Multidisciplinary rehabilitation for MS
The review looked at multidisciplinary rehabilitation conducted in three different settings:
- Inpatient (as a patient in hospital)
- Outpatient (hospital outpatient department or community centre)
- Home-based (in the person’s home)
Inpatient rehabilitation programs (conducted in hospitals)
- Strong evidence that they can improve overall activity levels and participation in society, even though it does not change the level of impairment due to multiple sclerosis (MS)
Inpatient and outpatient rehabilitation programs (conducted in hospitals, outpatient departments or in the community)
- Moderate evidence that they can improve disability, bladder-related activity and participation in society up to 12 months later
Outpatient and home-based rehabilitation programs conducted in outpatient departments, the community or at home.
- Strong evidence that low intensity programs (i.e. once a week for a year) can result in longer term gains in quality of life. Additionally, there was limited evidence that it also has benefits for carers of people with MS
- Limited evidence that high intensity programs (i.e. 6 days a week for 6 weeks) can improve participation in society and quality of life in the short term
It is possible that there are side-effects associated with rehabilitation but this is very uncommon.
While fatigue is a major issue in MS, this review found that multidisciplinary rehabilitation did not make fatigue worse.
What we don’t know from the results of this review
We don’t have a clear idea about what specific kind of rehabilitation program is most beneficial to people with MS. This is because the rehabilitation programs in the studies were so different. The therapy programs were conducted in different types of services and some programs had daily sessions for a few weeks, whereas others had weekly sessions for a year. Additionally, rehabilitation programs are usually tailored to an individual’s specific needs, so what works for one person may not be the best thing for someone else. It is also unclear what the effect of rehabilitation is immediately after a relapse as the studies didn’t provide enough information about whether the participants had recently experienced a relapse.
What about the quality of the these results?
Overall, the quality of the results is high. The studies were either randomised controlled trials (RCTs) or controlled clinical trials (CCTs), which are considered the most rigorous study design.
The reason the authors cannot be more specific in their conclusions about the effect of multidisciplinary rehabilitation for people with MS is because there are not enough studies and the rehabilitation programs are so variable that it is difficult to come up with an overall answer.
The really detailed answer
For more information, or to read about the individual studies included, you can access the Cochrane review on which this evidence summary is based:
- Khan F, Turner-Stokes L, Ng L, Kilpatrick T, Amatya B. Multidisciplinary rehabilitation for adults with multiple sclerosis. Cochrane Database of Systematic Reviews 2007, Issue 2