Multidisciplinary rehabilitation for adults with multiple sclerosis.
Identifieur interne : 003B78 ( Main/Corpus ); précédent : 003B77; suivant : 003B79Multidisciplinary rehabilitation for adults with multiple sclerosis.
Auteurs : F. Khan ; L. Turner-Stokes ; L. Ng ; T. KilpatrickSource :
- The Cochrane database of systematic reviews [ 1469-493X ] ; 2007.
English descriptors
- KwdEn :
- MESH :
- complications : Multiple Sclerosis.
- rehabilitation : Multiple Sclerosis.
- Adult, Ambulatory Care, Home Care Services, Hospitalization, Humans, Program Evaluation, Quality of Life, Randomized Controlled Trials as Topic.
Abstract
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 "CENTRAL", 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; 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 best 'dose' of therapy or supremacy of one therapy over another. This review highlights the limitations of RCTs in rehabilitation settings and 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.
DOI: 10.1002/14651858.CD006036.pub2
PubMed: 17443610
Links to Exploration step
pubmed:17443610Le document en format XML
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<author><name sortKey="Khan, F" sort="Khan, F" uniqKey="Khan F" first="F" last="Khan">F. Khan</name>
<affiliation><nlm:affiliation>University of Melbourne, Department of Rehabilitation Medicine, Poplar Road, Parkville, Melbourne, Victoria, Australia, 3052. fary.khan@mh.org.au</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Turner Stokes, L" sort="Turner Stokes, L" uniqKey="Turner Stokes L" first="L" last="Turner-Stokes">L. Turner-Stokes</name>
</author>
<author><name sortKey="Ng, L" sort="Ng, L" uniqKey="Ng L" first="L" last="Ng">L. Ng</name>
</author>
<author><name sortKey="Kilpatrick, T" sort="Kilpatrick, T" uniqKey="Kilpatrick T" first="T" last="Kilpatrick">T. Kilpatrick</name>
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<sourceDesc><biblStruct><analytic><title xml:lang="en">Multidisciplinary rehabilitation for adults with multiple sclerosis.</title>
<author><name sortKey="Khan, F" sort="Khan, F" uniqKey="Khan F" first="F" last="Khan">F. Khan</name>
<affiliation><nlm:affiliation>University of Melbourne, Department of Rehabilitation Medicine, Poplar Road, Parkville, Melbourne, Victoria, Australia, 3052. fary.khan@mh.org.au</nlm:affiliation>
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<author><name sortKey="Turner Stokes, L" sort="Turner Stokes, L" uniqKey="Turner Stokes L" first="L" last="Turner-Stokes">L. Turner-Stokes</name>
</author>
<author><name sortKey="Ng, L" sort="Ng, L" uniqKey="Ng L" first="L" last="Ng">L. Ng</name>
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<author><name sortKey="Kilpatrick, T" sort="Kilpatrick, T" uniqKey="Kilpatrick T" first="T" last="Kilpatrick">T. Kilpatrick</name>
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<series><title level="j">The Cochrane database of systematic reviews</title>
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<imprint><date when="2007" type="published">2007</date>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult (MeSH)</term>
<term>Ambulatory Care (MeSH)</term>
<term>Home Care Services (MeSH)</term>
<term>Hospitalization (MeSH)</term>
<term>Humans (MeSH)</term>
<term>Multiple Sclerosis (complications)</term>
<term>Multiple Sclerosis (rehabilitation)</term>
<term>Program Evaluation (MeSH)</term>
<term>Quality of Life (MeSH)</term>
<term>Randomized Controlled Trials as Topic (MeSH)</term>
</keywords>
<keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Multiple Sclerosis</term>
</keywords>
<keywords scheme="MESH" qualifier="rehabilitation" xml:lang="en"><term>Multiple Sclerosis</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Adult</term>
<term>Ambulatory Care</term>
<term>Home Care Services</term>
<term>Hospitalization</term>
<term>Humans</term>
<term>Program Evaluation</term>
<term>Quality of Life</term>
<term>Randomized Controlled Trials as Topic</term>
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<front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b>
</p>
<p>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.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>OBJECTIVES</b>
</p>
<p>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.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>SEARCH STRATEGY</b>
</p>
<p>The sources used included: Cochrane Central Register of Controlled Trials "CENTRAL", 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).</p>
</div>
<div type="abstract" xml:lang="en"><p><b>SELECTION CRITERIA</b>
</p>
<p>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.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>DATA COLLECTION AND ANALYSIS</b>
</p>
<p>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.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>MAIN RESULTS</b>
</p>
<p>Eight trials (7 RCTs; 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 best 'dose' of therapy or supremacy of one therapy over another. This review highlights the limitations of RCTs in rehabilitation settings and need for better designed randomized and multiple centre trials.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>AUTHORS' CONCLUSIONS</b>
</p>
<p>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.</p>
</div>
</front>
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<ArticleTitle>Multidisciplinary rehabilitation for adults with multiple sclerosis.</ArticleTitle>
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<Abstract><AbstractText Label="BACKGROUND" NlmCategory="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.</AbstractText>
<AbstractText Label="OBJECTIVES" NlmCategory="OBJECTIVE">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.</AbstractText>
<AbstractText Label="SEARCH STRATEGY" NlmCategory="METHODS">The sources used included: Cochrane Central Register of Controlled Trials "CENTRAL", 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).</AbstractText>
<AbstractText Label="SELECTION CRITERIA" NlmCategory="METHODS">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.</AbstractText>
<AbstractText Label="DATA COLLECTION AND ANALYSIS" NlmCategory="METHODS">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.</AbstractText>
<AbstractText Label="MAIN RESULTS" NlmCategory="RESULTS">Eight trials (7 RCTs; 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 best 'dose' of therapy or supremacy of one therapy over another. This review highlights the limitations of RCTs in rehabilitation settings and need for better designed randomized and multiple centre trials.</AbstractText>
<AbstractText Label="AUTHORS' CONCLUSIONS" NlmCategory="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.</AbstractText>
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