The impact of inpatient rehabilitation on progressive multiple sclerosis

Abstract

One of the primary aims of rehabilitation for patients with multiple sclerosis (MS) is to reduce their levels of disability and handicap, yet little systematic research into the outcomes of this intervention has been undertaken. This stratified, randomized, wait-list controlled study evaluated the effectiveness of a short period of multidisciplinary inpatient rehabilitation in people with MS. Sixty-six patients in the progressive phase of the disease were assessed at 0 and 6 weeks with validated measures of impairment (Expanded Disability Status Scale and Functional Systems), disability (Functional Independence Measure), and handicap (London Handicap Scale). Both groups were comparable in terms of age, sex, disease duration and severity, disability, and handicap. At the end of 6 weeks, although the level of impairment in both groups remained the same, those who participated in a short period of inpatient rehabilitation (average of 25 days) significantly improved their level of disability and handicap compared with those in the wait-list control group. Despite unchanging impairment, inpatient rehabilitation resulted in reduced disability and handicap in patients with progressive MS.

Effectiveness of Multidisciplinary Rehabilitation Services in Postacute Care: State-of-the-Science. A Review

“…33 The benefit of multidisciplinary rehabilitation for these conditions, as identified by outcomes measured more proximal to the treatment, should not go unnoticed, however. 34,35 There are also ethical restraints in using RCTs, particularly with severely affected patients for whom clinicians believe there are no realistic alternative interventions to specialized care. 11,36 Particularly for conditions in which multidisciplinary rehabilitation has become the standard of care without systematic evidence to support it in practice, 31 denying services randomly in order to conduct an RCT could be considered unethical, as has been the case with patients with spinal cord and traumatic brain injuries.…”

Rehabilitation in Multiple Sclerosis: Outcome Selection in Clinical Trials

“…The results of the correlation analysis from this study also provided interesting information. 19 The analysis showed that the association between each of the outcomes measured was weak to moderate (r = 0.08 -0.64), indicating that each of the scales measured a different concept, and therefore probably captured different aspects of the rehabilitation process. This suggests that measuring a single entity, such as physical disability, risks missing valuable benefits, and that measuring a range of dimensions may be necessary to capture the full impact of the rehabilitation process.…”

“…In looking at trials designed to measure the package of multidisciplinary rehabilitation that have been undertaken in the past decade, it is evident that earlier research focused almost entirely on physical disability (Table 1). [2][3][4][5][6][7][8][9][10][11][12][13][14] In recent years, however, there has been increasing recognition that disability is only one of the many aspects of health affected by rehabilitation, and there has consequently been a broadening of the domains measured to include other aspects, such as handicaps and quality of life. This extension of the outcomes measured is important, because it is known from clinical experience that MS has a widespread impact on an individual.…”

Comparison of Effectiveness of Ergotherapy in Different Types of Multiple Sclerosis

“…13 MS'li hastalarda yorgunluğun sık rastlanan bir yakınma olması nedeniyle ergoterapi programı içinde terapistlerin üzerinde durduğu önemli konulardan biri de enerji koruma prensiplerinin hastaya öğretilmesidir. Biz çalışmamızda ergoterapi programı içinde enerji koruma prensiplerine yer verdik.…”