KITE | MSBEST: Team-Based Rehabilitation: Functional and Quality of Life Outcomes

Team-Based Rehabilitation: Functional and Quality of Life Outcomes

Table 1

Author Year, Title, Country, Research Design, PEDro, Sample Size,	Methods	Self-Care Activity Results
Nedeljkovic et al. 2016 Multidisciplinary rehabilitation and steroids in the management of multiple sclerosis relapses: a randomized controlled trial Serbia RCT PEDro=5 N_Initial=49, N_Final=37	Population: Intervention Group (IG; n=17): Mean age=41.3yr; Gender: males=6, females=11; Disease course: RRMS; Mean EDSS=4.5; Mean disease duration=104.5mo. Control Group (CG; n=20): Mean age=39.4yr; Gender: males=5, females=15; Disease course=RRMS; Mean EDSS=4.0; Mean disease duration=80.6mo. Intervention: Subjects were randomized to a multidisciplinary inpatient rehabilitation program (IG) or standard care (CG) after receiving intravenous methylprednisolone (1g/d, 5d). Rehabilitation was comprised of physiotherapy (1h/d, 5d/wk) and occupational therapy (30min/d, 3d/wk) for a total of 3wks. Outcomes were assessed at baseline, 1mo, and 3mo. Primary Outcome Measures: Not specified. Self-Care Outcome Measures: Functional Independence Measure (FIM). Other Outcome Measures: EDSS; Beck Depression Inventory (BDI); Multiple Sclerosis Quality of Life-54 (MSQoL-54).	1. On the FIM motor, there was a significant improvement between baseline and 1mo that was sustained up to 3mo in both groups (p<0.001). There was no significant difference between groups at baseline (p=0.288), 1mo (p=0.102), or 3mo (p=0.217). 2. On the FIM cognition, there was no significant difference found between baseline and 1mo or 3mo in either group. There was no significant difference between groups at baseline (p=0.228), 1mo (p=0.284), or 3mo (p=0.657).
Pappalardo et al. 2016 Inpatient versus outpatient rehabilitation for multiple sclerosis patients: Effects on disability and quality of life Italy RCT PEDro=6 N_Initial=146, N_Final=146	Population: Group A outpatient (n=49): Mean age=48.0yr; Gender: males=18, females=31; Disease course: PPMS=18, SPMS=31; Mean EDSS=6.5; Disease duration: unspecified. Group B inpatient (n=49): Mean age=46.0yr; Gender: males=17, females=32; Disease course: PPMS=17, SPMS=32; Mean EDSS=6.5; Disease duration: unspecified. Group C control (n=48): Mean age=45.0yr; Gender: males=18, females=30; Disease course: PPMS=18, SPMS=30; Mean EDSS=6.4; Disease duration: unspecified. Intervention: MS patients were randomized to three groups: the outpatient treatment group (Group A), the inpatient treatment group (Group B), and the control waiting list (Group C). Assessments were performed at baseline (T0) and at 6mo follow-up (T1). Primary Outcome Measures: Functional Independence Measure (FIM). Self-Care Outcome Measures: FIM. Other Outcome Measures: 36-Health Survey Questionnaire (SF-36).	1. Total FIM score improved by a minimum of 20% in 22.6% of patients in the outpatient group A and 14.6% in inpatient B (p=0.5). 2. Motor FIM sub-items improved by a minimum of 20% in 32 % of patients in the outpatient group A and 21.4% in the inpatient group B (p=0.4) while cognitive FIM sub-items showed no improvement in the outpatient group A and an improvement in 3.5% of the inpatient group B. 3. A significant difference was found in terms of total FIM score between T0 and T1 in Group A (p=0.03), in Group B (p=0.008) and Motor FIM sub-items score in Group A (p=0.02). 4. In Group C, no significant variation was found between T0 and T1 in total FIM scores and its sub-items. 5. A significant difference in total FIM scores between the three groups was found (p=0.0003). Pairwise comparisons showed a significant difference between Group A and Group C (p=0.003) and Group B vs. Group C (p=0.001). 6. Motor FIM sub-item scores were significantly different between groups (p=0.0001). Pairwise comparisons showed a significant difference between Group A and Group C (p<0.001) and Group B vs. Group C (p<0.001). 7. No significant differences in cognitive FIM sub-item scores were observed between the three groups.
