) Brief Core Set for Multiple Sclerosis (Czech translation provided by ÚZIS), supplemented by additional categories focused on fine motor skills and upper limb control. Each category is rated using ICF qualifiers (0-4 for impairment severity; 0-4 / 8 / 9 for activities and participation). Assessment is conducted by an independent assessor through a structured interview, drawing on anamnestic data, clinical tests, questionnaires, and input from other specialists.

Participant-reported satisfaction and acceptability of the programme

A brief structured questionnaire administered at the end of the 3-month programme. Items assess the participant's perceived benefit of intensive physiotherapy, comparison with prior spa-based rehabilitation, awareness of new self-management strategies, affordability of comparable therapy intensity without grant subsidy, and perceived importance of comprehensive care for people with MS. Responses are collected on item-specific Likert-type scales supplemented by an open-ended qualitative item. No single summary score is derived; items are analysed individually.