Multidisciplinary rehabilitation for adults with multiple sclerosis.

BACKGROUND Multidisciplinary rehabilitation (MD) is an important component of symptomatic and supportive treatment for Multiple sclerosis (MS), but evidence base for its effectiveness is yet to be established. OBJECTIVES To assess the effectiveness of organized MD rehabilitation in adults with MS. To explore rehabilitation approaches that are effective in different settings and the outcomes that are affected. SEARCH STRATEGY The sources used included: Cochrane Central Register of Controlled Trials "CENTRAL", MEDLINE (1966- 2005), CINAHL (1982- 2005), PEDro (1990- 2005), EMBASE (1988- 2005), the Cochrane Rehabilitation and Related Therapies Field trials Register and the National Health Service National Research Register (NRR). SELECTION CRITERIA Randomized and controlled clinical trials that compared MD rehabilitation with routinely available local services or lower levels of intervention; or trials comparing interventions in different settings or at different levels of intensity. DATA COLLECTION AND ANALYSIS Three reviewers selected trials and rated their methodological quality independently. A 'best evidence' synthesis based on methodological quality was performed. Trials were grouped in terms of setting and type of rehabilitation and duration of patient follow up. MAIN RESULTS Eight trials (7 RCTs; 1 CCT) (747 participants and 73 caregivers) were identified. Seven RCTs scored well and one CCT scored poorly on the methodological quality assessment. There was 'strong evidence' that despite no change in the level of impairment, inpatient MD rehabilitation can produce short-term gains at the levels of activity (disability) and participation for patients with MS. For outpatient and home-based rehabilitation programmes there was 'limited evidence' for short-term improvements in symptoms and disability with high intensity programmes, which translated into improvement in participation and quality of life. For low intensity programmes conducted over a longer period there was strong evidence for longer-term gains in quality of life; and also limited evidence for benefits to carers. Although some studies reported potential for cost-savings, there is no convincing evidence regarding the long-term cost-effectiveness of these programmes. It was not possible to suggest best 'dose' of therapy or supremacy of one therapy over another. This review highlights the limitations of RCTs in rehabilitation settings and need for better designed randomized and multiple centre trials. AUTHORS' CONCLUSIONS MD rehabilitation programmes do not change the level of impairment, but can improve the experience of people with MS in terms of activity and participation. Regular evaluation and assessment of these persons for rehabilitation is recommended. Further research into appropriate outcome measures, optimal intensity, frequency, cost and effectiveness of rehabilitation therapy over a longer time period is needed. Future research in rehabilitation should focus on improving methodological and scientific rigour of clinical trials.

[1]  D. Silberberg,et al.  New diagnostic criteria for multiple sclerosis: Guidelines for research protocols , 1983, Annals of neurology.

[2]  B. Kemp,et al.  What the rehabilitation professional and the consumer need to know. , 2005, Physical medicine and rehabilitation clinics of North America.

[3]  A J Thompson,et al.  The impact of inpatient rehabilitation on progressive multiple sclerosis , 1997, Annals of neurology.

[4]  M. Campbell,et al.  Secondary health conditions among middle-aged individuals with chronic physical disabilities: implications for unmet needs for services. , 1999, Assistive technology : the official journal of RESNA.

[5]  M. Ravnborg,et al.  Quality of life as a measure of rehabilitation outcome in patients with multiple sclerosis , 1996, Acta neurologica Scandinavica.

[6]  Impact of a Comprehensive Long-Term Care Program on Caregivers and Persons with Multiple Sclerosis , 2000 .

[7]  C. Vaney,et al.  Assessing mobility in multiple sclerosis using the Rivermead Mobility Index and gait speed , 1996 .

[8]  A. Compston,et al.  The genetic epidemiology of multiple sclerosis. , 1999, Philosophical transactions of the Royal Society of London. Series B, Biological sciences.

[9]  Francesco PattiMD,et al.  Effects of a short outpatient rehabilitation treatment on disability of multiple sclerosis patients , 2003 .

[10]  J. Sitzia,et al.  Evaluation of a nurse-led multidisciplinary neurological rehabilitation programme using the Nottingham Health Profile , 1998, Clinical rehabilitation.

[11]  C. Pozzilli,et al.  Home based management in multiple sclerosis: results of a randomised controlled trial , 2002, Journal of neurology, neurosurgery, and psychiatry.

[12]  F. Mcdowell,et al.  PROBLEMS OF EXPERIMENTAL TRIALS OF THERAPY IN MULTIPLE SCLEROSIS: REPORT BY THE PANEL ON THE EVALUATION OF EXPERIMENTAL TRIALS OF THERAPY IN MULTIPLE SCLEROSIS , 1965, Annals of the New York Academy of Sciences.

[13]  R. Detels,et al.  Multiple sclerosis and age at migration. , 1978, American journal of epidemiology.

[14]  D. English,et al.  The epidemiology of multiple sclerosis in three Australian cities: Perth, Newcastle and Hobart. , 1988, Brain : a journal of neurology.

[15]  M. Aisen,et al.  Inpatient Rehabilitation for Multiple Sclerosis , 1996 .

