Effects of a short outpatient rehabilitation treatment on disability of multiple sclerosis patients

Abstract

It is well known that neurorehabilitation can reduce disability or improve handicap of people with multiple sclerosis (MS). The aim of this study was to evaluate the effectiveness of a short period (6 weeks) of a tailored, individualised outpatient rehabilitation program in people with progressive MS. A randomised-controlled trial was undertaken in patients with primary and secondary progressive MS referred to the Centro Sclerosi Multipla of Catania. One hundred and eleven patients were assessed at baseline and at 12 weeks with validated measures of disability (Functional Independence Measure (FIM)) and impairment (Expanded Disability Status Scale (EDSS) and Functional Systems Scale). Of the 111, 58 were randomly assigned to the treatment group and 53 to the control group. All patients had been previously trained in a home exercise program. Both groups were well matched for age, sex, disease duration and severity, disability and quality of life (Short Form-36). At the end of 6 weeks patients allocated to the rehabilitation treatment group showed significant improvement in their level of disability compared with the control group,while the level of impairment did not change. Thirty-two patients of the treatment group and four of the control group improved on the FIM by two or more steps at 12 weeks (p<0.0001). An improvement by 1 EDSS step occurred in only two patients of the treatment group and in one patient of the control group. Benefits were maintained for a further six weeks. This study demonstrates that a short outpatient rehabilitation treatment improves disability of MS patients, without changing their impairment and confirms the effectiveness of rehabilitation in people with MS.

Neurorehabilitation in Persons with Multiple Sclerosis: Scientific Basis and Options of Treatment

“…Patti et al observed carry-over of benefits on disability for a further six weeks after a short outpatient treatment, without changing on impairment [27]. In Solari et al study, physical rehabilitation determined improvement in disability detected by FIM motor domains and had a positive impact on mental components of HRQoL perception [25].…”

“…Inpatient setting was associated with a significant improvement in functional impairment [], disability [23], functional independence [25,38] and HRQoL [25,26]. Trials conducted in outpatient setting demonstrated effectiveness of rehabilitation in improvement of muscular strength [22], walking capacity [30], functional independence [27,38], HRQoL [22,24,26]. Home-based rehabilitation produced significant improvement in HRQoL [34, 82,83] Below, we report the conclusions of several systematic reviews which searched to assess the effectiveness of multidisciplinary rehabilitation in PwMS to explore rehabilitation approaches in different settings.…”

Demographic and Clinical Features of Hospitalized Multiple Sclerosis Patients Undergoing a Rehabilitation Program at our Clinic

“…It was stated in a Cochrane review that consisted of 14 randomized controlled and controlled clinical trials that a multidisciplinary rehabilitation approach was at the "strong evidence" level for short-term gains in the level of activity and participation in MS patients (1). There are a limited number of investigations about MS rehabilitation in the literature (1,(4)(5)(6)(7)(8)(9). Therefore, in our study, we aimed to review the sociodemographic and clinical features of the MS patients who were hospitalized at our inpatient clinic and the rehabilitation methods applied and to shed light on the studies that would be conducted on this subject.…”

Inpatient versus outpatient rehabilitation for multiple sclerosis patients: effects on disability and quality of life

“…Functional independence and healthrelated quality of life (HRQoL) are among the outcome measures more investigated. Some studies showed as rehabilitation can improve the motor parameters of functional independence measures (FIM) in PwMS [3][4][5][6][7].…”

“…To date, four possible options of rehabilitation's setting are described in clinical practice: home-based therapy, outpatient ambulatory therapy, inpatient hospital-based therapy and outpatient hospital-based therapy [3][4][5][8][9][10][11][12][13][14][15][16][17][18][19][20].…”