Rietberg et al. 2014 Effects of multidisciplinary rehabilitation on chronic fatigue in multiple sclerosis: a randomized controlled trial The Netherlands RCT PEDro=7 N_Initial=48, N_Final=44	Population: Multidisciplinary outpatient rehabilitation (MDR) group (n=23): Mean age=45yr; Gender: males=9, females=14; Disease course: RRMS=16, PPMS=2, SPMS=5; Median EDSS=3; Mean disease duration=7yr. Nurse consultation (NC) group (n=25): Mean age=47yr; Gender: males=8, females=17; Disease course: RRMS=12, PPMS=6, SPMS=7; Median EDSS=4; Mean disease duration=8yr. Intervention: MS patients with chronic fatigue were randomized to MDR or to MS-NC groups. Assessments were performed at baseline and after intervention. Primary Outcome Measures: Checklist Individual Strength (CIS-20R). Self-Care Outcome Measures: Functional Independence Measure (FIM). Other Outcome Measures: MS Impact Scale (MSIS-29); Impact on Participation and Autonomy (IPA); Modified Fatigue Impact Scale (MFIS); Fatigue Severity Scale (FSS); Disability and Impact Profile (DIP).	1. No significant between-group differences were found for the FIM from baseline to 12wks (p=0.13) or from 12wks to 24wks (p=0.34). 2. No significant within-group effects were found for multidisciplinary rehabilitation or nurse consultation with respect to the primary and secondary outcome measures from baseline to 12 or 24wks.
Salhofer-Polanyi et al. 2013 Benefits of inpatient multidisciplinary rehabilitation in multiple sclerosis Austria RCT PEDro=5 N_Initial=21, N_Final=19	Population: Intervention Group (n=10): Mean age=53.8yr; Gender: males=5, females=5; Disease course: RRMS=2, PPMS=2, SPMS=6; Median EDSS=6; Mean disease duration=17.6yr. Control Group (n=9): Mean age=52.9yr; Gender: males=3, females=6; Disease course: RRMS=2, SPMS=7; Median EDSS=5.5; Mean disease duration=15.9yr. Intervention: Subjects were randomized to a multidisciplinary inpatient rehabilitation program (intervention) or a waiting list (control). Rehabilitation was provided 5d/wk with 4-5 sessions/d, for a total of 3wks. Outcomes were assessed at baseline and after 15wks. Primary Outcome Measures: Timed 50m Walk (T50MW); 2-min Walk Test (2MW); 6-min Walk Test (6MW); Walking Speed. Self-Care Outcome Measures: Rivermead Mobility Index (RMI). Other Outcome Measures: Functional Assessment in Multiple Sclerosis (FAMS); EDSS; Berg Balance Scale (BBS); Tinetti Test (TT); MS Functional Composite: 9 Hole Peg Test (9HPT), Timed 25ft Walk (T25FW), Paced Auditory Serial Addition Test (PASAT); MS Self-Efficacy Scale (MSSE); Global Clinical Impression Scale (GCIS).	1. There was no significant difference between the intervention group and the control group in mean change on the RMI (p=0.350) after treatment. 2. RMI showed some improvement in the intervention group, although without reaching statistical significance.
Khan et al. 2010 A randomised controlled trial: outcomes of bladder rehabilitation in persons with multiple sclerosis Australia RCT PEDro=9 N_Initial=74, N_Final=58	Population: Treatment group (n=24): Mean age=49.9yr; Gender: males=9, females=15; Disease course: RRMS=6; PPMS=4; SPMS=14; EDSS: 0-3=5, 3.5-6.0=9, 6.5 or greater=10; Mean disease duration=12.2yr. Control group (n=34): Mean age=51.1yr; Gender: males=5, females=29; Disease course: RRMS=14, PPMS=4, SPMS=16; EDSS: 0-3=9, 3.5-6.0=21, 6.5 or greater=4; Mean disease duration=10.0yr. Intervention: Patients were randomized to either the intervention group where they received a multifaceted, individualized, bladder rehabilitation programme, or to the control group (no intervention). Ten participants randomized to control group required some treatment during the study. Primary Outcome Measures: Urogenital distress inventory (UDI6); Incontinence impact questionnaire (IIQ7). Self-Care Outcome Measures: Guy's Neurological Disability Scale (GNDS – bladder subscale only). Other Outcome Measures: AUA Symptom Index.	1. There was a statistically significant difference in change scores between the treatment and control groups with respect to the GNDS (p<0.001). The effect size was large (0.58), as per Cohen's criteria.