[16]  A. Thompson,et al.  Inpatient rehabilitation in multiple sclerosis , 1999, Neurology.

[17]  G. Baker,et al.  A randomised controlled trial comparing rehabilitation against standard therapy in multiple sclerosis patients receiving intravenous steroid treatment , 2003, Journal of neurology, neurosurgery, and psychiatry.

[18]  George Davey Smith,et al.  meta-analysis bias in location and selection of studies , 1998 .

[19]  Julie F Pallant,et al.  Use of the International Classification of Functioning, Disability and Health (ICF) to identify preliminary comprehensive and brief core sets for multiple sclerosis , 2007, Disability and rehabilitation.

[20]  N. Losseff,et al.  The benefit of inpatient neurorehabilitation in multiple sclerosis , 1995 .

[21]  A R Jadad,et al.  Assessing the quality of reports of randomized clinical trials: is blinding necessary? , 1996, Controlled clinical trials.

[22]  A. Compston,et al.  Recommended diagnostic criteria for multiple sclerosis: Guidelines from the international panel on the diagnosis of multiple sclerosis , 2001, Annals of neurology.

[23]  S. Horn,et al.  Applying the clinical practice improvement approach to stroke rehabilitation: methods used and baseline results. , 2005, Archives of physical medicine and rehabilitation.

[24]  A. Thompson.  The effectiveness of neurological rehabilitation in multiple sclerosis. , 2000, Journal of rehabilitation research and development.

[25]  Peter Langhorne,et al.  What are the components of effective stroke unit care? , 2002, Age and ageing.

[26]  F. Patti,et al.  The impact of outpatient rehabilitation on quality of life in multiple sclerosis , 2002, Journal of Neurology.

[27]  Andrea Furlan,et al.  Updated Method Guidelines for Systematic Reviews in the Cochrane Collaboration Back Review Group , 2003, Spine.

[28]  L M Bouter,et al.  Occupational therapy for multiple sclerosis. , 2003, The Cochrane database of systematic reviews.

[29]  J. Hobart,et al.  Comparison of physician outcome measures and patients' perception of benefits of inpatient neurorehabilitation , 2002, BMJ : British Medical Journal.

[30]  L. Scheinberg,et al.  Multiple Sclerosis Rehabilitation: Inpatient vs. Outpatient , 1988, Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses.

[31]  M. Battaglia,et al.  A cost evaluation of multiple sclerosis. , 2000, Journal of neurovirology.

[32]  J. Baskerville,et al.  The natural history of multiple sclerosis: a geographically based study. 5. The clinical features and natural history of primary progressive multiple sclerosis. , 1999, Brain : a journal of neurology.

[33]  W. Gordon,et al.  Empowerment in measurement: "muscle," "voice," and subjective quality of life as a gold standard. , 2004, Archives of physical medicine and rehabilitation.

[34]  J. Feigenson,et al.  The cost‐effectiveness of multiple sclerosis rehabilitation , 1981, Neurology.

[35]  E. McDonald,et al.  The cost of multiple sclerosis in Australia , 2007, Journal of Clinical Neuroscience.

[36]  R. Carey,et al.  Who makes the most progress in inpatient rehabilitation? An analysis of functional gain. , 1988, Archives of physical medicine and rehabilitation.

[37]  L M Bouter,et al.  Method guidelines for systematic reviews in the Cochrane Collaboration Back Review Group for Spinal Disorders. , 1997, Spine.

[38]  A Thompson,et al.  The Multiple Sclerosis Impact Scale (MSIS-29): a new patient-based outcome measure. , 2001, Brain : a journal of neurology.

[39]  Heather Becker,et al.  A randomized clinical trial of a wellness intervention for women with multiple sclerosis. , 2003, Archives of physical medicine and rehabilitation.

[40]  D. Wade,et al.  Multi-disciplinary rehabilitation for acquired brain injury in adults of working age. , 2005, The Cochrane database of systematic reviews.

[41]  J. Hauw,et al.  Infarction in the anterior rostral cerebellum (the territory of the lateral branch of the superior cerebellar artery) , 1991, Neurology.

[42]  V. Tomassini,et al.  Relationship between emotional distress in caregivers and health status in persons with multiple sclerosis , 2004, Multiple sclerosis.

[43]  C. Wiles,et al.  The effectiveness of occupational therapy and physiotherapy in multiple sclerosis patients with ataxia of the upper limb and trunk , 1996 .

[44]  Alan J. Thompson,et al.  Does neurorehabilitation have a role in relapsing-remitting multiple sclerosis? , 2003, Journal of Neurology.

[45]  G. Samsa,et al.  Cost of multiple sclerosis by level of disability: a review of literature , 2005, Multiple sclerosis.

[46]  S. Beer,et al.  Impact of Neurorehabilitation on Disability in Patients with Acutely and Chronically Disabling Diseases of the Nervous System Measured by the Extended Barthel Index , 2001, Neurorehabilitation and neural repair.

[47]  P. Gøtzsche.  Reference bias in reports of drug trials. , 1987, British medical journal.

