Rehabilitation for people with multiple sclerosis: an overview of Cochrane Reviews

Amatya, Bhasker; Khan, Fary; Galea, Mary P.

doi:10.1002/14651858.cd012732.pub2

Cited by 132 publications

(123 citation statements)

References 74 publications

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“…• • The acute phase of sudden onset disorders; stroke, 6 acute episodes of coronary artery disease, 10 hip fracture, 18 and traumatic brain injury; 16 | | including those where there is no 'natural recovery', such as spinal cord injury where rehabilitation has transformed life expectancy and social functioning. 36,37 • • The later, more stable phases of acute onset disorders: stroke; 38 • • Diseases that have a slow or fluctuant onset and are progressive to a greater or lesser degree: multiple sclerosis, [12][13][14] osteoarthritis, 39 chronic back pain; 21 • • Diseases that are more inexorably progressive: Parkinson's disease 17 and Alzheimer's disease. 40,41 One may conclude that rehabilitation is likely to be beneficial to a person with disability at any stage of their illness and whatever the nature of their prognosis, including when receiving palliative care: rehabilitation can benefit people with advanced cancer.…”

Section: Does Stage or Prognosis Of Disease Affect Effectiveness?mentioning

confidence: 99%

What is rehabilitation? An empirical investigation leading to an evidence-based description

2020

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Background: There is no agreement about or understanding of what rehabilitation is; those who pay for it, those who provide it, and those who receive it all have different interpretations. Furthermore, within each group, there will be a variety of opinions. Definitions based on authority or on theory also vary and do not give a clear description of what someone buying, providing, or receiving rehabilitation can actually expect. Method: This editorial extracts information from systematic reviews that find rehabilitation to be effective, to discover the key features and to develop an empirical definition. Findings: The evidence shows that rehabilitation may benefit any person with a long-lasting disability, arising from any cause, may do so at any stage of the illness, at any age, and may be delivered in any setting. Effective rehabilitation depends on an expert multidisciplinary team, working within the biopsychosocial model of illness and working collaboratively towards agreed goals. The effective general interventions include exercise, practice of tasks, education of and self-management by the patient, and psychosocial support. In addition, a huge range of other interventions may be needed, making rehabilitation an extremely complex process; specific actions must be tailored to the needs, goals, and wishes of the individual patient, but the consequences of any action are unpredictable and may not even be those anticipated. Conclusion: Effective rehabilitation is a person-centred process, with treatment tailored to the individual patient’s needs and, importantly, personalized monitoring of changes associated with intervention, with further changes in goals and actions if needed.

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Section: Does Stage or Prognosis Of Disease Affect Effectiveness?mentioning

confidence: 99%

What is rehabilitation? An empirical investigation leading to an evidence-based description

2020

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“…Management of symptoms is, however, a complex task requiring a multidisciplinary approach. In some cases, non-pharmacological interventions may be beneficial, e.g., physiotherapy for spasticity, but might have a limited time effect and the evidence supporting such approaches is not always strong (30), and pharmacological interventions are often considered necessary. As shown in Table 2, a wide variety of agents can be used (31,32).…”

Section: Management Of Spasticity Symptomsmentioning

confidence: 99%

The Broad Concept of “Spasticity-Plus Syndrome” in Multiple Sclerosis: A Possible New Concept in the Management of Multiple Sclerosis Symptoms