Khan et al. 2008 Effectiveness of rehabilitation intervention in persons with multiple sclerosis: a randomised controlled trial Australia RCT PEDro=8 N_Initial=101, N_Final=98	Population: Treatment Group (n=49): Mean age=49.5yr; Gender: males=18, females=31; Disease course: RRMS=13, PPMS=7, SPMS=29; EDSS: 0-3=7, 3.5-6.0=27, 6.5+=15; Mean disease duration=10.69yr. Control Group (n=52): Mean age=51.1yr; Gender: males=11, females=41; Disease course: RRMS=18, PPMS=7, SPMS=27; EDSS: 0-3=12, 3.5-6.0=32, 6.5+=8; Mean disease duration=9.73yr. Intervention: The treatment group underwent multidisciplinary rehabilitation and received either individualized patient (IP) or outpatient (OP) rehabilitation. IP rehabilitation: 3-6wks, 3 or more times/wk, 3h therapy/d, 2 blocks of 45min physiotherapy and occupational therapy with other blocks comprised of speech pathology, neuropsychology and social work. OP rehabilitation: Up to 6wks, 2-3times/wk, 30min sessions for physiotherapy, occupational therapy, social work and speech pathology in addition to doing stretching home exercises. The control group received no intervention, only an 8 weekly monitoring phone call for information about medical hospital visits in the previous month and received no other information. Primary Outcome Measures: Functional Independence Measure (FIM) motor subscale. Self-Care Outcome Measures: FIM motor and cognitive subscales. Other Outcome Measures: Multiple Sclerosis Impact Scale (MSIS-29); General Health Questionnaire (GHQ-28).	1. There were significant differences post treatment between the treatment and control groups for FIM motor total scores (p<0.001) and FIM cognitive subscale scores (p<0.016). 2. The treatment group showed significantly greater improvement in FIM motor scores (p<.001; effect size= 1.13). 3. More patients in the treatment group had improved FIM scores throughout the study (70.8% vs. 13%) and more patients in the control group had FIM scores suggesting deterioration compared to the treatment group (58.7% vs. 16.7%). The difference in these proportions was significantly different (p<0.001).
Storr et al. 2006 The efficacy of multidisciplinary rehabilitation in stable multiple sclerosis patients Denmark RCT PEDro=8 N_Initial=106, N_Final=90	Population: Control group (n=52): Mean age=50.1yr; Gender: males=16, females=36; Disease course: RRMS=12 (23%), PPMS=11 (21%), SPMS=29 (56%); Median EDSS=6.5; Median disease duration=9.0yr. Intervention group (n=38): Mean age=53.0yr; Gender: males=16, females=22, Disease course: RRMS=5 (13%), PPMS=9 (24%), SPMS=24 (63%); Median EDSS=6.5; Median disease duration=9.0yr. Intervention: Individuals were randomized either to the control group and received no rehabilitation treatment, or to the intervention group and received rehabilitation treatment from the MS rehabilitation hospital in Haslev Denmark. Primary Outcome Measures: Functional Assessment in Multiple Sclerosis (FAMS). Self-Care Outcome Measures: Guy's Neurological Disability Scale (GNDS). Other Outcome Measures: Multiple Sclerosis Impairment Scale (MSIS); EDSS; Visual Analog Scale for symptoms (VAS); 10 meter walk test (TW10); Nine-Hole Peg Test (9HPT); Life Appreciation and Satisfaction Questionnaire (LASQ).	1. No significant difference was found between the control and the intervention groups on any of the outcome measures.
