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The efficacy of multidisciplinary rehabilitation in stable multiple sclerosis patients

Copenhagen Multiple Sclerosis Centre, the Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, DK 2100 Copenhagen, Denmark

P S Sørensen

Copenhagen Multiple Sclerosis Centre, the Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, DK 2100 Copenhagen, Denmark

M Ravnborg

The MS Hospital in Haslev, 4690 Haslev, Denmark

Objective To evaluate the short-term efficacy of multidisciplinary, inpatient rehabilitation of multiple sclerosis (MS) patients.

Methods A double-blind, randomized, parallel group design was used. The intervention group were offered comprehensive, multidisciplinary inpatient rehabilitation at the Haslev MS Hospital for an average of 35.5 days, while the control group received no treatment related to the study. All patients were examined in their homes twice with a 10-week interval. The rehabilitation of the intervention group started 2-3 weeks after the first examination and ended 2-3 weeks before the second examination. Impairment was assessed by the Multiple Sclerosis Impairment Scale and the Expanded Disability Status Scale. Disability was assessed by means of Guy’s Neurological Disability Scale. Two specific scales were used to assess upper limb function and ambulation: The Nine-Hole Peg Test and timed 10-metre walking. Patients’ own perception of bodily pain, bladder symptoms, spasticity, fatigue, impaired walking and transfers were recorded using visual analogue scales. Finally, quality of life was assessed using the Life Appreciation and Satisfaction Questionnaire and the Functional Assessment in Multiple Sclerosis.

Patients Two hundred and thirty-three patients were screened and of those 38 were included for treatment and 52 as controls.

Results We found no statistically significant differences between the two groups in any of the outcome measures.

Conclusion Although the study was underpowered, the negative outcome exposes the difficulties in quantitative analyses of the efficacy of multidisciplinary rehabilitation, which is liable to confounding factors such as variation in the indication for treatment, in the placebo effect, and in the reliability and responsiveness of the outcome measures.

Key Words: EDSS • disability • FAMS • impairment • inpatient • LASQ • MSIS • multiple sclerosis • Quality of Life • rehabilitation

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