[48]  P. Langhorne.  Developing comprehensive stroke services: an evidence-based approach. , 1995, Postgraduate medical journal.

[49]  M. Reding,et al.  Acute-Hospital Care versus Rehabilitation Hospitalization for Management of Nonemergent Complications in Multiple Sclerosis , 1987 .

[50]  A. Thompson,et al.  Self-efficacy predicts self-reported health status in multiple sclerosis , 2004, Multiple sclerosis.

[51]  C. Granger,et al.  Functional assessment scales: a study of persons with multiple sclerosis. , 1990, Archives of physical medicine and rehabilitation.

[52]  R. Loos,et al.  A quantitative study of unpaid caregiving in multiple sclerosis , 2000, Multiple sclerosis.

[53]  K Whetten-Goldstein,et al.  A comprehensive assessment of the cost of multiple sclerosis in the United States , 1998, Multiple sclerosis.

[54]  Multiple sclerosis in Iceland , 1982, Neurology.

[55]  F. Khan,et al.  Multidisciplinary care for adults with amyotrophic lateral sclerosis or motor neuron disease. , 2009, The Cochrane database of systematic reviews.

[56]  M. Turk,et al.  The health of women with cerebral palsy. , 2001, Physical medicine and rehabilitation clinics of North America.

[57]  A. Thompson,et al.  Effects of a short outpatient rehabilitation treatment on disability of multiple sclerosis patients , 2003, Journal of Neurology.

[58]  P. Sørensen,et al.  The efficacy of multidisciplinary rehabilitation in stable multiple sclerosis patients , 2006, Multiple sclerosis.

[59]  Thomas J. Kiresuk,et al.  Goal attainment scaling: A general method for evaluating comprehensive community mental health programs , 1968, Community Mental Health Journal.

[60]  L. Turner-Stokes,et al.  Use of goal attainment scaling in inpatient rehabilitation for persons with multiple sclerosis. , 2008, Archives of physical medicine and rehabilitation.

[61]  A. Tennant,et al.  A randomised controlled trial to determine the effect of intensity of therapy upon length of stay in a neurological rehabilitation setting. , 2002, Journal of rehabilitation medicine.

[62]  S. Roush.  The satisfaction of patients with multiple sclerosis regarding services received from physical and occupational therapists , 1995 .

[63]  P. Langhorne,et al.  Systematic reviews in rehabilitation for stroke: issues and approaches to addressing them , 2002, Clinical rehabilitation.

[64]  J. Kesselring,et al.  Effect of pulsed magnetic field therapy on the level of fatigue in patients with multiple sclerosis - a randomized controlled trial , 2005, Multiple sclerosis.

[65]  R P Di Fabio,et al.  Health-related quality of life for patients with progressive multiple sclerosis: influence of rehabilitation. , 1997, Physical therapy.

[66]  F. Khan,et al.  Use of International Classification of Functioning, Disability and Health (ICF) to describe patient-reported disability in multiple sclerosis and identification of relevant environmental factors. , 2007, Journal of rehabilitation medicine.

[67]  T. Kilpatrick,et al.  Effectiveness of rehabilitation intervention in persons with multiple sclerosis: a randomised controlled trial , 2008, Journal of Neurology, Neurosurgery, and Psychiatry.

[68]  R. P. Fabio,et al.  Extended outpatient rehabilitation: its influence on symptom frequency, fatigue, and functional status for persons with progressive multiple sclerosis. , 1998, Archives of physical medicine and rehabilitation.

[69]  A J Thompson,et al.  Multiple sclerosis: a preliminary study of selected variables affecting rehabilitation outcome , 1999, Multiple sclerosis.

[70]  A. Thompson,et al.  Evaluating neurorehabilitation: lessons from routine data collection , 2005, Journal of Neurology, Neurosurgery & Psychiatry.

[71]  A. Elstein,et al.  Clinical problem solving and diagnostic decision making: selective review of the cognitive literature , 2002, BMJ : British Medical Journal.

[72]  M. Dewey,et al.  Education for people with progressive neurological conditions can have negative effects: Evidence from a randomized controlled trial , 2004, Clinical rehabilitation.

[73]  M. Fuhrer.  Conducting multiple-site clinical trials in medical rehabilitation research. , 2005, American journal of physical medicine & rehabilitation.

[74]  J. Whyte.  Traumatic brain injury rehabilitation: are there alternatives to randomized clinical trials? , 2002, Archives of physical medicine and rehabilitation.

[75]  A J Thompson,et al.  Measuring change in disability after inpatient rehabilitation: comparison of the responsiveness of the Barthel Index and the Functional Independence Measure , 1999, Journal of neurology, neurosurgery, and psychiatry.

[76]  B M J Uitdehaag,et al.  Exercise Therapy for Multiple Sclerosis , 2022 .

[77]  J. Hobart,et al.  Health-Related Quality of Life in People with Multiple Sclerosis Undergoing Inpatient Rehabilitation , 1996 .

[78]  A. Thompson,et al.  Prospective study of neurorehabilitation in multiple sclerosis. , 1997, Journal of neurology, neurosurgery, and psychiatry.