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Purpose. To determine the most commonly used manual wheelchair propulsion pattern by people with multiple sclerosis (MS) and to assess which factors influence the preference. Method. Sixty manual wheelchair users with MS from an MS outpatient rehabilitation centre in Northern Italy were assessed on upper limb range of motion and trunk stability to determine if these factors or demographic, disease or wheelchair use history, influenced the choice of wheelchair propulsion pattern. Results. Fifty-four (90%) subjects used the arcing propulsion pattern, the least efficient pattern as reported in the literature. Sixteen (26.7%) subjects had impaired trunk stability and 38 (63.3%) subjects demonstrated some deficit on either extremity for active range flexion–extension. Twenty (33%) subjects had no deficits on active range flexion–extension and had normal trunk control. Upper limb range of motion and trunk stability were not significant in determining the preference for propulsion pattern ( p = 1.05 and 0.38, respectively). Demographic and disease factors and wheelchair use history were also not significant in determining propulsion pattern. Conclusions. The person with MS uses the least efficient pattern overall, requiring frequent repetition, although a smaller range of movement. This may be an energy conservation technique that helps in managing fatigue. [ABSTRACT FROM AUTHOR]