Craig et al. 2003 A randomised controlled trial comparing rehabilitation against standard therapy in multiple sclerosis patients receiving intravenous steroid treatment UK RCT PEDro=5 N_Initial=41, N_Final=40	Population: Control group (n=20): Mean age=42yr; Gender: males=4, females=16; Disease course: active relapsing; Mean EDSS=5.1; Mean disease duration=5.69yr. Intervention group (n=20): Mean age=38yr; Gender: males=9, females=11, Disease course: active relapsing; Mean EDSS=5.4; Mean disease duration=7.42yr. Intervention: All MS participants were randomized to either the control group and received standard ward routine care and 3d of intravenous methylprednisolone (IVMP), or to the intervention group and received planned coordinated multidisciplinary team treatment and 3d of IVMP. Participants were assessed at baseline upon receiving IVMP treatment, at 1mo and at 3mo after the first day of IVMP. Primary Outcome Measures: Guy's Neurological Disability Scale (GNDS); Amended Motor Club Assessment (AMCA). Self-Care Outcome Measures: GNDS; AMCA; Barthel Index (BI). Other Outcome Measures: Human Activity Profile (HAP); 36-Item Short Form Health Survey (SF-36).	1. The difference in the mean scores from baseline to 3mo between treatment and control groups was significant for GNDS (p=0.030), AMCA (p=0.035), and BI (p=0.018).
Patti et al. 2003 Effects of a short outpatient rehabilitation treatment on disability of multiple sclerosis patients - a randomised controlled trial Italy RCT PEDro=8 N_Initial=111, N_Final=111	Population: Outpatient rehabilitation (n=58): Mean age=45.2yr; Gender: males=24, females=34; Disease course: PPMS=12, SPMS=46; Mean EDSS=6.2; Mean disease duration=17.2yr. Home exercise (n=53): Mean age=46.1yr; Gender: males=23, females=30; Disease course: PPMS=11, SPMS=42; Mean EDSS=6.1; Mean disease duration=17.2yr. Intervention: Patients were randomized to a comprehensive rehabilitation program and a home exercise group. The patients in the comprehensive rehabilitation group received an individualized, goal-oriented program involving an interdisciplinary team, addressing a wide range of areas for 6wks (6x/wk) and a home exercise program for a further 6wks. The home exercise group received the home exercise program for 12wks. Both groups were assessed at baseline and at 12wks. Primary Outcome Measures: Functional Independence Measure (FIM). Self-Care Outcome Measures: FIM. Other Outcome Measures: EDSS; Functional System Scale; Social Experience Tempelaar Checklist (SET).	1. There were significantly greater improvements for the rehabilitation program group compared to the home exercise group on FIM scores (p<0.0001); particularly in locomotion, self-care and transfers (p<0.001).
Pozzilli et al. 2002 Home based management in multiple sclerosis: results of a randomised controlled trial Italy RCT PEDro=5 N_Initial=201, N_Final=188	Population: Intervention group (n=133): Mean age=47yr; Gender: males=47, females=86; Disease course: RRMS=26, PPMS=27, SPMS=80; Mean EDSS=6.0; Mean disease duration=18.4yr. Control group (n=68): Mean age=46.7yr; Gender: males=21, females=47; Disease course: RRMS=14, PPMS=14, SPMS=40; Mean EDSS=6.0; Mean disease duration=18.6yr. Intervention: MS patients were randomized to receive either individually tailored multidisciplinary home-based medical care with regular phone support available 5d/wk (intervention group) or routine care involving multidisciplinary care coordinated through a hospital-based MS centre (control group). Assessments were performed at baseline and at 12mo. Primary Outcome Measures: Not specified. Self-Care Outcome Measures: Functional Independence Measure (FIM). Other Outcome Measures: 36 item short form health survey questionnaire (SF-36); EDSS; Mini-Mental State Examination (MMSE); Fatigue Severity Scale (FSS); State Trait Anger Expression Inventory (STAXI); State Trait Anxiety Inventory (STAI); Clinical Depression Questionnaire (CDQ); cost resource assessment.	1. No significant differences between intervention and control groups were detected for the FIM.
