New Zealand Rehabilitation Association, Inc.

A number of Cochrane Reviews have been conducted in the past looking at the evidence regarding the effectiveness of various interventions for people with multiple sclerosis (MS).  These have included reviews of occupational therapy and MS (Steultjens et al., 2003), exercise therapy and MS (Rietberg et al., 2004), psychological interventions and MS (Thomas et al, 2006), and of course a whole range of medical interventions and MS (you'll have to look these ones up yourself - there's heaps!)  These reviews have concluded, respectively, that there is no strong research evidence either way for OT intervention, although some favourable anecdotal evidences - more research needs to be conducted, that there was strong evidence that exercise therapy can improve muscle function and mobility, and that there was some limited evidence that cognitive behavioural therapy could be useful to helping people adjust to and cope with having MS or help them if they became depressed.  (An overview of reviews into medication for multisclerosis is outside the scope of this brief blog!)

Khan et al. (2007) however conducted this review to evaluate and collate the best available research into the effectiveness of multidisciplinary approaches to rehabilitation for people with MS.  They identified eight clinical trials that were relevant to their review - seven good quality randomised controlled trials and one low quality case control study.  While, like most Cochrane Reviews of this nature, the authors concluded that further high quality, multicentre studies were needed, they were able to draw a series of informative conclusions.  It seems, from this review, that there is strong evidence in favour of inpatient multidisciplinary rehabilitation for people with MS, but that gains tend to be made in terms of improvements in their ability to be independent with activities of daily living and social participation rather than in terms of reduction of impairments.  The evidence around outpatient and community based rehabilitation programmes suggested that low intensity interventions over longer periods (e.g. one session a week for a year) tended to be more successful in achieving longer-term gains, but that there was insufficient evidence to reach any strong conclusions about high intensity programme of short duration.  Further research appears to be needed to address questions regarding the cost-effectiveness of various rehabilitation programme for MS and in terms of the dose-response effects from various level of rehabilitation intensity.

References:

Rietberg MB, Brooks D, Uitdehaag BMJ, Kwakkel G. Exercise therapy for multiple sclerosis. Cochrane Database of Systematic Reviews 2004, Issue 3. 

Steultjens EEMJ, Dekker JJ, Bouter LM, Cardol MM, Van den Ende ECHM, van de Nes J. Occupational therapy for multiple sclerosis. Cochrane Database of Systematic Reviews 2003, Issue 3 

Thomas PW, Thomas S, Hillier C, Galvin K, Baker R. Psychological interventions for multiple sclerosis. Cochrane Database of Systematic Reviews 2006, Issue 1.