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Rehabilitation in Multiple Sclerosis: A Systematic Review of Systematic Reviews

Archives of Physical Medicine and Rehabilitation, In Press, Corrected Proof, Available online 20 May 2016

Abstract

Objectives

To systematically evaluate existing evidence from published systematic reviews of clinical trials for the effectiveness of rehabilitation for improving function and participation in persons with multiple sclerosis (MS).

Data Sources

A literature search was conducted using medical and health science electronic databases (MEDLINE, EMBASE, CINAHL, PubMed, Cochrane Library) up to January 31, 2016.

Study Selection

Two reviewers independently applied inclusion criteria to select potential systematic reviews assessing the effectiveness of organized rehabilitation for persons with MS. Data were summarized for type of interventions, type of study designs included, outcome domains, method of data synthesis, and findings.

Data Extraction

Data were extracted by 2 reviewers independently for methodological quality using the Assessment of Multiple Systematic Reviews. Quality of evidence was critically appraised with the Grades of Recommendation, Assessment, Development, and Evaluation.

Data Synthesis

Thirty-nine systematic reviews (one with 2 reports) evaluated best evidence to date. There is “strong” evidence for physical therapy for improved activity and participation, and for exercise-based educational programs for the reduction of patient-reported fatigue. There is “moderate” evidence for multidisciplinary rehabilitation for longer-term gains at the levels of activity (disability) and participation, for cognitive-behavior therapy for the treatment of depression, and for information-provision interventions for improved patient knowledge. There is “limited” evidence for better patient outcomes using psychological and symptom management programs (fatigue, spasticity). For other rehabilitation interventions, the evidence is inconclusive because of limited methodologically robust studies.

Conclusions

Despite the range of rehabilitative treatments available for MS, there is a lack of high-quality evidence for many modalities. Further research is needed for effective rehabilitation approaches with appropriate study design, outcome measurement, type and intensity of modalities, and cost-effectiveness of these interventions.

Keywords: Multiple sclerosis, Patient outcome assessment, Rehabilitation, Treatment outcome.

List of abbreviations: AMSTAR - Assessment of Multiple Systematic Reviews, GRADE - Grades of Recommendation, Assessment, Development, and Evaluation, MDR - multidisciplinary rehabilitation, MS - multiple sclerosis, pwMS - persons with multiple sclerosis.

Footnotes

a Department of Rehabilitation Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia

b Department of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia

c School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia

Corresponding author Fary Khan, MBBS, MD, FAFRM (RACP), Department of Rehabilitation Medicine, Royal Melbourne Hospital, 34-54 Poplar Rd, Parkville VIC 3052, Australia.

Supported by the internal resources of the Rehabilitation Department, Royal Melbourne Hospital, Royal Park Campus, Melbourne, Australia.

Disclosures: none.