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Combining Self-help and Professional Help to Minimize Barriers to Physical Activity in Persons With Multiple Sclerosis: A Trial of the “Blue Prescription” Approach in New Zealand

Mulligan, Hilda PhD; Treharne, Gareth J. PhD; Hale, Leigh A. PhD; Smith, Cath PhD

Journal of Neurologic Physical Therapy: June 2013 - Volume 37 - Issue 2 - p 51–57
doi: 10.1097/NPT.0b013e318292799e
Research Article
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Background and Purpose: Increasing participation in physical activity is a goal for many health care providers working with persons with disability. In order to reduce the physical and social barriers to participation, there is a need to develop approaches that integrate self-help with professional help for autonomous yet supported health promotion. This study reports on an innovative program, entitled the “Blue Prescription approach”, in which physical therapists work collaboratively with persons with a disability to promote community-based physical activity participation.

Methods: We trialed this collaborative approach with two physical therapists and 27 participants with multiple sclerosis (MS) over a three month period. We gathered qualitative data from four sources: (i) individual interviews with our participants, (ii) individual interviews with the physical therapists, (iii) clinical notes, and (iv) Advisory Group meeting notes. We then analyzed these data for categories to inform the content and resources required for delivery of the approach.

Results: For most participants, the Blue Prescription approach facilitated regular engagement in the physical activity of their choice. The Advisory Group provided advice to help solve individual contexts that presented as challenges to participants. Based on review of interview transcripts, we identified four strategies or issues to inform the further development of Blue Prescription.

Discussion and Conclusions: Evidence indicated that the Blue Prescription approach can provide a collaborative and flexible way for physical therapists to work with individuals with MS, to increase participation in community-based physical activity. To further develop the approach, there is a need to address issues related to the use of standardized measures and develop strategies to train physical therapists in collaborative approaches for promotion of physical activity.

The integration of self-help and professional help provided by the Blue Prescription approach appeared to result in successful promotion of physical activity in persons with MS. Additional testing is required to examine its efficacy in other health care systems, in conditions beyond MS, and in terms of its economic impact.

Video Abstract available (see Video, Supplemental Digital Content 1, for more insights from the authors.

Centre for Physiotherapy Research (H.M., L.A.H., and C.M.) and Department of Psychology (G.J.T.), University of Otago, Dunedin, Aotearoa/New Zealand.

Correspondence: Hilda Mulligan, PhD, School of Physiotherapy, University of Otago, PO Box 56, Dunedin 9054, New Zealand (

Funded by University of Otago Research Grant.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

The authors declare no conflicts of interest.

© 2013 Neurology Section, APTA