Purpose: The overarching aim of this research was to better understand what persons with multiple sclerosis (pwMS) chose to do and what physical therapists recommended to maxmize gait and balance (G&B) after discharge from out-patient physical therapy (OP-PT), and the factors influencing those decisions. Methods: A descriptive, exploratory case series design with multiple methods was used. Data was collected from pwMS at two time points and PT at one time point following pwMS discharge from OP-PT. All interviews were audio recorded and transcribed verbatim. Stake’s case series and Brewer’s multi-methods guidelines were used to direct both within and across case content and constant comparative analysis of both pwMS and PT and narrative and numeric data. Results: Seven matched pwMS – PT pairs participated, n=12, because one PT participated three times. Exercise was the most important behavior used by pwMS and recommended by PTs to maximize G&B, although pwMS used a wider variety of behaviors, ranging from lifestyle physical activity to stress management. The key themes were challenging self by pushing but respecting limits for pwMS and finding the right fit for PTs with both aiming to maximize pwMS engagement in meaningful activities and life roles. The four key factors impacting engagement decisions were importance, confidence, support, and resilience. Facilitators had to outweigh barriers for engagement to occur. To optimize PT practice, key recommendations from these combined analyses for further discussion, analysis, and testing were: 1) focus but be comprehensive and long-term in planning, 2) support pwMS by developing and refining knowledge, attitude, and skills, for not only valued behaviors and how to challenge and monitor self, but how to make self-management decisions and develop routines that can become flexible habits, 3) seek, understand, and value the expertise and uncertainty pwMS bring to decision making 4) assess and address importance, confidence, support and resilience to individual behaviors, and 5) self-reflect on personal toolbox and beliefs and how they may impact decisions and recommendations. Conclusion: Better understanding of the valued behaviors, decision making processes, and underlying influential factors of both pwMS and PTs towards maximizing G&B, has potential to optimize the pwMS-PT experience, engagement rates, and, ultimately, meaningful G&B outcomes for pwMS.