et al. 2020

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Multiple sclerosis (MS) pathology progressively affects multiple central nervous system (CNS) areas. Due to this fact, MS produces a wide array of symptoms. Symptomatic therapy of one MS symptom can cause or worsen other unwanted symptoms (anticholinergics used for bladder dysfunction produce impairment of cognition, many MS drugs produce erectile dysfunction, etc.). Appropriate symptomatic therapy is an unmet need. Several important functions/symptoms (muscle tone, sleep, bladder, pain) are mediated, in great part, in the brainstem. Cannabinoid receptors are distributed throughout the CNS irregularly: There is an accumulation of CB 1 and CB 2 receptors in the brainstem. Nabiximols (a combination of THC and CBD oromucosal spray) interact with both CB 1 and CB 2 receptors. In several clinical trials with Nabiximols for MS spasticity, the investigators report improvement not only in spasticity itself, but also in several functions/symptoms mentioned before (spasms, cramps, pain, gait, sleep, bladder function, fatigue, and possibly tremor). We can conceptualize and, therefore, hypothesize, through this indirect information, that it could be considered the existence of a broad "Spasticity-Plus Syndrome" that involves, a cluster of symptoms apart from spasticity itself, the rest of the mentioned functions/symptoms, probably because they are interlinked after the increase of muscle tone and mediated, at least in part, in the same or close areas of the brainstem. If this holds true, there exists the possibility to treat several spasticity-related symptoms induced by MS pathology with a single therapy, which would permit to avoid the unnecessary adverse effects produced by polytherapy. This would result in an important advance in the symptomatic management of MS.

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“…To solve this problem, it is crucial to establish standardized telerehabilitation methods. While telecommunicationbased rehabilitation methods have recently been developed [12], the methods have mostly been applied for the rehabilitation of middle-aged patients, with diseases including multiple sclerosis [13], stroke [14] and cardiac disease [15], rather than elderly people. There have been no trials of telerehabilitation focused on preventive rehabilitation for general elderly people.…”

Section: Discussionmentioning

confidence: 99%

“…Recently new telecommunication-based methods that enable the patients to receive rehabilitation in their own home have been developed and applied in the eld of rehabilitation [12]. While telerehabilitation has been clinically applied, most patients have been middle-aged adults with diseases including multiple sclerosis [13], stroke [14] and cardiac disease [15]. Thus, the e cacy of telerehabilitation for fallprevention in elderly people has been totally unclear.…”

Section: Introductionmentioning

confidence: 99%

A novel telerehabilitation with educational program for caregivers using telelecture is a feasible procedure for fall prevention in elderly people – A pilot study

Moriichi

Fujiya

et al. 2020

Preprint

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Background: The importance of fall prevention rehabilitations has been well recognized. Recently, telerehabilitation was developed, however, there have been no reports on the use of telerehabilitation with direct support from specialists for fall prevention among the elderly. We herein reported telerehabilitation by carers educated by our novel educational program.Methods: Nine elderly people in two nursing homes were enrolled using our original criteria. Carers are educated with our educational program using telelecture system. Telerehabilitation was performed by carers following the instruction from rehabilitation specialists in Asahikawa Medical University using the telemedicine system every 2-4 weeks for three months. Carers were assessed with our original questionnaire before and after the telelecture. Berg Balance Scale (BBS), Timed Up & Go test (TUG test), Hand-held dynamometer (HHD) and Mini-Mental State Examination (MMSE) were assessed before and after telerehabilitation.Results: The average number of times to perform telerehabilitation in all institutes was 4.7. Levels of understanding of carers were significantly increased after the telelecture. No adverse event occurred during the study period. Median BBSs before and three months after telerehabilitation were 43 and 49, respectively. Those of TUG test, right and left HHD and MMSE were 17.89 and 18.53, 7.95 and 11.55, 9.85 and 13.20, and 16 and 19, respectively. All results were improved after telerehabilitation.Conclusions: Our telerehabilitation program exhibited significant effects in elderly people as well as levels of understanding rehabilitation of caregivers in the facilities for the elderly people safely.Trial registration: University Hospital Medical Information Network Clinical Trials Registry（UMIN-CTR）UMIN000041439, August 17th, 2020

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Rehabilitation for people with multiple sclerosis: an overview of Cochrane Reviews

Abstract: Rehabilitation for people with multiple sclerosis: an overview of Cochrane Reviews.

Cited by 132 publications

References 74 publications

What is rehabilitation? An empirical investigation leading to an evidence-based description

What is rehabilitation? An empirical investigation leading to an evidence-based description

The Broad Concept of “Spasticity-Plus Syndrome” in Multiple Sclerosis: A Possible New Concept in the Management of Multiple Sclerosis Symptoms

A novel telerehabilitation with educational program for caregivers using telelecture is a feasible procedure for fall prevention in elderly people – A pilot study

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