About MSBEST

MSBEST aims to develop comprehensive systematic reviews in multiple sclerosis rehabilitation to inform evidence-based care and improve the lives of people living with MS.

The MSBEST (Multiple Sclerosis Best Evidence-Based Strategies and Treatment/Therapies for Rehabilitation) project consists of a series of systematic reviews of the literature on topics in MS care and rehabilitation.

A group of researchers and clinicians in North America with expertise in MS rehabilitation initiated MSBEST. The website provides a comprehensive summary of the research, in addition to clinicians' guidance about appropriate care and rehabilitation for people living with MS. Topic reviews are freely accessible as online modules.

The MSBEST modules help translate research findings into practice, however further strategies are needed. The MSBEST leadership team in partnership with MS Canada hosted a knowledge mobilization summit in 2023, engaging experts and key stakeholders to develop knowledge mobilization priorities for MS rehabilitation. A key priority identified from the summit was the need to create an MS Rehabilitation Best Practice Guideline. The work of the MBSEST team and the next MSBEST modules will be conducted in view of this priority.

The MSBEST team would like to thank The Ralph M. Barford Foundation for their ongoing support. We would also like to acknowledge the Collaboration of Rehabilitation Research Evidence group (CORRE), the University of Saskatchewan College of Medicine, the Saskatchewan Health Authority and the Saskatchewan Health Research Foundation.

MSBEST Team

Project Leads
Name	Affiliation
Katherine B Knox, MD, FRCPC	Department of Physical Medicine and Rehabilitation, College of Medicine, University of Saskatchewan, Saskatoon, SK, Can
Sarah J Donkers, BSc, MPT, MSc, PhD	School of Rehabilitation Science, University of Saskatchewan, SK, Can
Mark Bayley, MD, FRCPC	University Health Network-Toronto Rehabilitation Institute, Toronto, ON, Can
Tania Bruno, MD, FRCPC	University Health Network-Toronto Rehabilitation Institute, Toronto, ON, Can
Project coordinators
Name	Affiliation
Ailene Kua, MSc, PMP	University Health Network-Toronto Rehabilitation Institute, Toronto, ON, Can
Devon Ireland, BSc In Memory	Past project coordinator Department of Physical Medicine and Rehabilitation, College of Medicine, University of Saskatchewan, Saskatoon, SK, Can
Magdalena Mirkowski, MSc	Past project coordinator Collaboration of Rehabilitation Research Evidence (CORRE), Parkwood Institute Research, London, ON, Can
Project Team Members
Name	Affiliation
Eman Abdulhadi, MPT, BKin (hons), BA	Department of Physical Medicine and Rehabilitation, College of Medicine, University of Saskatchewan, Saskatoon, SK, Can
Afsoun Amiraslany, BSc	College of Medicine, University of Saskatchewan, Saskatoon, SK, Can
Mohammad Alshahrani, MD	University Health Network-Toronto Rehabilitation Institute, Toronto, ON, Can
Melissa Andersen, BSc, MPT, MD	Department of Physical Medicine and Rehabilitation, University of Saskatchewan, Saskatoon, SK, Can
Deborah Backus, PT, PhD, FACRM	Virginia C. Crawford Institute at Shepherd Center, Atlanta, Georgia, USA
Ali Bateman MD, FRCPC, CSCN Diplomate (EMG), MSc(c) QIPS	Parkwood Institute, St. Joseph's Health Care London, Department of Physical Medicine & Rehabilitation, Schulich School of Medicine & Dentistry, Western University, London, ON, Can
B. Catharine Craven, MD, MSc, FRCPC	University Health Network-Toronto Rehabilitation Institute, Toronto, ON, Can
Whitney Duff, BSc, MSc, PhD	Department of Physical Medicine and Rehabilitation, University of Saskatchewan, Saskatoon, SK, Can
Karen Ethans, MD, FRCPC	Winnipeg's Health Sciences Centre, Winnipeg, MB, Can
Marcia Finlayson, PhD	Queen's University, Kingston, ON, Can
Emma Le, PhD	Department of Physical Medicine and Rehabilitation, University of Saskatchewan, Saskatoon, SK, Can
Nancy Mayo, BSc (PT), MSc, PhD	McGill University, Montreal, QC, Can
Amanda McIntyre, RN MSc	Collaboration of Rehabilitation Research Evidence (CORRE), Parkwood Institute Research, Lawson Health Research Institute, London, ON, Can
Sarah A Morrow, MD, FRCPC, MS	Western University, London, ON, Can
Rob Motl, PhD	University of Illinois, Chicago, USA
Darren Nickel, PhD	Department of Physical Medicine and Rehabilitation College of Medicine University of Saskatchewan, Saskatoon, SK, Can
Colleen O'Connell, MD, FRCPC	Stan Cassidy Centre for Rehabilitation, Fredericton NB, Can
Eleni M. Patsakos, HBSc, MSc	Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, KITE Research Institute, University Health Network, Toronto, Ontario, Canada
Michelle Ploughman, BSc, PT, MSc, PhD	Memorial University of Newfoundland, St. John's, NL, Can
Dale Robinson, MD, FRCPC	Markham Stouffville Hospital, Markham, ON, Can
Christine Short, MD, FRCPC, FACP	Nova Scotia Rehabilitation Centre, Halifax, NS, Can
Robert Simpson, PhD MBChB	University Health Network-Toronto Rehabilitation Institute, Toronto, ON, Can
Abe Snaiderman, MD, FRCPC	University Health Network-Toronto Rehabilitation Institute, Toronto, ON, Can
Robert Teasell, MD, FRCPC	Collaboration of Rehabilitation Research Evidence (CORRE), Parkwood Institute Research, Lawson Health Research Institute, London, ON, Can
Daria Trojan, MD, MSc	McGill University, Montreal, QC, Can
Geoffrey K. Turnbull, MD	Department of Medicine, Dalhousie University, Halifax, NS, Can
Joy Williams, PT, DPT	Crawford Research Institute Kaiser Permanente, Northern California, USA

