||Khan, F., Turner-Stokes, L., Ng, L., & Kilpatrick, T. (2007). Multidisciplinary rehabilitation for adults with multiple sclerosis. Cochrane Database of Systematic Reviews 2007, 2, CD006036.
||cognitive therapy, social work, dietetics, diet therapy, gait disorder, multiple sclerosis, rehabilitation, physical therapy, home care services, cognitive therapy, behavior therapy
||Background: Multidisciplinary rehabilitation (MD) is an important component of symptomatic and supportive treatment for multiple sclerosis (MS), but evidence base for its effectiveness is yet to be established.
Objectives: To assess the effectiveness of organized MD rehabilitation in adults with MS. To explore rehabilitation approaches that are effective in different settings and the outcomes that are affected.
Search strategy: The sources used included: Cochrane Central Register of Controlled Trials, MEDLINE (1966- 2005), CINAHL (1982-2005), PEDro (1990-2005), EMBASE (1988-2005), the Cochrane Rehabilitation and Related Therapies Field Trials Register, and the National Health Service National Research Register (NRR).
Selection criteria: Randomized and controlled clinical trials that compared MD rehabilitation with routinely available local services or lower levels of intervention; or trials comparing interventions in different settings or at different levels of intensity.
Data collection and analysis: Three reviewers selected trials and rated their methodological quality independently. A "best evidence" synthesis based on methodological quality was performed. Trials were grouped in terms of setting and type of rehabilitation and duration of patient follow-up.
Main results: Eight trials (7 RCTs and 1 CCT; 747 participants and 73 caregivers) were identified. Seven RCTs scored well and one CCT scored poorly on the methodological quality assessment. There was "strong evidence" that despite no change in the level of impairment, inpatient MD rehabilitation can produce short-term gains at the levels of activity (disability) and participation for patients with MS. For outpatient and home-based rehabilitation programmes there was "limited evidence" for short-term improvements in symptoms and disability with high intensity programmes, which translated into improvement in participation and quality of life. For low intensity programmes conducted over a longer period there was strong evidence for longer-term gains in quality of life; and also limited evidence for benefits to carers. Although some studies reported potential for cost-savings, there is no convincing evidence regarding the long-term cost-effectiveness of these programmes. It was not possible to suggest the best "dose" of therapy or supremacy of one therapy over another. This review highlights the limitations of RCTs in rehabilitation settings and the need for better designed randomized and multiple centre trials.
Authors’ conclusions: MD rehabilitation programmes do not change the level of impairment, but can improve the experience of people with MS in terms of activity and participation. Regular evaluation and assessment of these persons for rehabilitation is recommended. Further research into appropriate outcome measures, optimal intensity, frequency, cost, and effectiveness of rehabilitation therapy over a longer time period is needed. Future research in rehabilitation should focus on improving methodological and scientific rigour of clinical trials.
|Plain Language Summary:
Multidisciplinary rehabilitation as supportive treatment action, medicine, therapy for adults with multiple sclerosis
Multiple sclerosis is a chronic constant, never ending, does not go away, long term, lasting a long time, long-lasting neurological related to the brain and nervous system condition, which can cause multiple disabilities and limit participation in young adults. This review go over, check looked for evidence of MD rehabilitation in adults with multiple sclerosis. The authors concluded there was strong evidence that inpatient or outpatient rehabilitation can lead to improvement in activity (disability) and in overall ability skill, are able, can to participate take part, join, share in society, even though there is no reduction in actual impairment. There was limited evidence for short-term improvements in symptoms and disability, and in participation and quality of life with the high intensity outpatient and home-based rehabilitation programmes. For low intensity programmes conducted over a longer period sore, wound, infection there were longer term gains in quality of life; and for benefits to carers in terms of general health and engagement in social activities. The evidence available on hand, at hand, ready, nearby, handy, ready for other aspects of MD rehabilitation, including outpatient and home based therapy treatment action, medicine, therapy is not yet sufficient enough, plenty, ample to allow many conclusions to be drawn.