Multidisciplinary rehabilitation for adults with multiple sclerosis: Cochrane

A Cochrane review has concluded that multidisciplinary rehabilitation (MDR) programmes do not change the level of impairment, but can improve the experience of people with multiple sclerosis (MS) in terms of activity and participation. Multidisciplinary rehabilitation (MDR) is an important component of symptomatic and supportive treatment for multiple sclerosis (MS), but evidence base for its effectiveness is yet to be established. For the purposes of this study, MDR was defined as an inpatient, outpatient, home or community based programme, delivered by two or more disciplines in conjunction with physician consultation, and targeted towards improvements at the level of activity and/or participation. Eight trials were selected, comprising 747 MS participants (and 73 caregivers) and included patients with definite MS and all stages of disease, between 18 and 64 years of age (mean 38—52 years), mostly women, and a range of disabilities (Expanded Disability Status Scale score range 3.6—9). There was "strong evidence" that despite no change in the level of impairment, inpatient MDR produced 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. 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. Implications for future research include the need for high quality RCTs and other designs, which assess the effectiveness of specific rehabilitation interventions (components, intensity, settings) and cost effectiveness of these programmes, the researchers concluded. Reference...