Literature Search

A systematic literature search is conducted following PRISMA guidelines for each module topic with the online databases PubMed, MEDLINE, CINAHL, Scopus and EMBASE. Each search is limited to articles published after January 1, 1970, investigating rehabilitation interventions for multiple sclerosis and published in English in a peer-reviewed journal. Population key words (i.e., “multiple sclerosis” or “MS”) and complication key words pertaining to a particular symptom are used in combination with intervention key words. Customized complication and intervention search terms are applied for each module with input from content expert MSBEST team members. Literature searches for individual modules are completed independently at various time points.

Selection Criteria

Articles are included if they meet the following criteria:

(1) ≥ 3 adults (≥ 18 years) with multiple sclerosis in the study sample

(2) ≥50% of included participants have a diagnosis of multiple sclerosis, unless the results are stratified by disorder

Case studies/reports, abstracts, editorials/commentaries, protocols, reviews, qualitative studies, and assessment tool evaluations/psychometric analyses are excluded. Additional module specific exclusion/inclusion criteria are detailed in the introduction of each module.

Quality Evaluation and Data Extraction

Methodological quality of randomized controlled trials (RCTs) was assessed using the Physiotherapy Evidence Database (PEDro) tool. The PEDro scale consists of 11 items; the first item relates to external validity and the remaining ten items assess internal validity. One point was given for each satisfied criterion (items 2-11) with the exception of the first item, which was given a yes or no, yielding a maximum score of ten. A higher score is representative of a study with better methodological quality. Studies included in this review using a non-RCT design (prospective controlled trials, cohort studies, case controls, pre-post tests, post-tests, and case series) were not assigned a PEDro score.

Data from journal articles included in each module were extracted to form evidence summary tables. The journal article extraction format is described below:

1. Study: Author, year, title, country, research design, PEDro score (if applicable), sample size
2. Methods:
   1. Population: Study sample demographics (age, sex, disease course, disease severity, disease duration)
   2. Intervention: Nature/type of treatment provided
   3. Outcomes/Outcome Measures: Measurements/assessments of primary and/or secondary outcomes
3. Results: Key results of the study - in cases where a single study overlapped into multiple modules, the results presented in the tables focus on the outcomes relevant to that module

Formulating Levels of Evidence and Conclusions

Research findings were summarized by creating levels of evidence to determine the strength of the evidence for each rehabilitation intervention. The levels of evidence presented throughout each module were determined according to the levels of evidence by Sackett et al. (2000). The original system proposed by Sackett et al. (2000) has been modified to reduce the original ten categories into a less complex system comprised of five levels (see Table 1 below). Level 1 evidence pertains to high quality RCTs (PEDro≥6) and has been divided into two subcategories, Level 1a (more than one RCT with a PEDro score of ≥6) and 1b (a single RCT with a PEDro score of ≥6), based on the number of RCTs supporting the evidence statement.

Using this system, RCTs received priority when formulating concluding statements. Conclusions were easily formed when the results of multiple studies were in agreement. In cases where RCTs differed in terms of results and methodological quality, the results of the study (or studies) with higher PEDro score(s) were more heavily weighted to arrive at the final conclusions. In cases where studies of equal methodological quality reported conflicting results, final conclusions were deemed to be conflicting or inconclusive. In cases where the results of a single study of higher quality conflicted with those of several studies of inferior quality, the authors needed to make a more difficult judgment. In these cases, we attempted to provide rationale for our decision in order to make the process as transparent as possible. Readers are always encouraged to be a critical consumer of all the material presented in MSBEST.

Table 1. Modified Sackett Scale

References

Sackett, D., Straus, S., Richardson, W., Rosenberg, W., & Haynes, R. (2000). Evidence-Based Medicine: How to Practice and Teach EBM. Toronto, ON: Churchill Livingstone.