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

Abstract

Background: The most suitable setting of rehabilitation for Persons with Multiple Sclerosis (PwMS) has not been identified so far because there is a general lacking of controlled studies. Aim of this study was to evaluate the treatment efficacy in terms of functional independence between two different settings. Methods: A randomized, wait-list controlled study was performed at the MS Center of the University of Catania, and Rehabilitation Center of the Hospital of Acireale, Italy. Inclusion criteria were: a) range of age 18-75, b) Expanded Disability Status Scale ≥4.0 and ≤8.0 c) self-reported worsening of standing or walking abilities in the last 6 months. The examining physician was blind to patient allocation program. The Functional Independence Measure (FIM), and the 36-Health Survey Questionnaire (SF-36) data were collected at T0 (baseline) and T1 (follow-up). Results: One-hundred forty-six patients were randomly assigned to three groups. Forty-nine PwMS were allocated in the outpatient treatment group (Group A), 49 patients in the inpatients treatment group (Group B) and 48 patients in the control waiting list (Group C). Both Group A and Group B showed a significant improvement in total FIM scores (p = 0.03, p = 0.008; respectively) at T1 compared to T0. No difference was found between Group A and B with regard to the FIM scores in the intergroup analysis. Group A showed significant improvement at T1 compared to T0 in all sub-items of SF-36 (p < 0.05), contrary to Group B. A significant difference in total FIM score between the three groups was found (p = 0.0003). The pairwise comparisons showed a significant difference between Group A vs Group C (p = 0.003) and Group B versus Group C (p = 0.001). Conclusions: Inpatients and oupatients rehabilitation approaches both showed efficacy in improving total FIM score. Outpatient rehabilitation setting seems to be more effective in improving patients QoL.

SROI-EM. Impacto clínico, asistencial, económico y social del abordaje ideal de la Esclerosis Múltiple en comparación con el abordaje actual

“…Sin embargo, el acceso a la rehabilitación en la actualidad es limitado: se estima que tan sólo el 16% de los pacientes con EM acceden a ella [137] . Esto implica una pérdida tanto de CV como de independencia potencialmente evitables para muchos de ellos [138] .…”

“…• Se mejoraría el estado motor y la autonomía de los pacientes, consecuencia de las visitas a fisioterapia [138] .…”

“…• Se reduciría la carga de cuidado a los pacientes, consecuencia de la mejora del estado motor [138] .…”

Recent Considerations on Gaming Console Based Training for Multiple Sclerosis Rehabilitation

“…All these troubles negatively affect the Quality of Life (QoL) of MS patients and their care-givers, triggering an increasing demand for healthcare, social and vocational services, and caregiver burden. The assisted and symptomatic management provided by a comprehensive multidisciplinary goal-oriented rehabilitation program, including occupational, psychological, and speech therapy, remains the only treatment approach for severely impaired MS patients [ 5 , 6 , 7 , 8 ].…”

Cost-efficiency of specialist inpatient rehabilitation for adults with multiple sclerosis: A multicentre prospective cohort analysis of the UK Rehabilitation Outcomes Collaborative national clinical dataset for rehabilitation centres in England

“…Specialist rehabilitation is increasingly recognised as an essential component of healthcare for this group of patients, but it can be a costly intervention and systematic evaluation is required to demonstrate that programmes are both effective and cost-efficient. [3][4][5] There is a growing body of evidence for the effectiveness of rehabilitation in MS, [6][7][8][9][10][11][12][13][14][15] but with everincreasing financial pressures on healthcare systems it is necessary to demonstrate value for money. Such evidence is required not only in the context of clinical trials but also in real-life clinical practice.…”