A randomised controlled trial comparing rehabilitation against standard therapy in multiple sclerosis patients receiving intravenous steroid treatment

Abstract

Background: There is evidence to support both the use of intravenous methylprednisolone (IVMP) in multiple sclerosis (MS) relapse and physiotherapy in the management of MS, but no studies have investigated the combination of steroids and rehabilitation together. Objectives: To evaluate the benefits of IVMP with planned, comprehensive multidisciplinary team (MDT) care compared to IVMP with standard care. Methods: In this randomised controlled trial, patients confirmed to have had a definite MS relapse severe enough to warrant IVMP (1 g daily for three days) were randomised to two groups. The control group was managed according to the standard ward routine; the treatment group received planned coordinated multidisciplinary team assessment and treatment. Baseline assessments, including demographics and Expanded Disability Status Scale (EDSS) were carried out on both groups. The primary outcome measures were Guy's Neurological Disability Scale (GNDS), and Amended Motor Club Assessment (AMCA). The secondary measures were the Barthel Index (BI), Human Activity Profile (HAP), and Short Form Item 36 Health Survey (SF-36). All measures have published data on reliability and validity. Measures were administered at one and three months. Results: Forty subjects, including 27 females, completed data collection. There were no significant differences between the two groups at baseline. Results showed statistically significant differences in GNDS (p = 0.03), AMCA (p = 0.03), HAPM (p < 0.01), HAPA (p = 0.02), and BI (p = 0.02) at three months in favour of planned MDT care. Conclusion: This study indicates that combining steroids with planned MDT care is superior to administering them in a standard neurology or day ward setting. Further research is necessary in order to confirm this finding.

Barriers and Facilitators Related to Rehabilitation Stays in Multiple Sclerosis

“…Multidisciplinary rehabilitation has been shown to have a positive effect on measures of functional independence including locomotion, sphincter control, and self-care. 16 In studies of health-related quality of life, improvement has been shown in fatigue, 17,18 pain, 17 general health, 17 physical health, 17,20,21 social function, 17,21 social support, 17 cognitive ability, 17 and emotional well-being. 20,21 with a neurologist, patients may contact one of four dedicated MS nurses at the outpatient clinic.…”

“…2,3 Motor and cognitive impairment, fatigue, depression, pain, incontinence, sexual dysfunction, and the unpredictability of the disease reduce health-related quality of life [4][5][6][7][8][9][10][11] and participation in work and life. 2,12,13 Although it has been difficult to show the effect of multidisciplinary rehabilitation stays in clinical trials, 14,15 several studies have suggested a positive effect of multidisciplinary rehabilitation on disability [15][16][17][18][19][20][21] and aspects of health-related quality of life. 15,17,18,20,21 A review by Khan et al 15 concluded that there was strong evidence that inpatient or outpatient rehabilitation can increase activity and participation in society, despite a lack of reduction in actual impairment.…”

“…2,12,13 Although it has been difficult to show the effect of multidisciplinary rehabilitation stays in clinical trials, 14,15 several studies have suggested a positive effect of multidisciplinary rehabilitation on disability [15][16][17][18][19][20][21] and aspects of health-related quality of life. 15,17,18,20,21 A review by Khan et al 15 concluded that there was strong evidence that inpatient or outpatient rehabilitation can increase activity and participation in society, despite a lack of reduction in actual impairment. Multidisciplinary rehabilitation has been shown to have a positive effect on measures of functional independence including locomotion, sphincter control, and self-care.…”

Developing a Wellness Program for People with Multiple Sclerosis

“…Because MS has a profound impact on many aspects of a person's life, the program's content and measures used to examine treatment effectiveness included several constructs, including physical functioning and emotional well-being. The favorable results observed in our study are consistent with the results reported for other conservative intervention programs that used similar treatment content designs for adults with MS. 17,31,32 For example, interventions focusing on either physical exercise 32 or educational programs 17,31 have demonstrated an equally positive impact on fatigue, depression, and/or quality of life issues for people with MS.…”

Production of Human Interferon β by Recombinant E. coli Using the Codon Optimized Gene

“…다발성 경화증의 증상은 주 로 감각장애, 통증, 운동마비, 시각장애가 있다. 다발성경화 증의 치료제로는 스테로이드와 면역억제제가 주로 사용되고 있으며, 이는 신체의 면역 기능을 약화시킴으로써 다발성경 화증을 조절하는 방법이다 [3][4][5]. 현재 많이 사용되는 다발성 경화증의 치료제로는 인터페론 베타 (interferon β)가 있다 [6,7].…”