Physiotherapy and confirmed disability improvement in people with multiple sclerosis.

BACKGROUND: Confirmed disability improvement (CDI) is an emerging outcome in disease-modifying treatment (DMT) trials in people with multiple sclerosis (pwMS). Physiotherapy (PT) can significantly influence walking speed and therefore CDI occurrence, but is rarely incorporated into trial analysis. OBJECTIVES: Evaluate CDI occurrence in relation to exposure to PT. METHODS: PwMS in the German MS Registry (exported Sep. 2025) receiving continuous PT ≥6 months were matched to those without PT. CDI was defined by tiers of Expanded Disability Status Scale (EDSS) improvement confirmed after ≥3 months. Mean cumulative function (MCF) estimation for recurrent events assessed CDI occurrence related to, and independent from, PT. RESULTS: From 45949 pwMS records, 1430 patients qualified; 362 undergoing PT were matched to 362 without. PT was associated with a higher CDI incidence (16.3% vs. 11.1%; p = 0.040) over up to 8 years of follow-up. Subgroup analyses revealed higher CDI occurrence in pwMS with EDSS scores ≥4 (p = 0.006) and with older age (p = 0.031). CONCLUSIONS: This study demonstrates the determinants of CDI in pwMS and the impact of PT on CDI occurrence, particularly for pwMS with higher EDSS scores and older age.