Guagenti-Tax et al. 2000 Impact of a comprehensive long-term care program on caregivers and persons with multiple sclerosis US RCT PEDro=5 N_Initial=73, N_Final=59 (patient-caregiver units)	Population: Patients (n=59): Experimental: Mean age=44.0yr; Gender: males=8 (13.3%), females=51 (86.7%); Disease course: CPMS=39 (66.7%); Mean EDSS=7.06; Mean disease duration=8.9yr. Control: Mean age=49.0yr; Gender: males=18 (31.0%), females=41 (69.0%); Disease course: CPMS=51 (86.2%); Mean EDSS=7.24; Mean disease duration=14.2yr. Caregivers (n=59): Experimental: Mean age=44.9yr; Gender: males=43.3%, females=56.7%. Control: Mean age=51.8yr; Gender: males=48.3%, females=51.7%. Intervention: Patient-caregiver units were randomized to a comprehensive rehabilitation program or a standard care group. The comprehensive rehabilitation program consisted of 4 coordinated components: 1) twice-monthly medical day-care program, 2) a series of semi-annual workshops for persons with MS and family caregivers, 3) monthly home visits by social workers, nurses, and volunteers, 4) case management and liaison services. Patients and caregivers were assessed at baseline, 12 and 24mo. Primary Outcome Measures: Not specified. Self-Care Outcome Measures: Incapacity Status Scale (ISS). Other Outcome Measures: EDSS; Number of acute hospital admissions; Perceived deficits questionnaire (PDQ); Hopkins Verbal Learning Test (HVLT); Mental Health Inventory (MHI); Sickness Impact Profile (SIP); Revised UCLA Loneliness-Companionship Scale; Questionnaire on Resource and Stress (QRS); 36-Item Short Form Health Survey (SF-36); Satisfaction with care; Length of stay.	1. There was significant decline in ISS scores (p=0.000) for all patients. 2. No interaction effects (only main effects) were reported for the above findings. 3. All patients reported an increase in satisfaction with the help they received from their caregivers for their daily routines (p=0.005) and within a reasonable time frame (p=0.039). 4. On the QRS, caregivers reported an increase in martyrdom (p=0.000). 5. Control patients reported significantly greater satisfaction with getting help with their daily routine compared to the rehabilitation patients (p=0.004).
Freeman et al. 1997 The impact of inpatient rehabilitation on progressive multiple sclerosis UK RCT PEDro=5 N_Initial=70, N_Final=66	Population: Rehabilitation group (n=32): Mean age=43.2yr; Gender: males=11, females=21; Disease course: PPMS=2, SPMS=30; Median EDSS=6.5; Mean disease duration=9.6yr. Waitlist group (n=34): Mean age=44.6yr; Gender: males=13, females=21; Disease course: PPMS=4, SPMS=30; Median EDSS=6.5; Mean disease duration=11.4yr. Intervention: Patients were randomized to either the rehabilitation or the waitlist groups. The rehabilitation program consisted of a multidisciplinary team approach, interventions tailored to meet the individual's needs and a patient centered functional goal setting approach. The waitlist group continued with their normal routine. Interventions were 6wks. Patients were tested at baseline and at 6wks. Primary Outcome Measures: Not specified. Self-Care Outcome Measures: Functional Independence Measure (FIM). Other Outcome Measures: EDSS; London Handicap Scale (LHS).	1. The rehabilitation group had significantly greater improvements compared to the waitlist group for overall FIM motor score (p<0.001) and on the subscales of: self-care (p<0.0001), transfers (p<0.001), and sphincter control (p<0.001).
Francabandera et al. 1988 Multiple Sclerosis Rehabilitation: Inpatient vs. Outpatient US RCT PEDro=4 N_Initial=84, N_Final=84	Population: Inpatient group (n=42). Outpatient group (n=42). Demographic data not reported. Inclusion criteria: severe disability (EDSS 6-9) and not institutionalized. Intervention: MS patients were randomized to either inpatient or outpatient rehabilitation. An individualized plan of care was instituted for each patient. An average of two 45min physical therapy sessions and one occupational therapy session per day was scheduled for each patient. Bladder management, speech therapy, and social services were provided as needed. Equipment needs were assessed, and appropriate devices were recommended and ordered. Assessments were performed at baseline and after 3, 6, 9, and 12mo. Primary Outcome Measures: Incapacity Status Scale (ISS). Self-Care Outcome Measures: ISS. Other Outcome Measures: None.	1. There was a statistically significant difference in ISS between the inpatient and outpatient groups at the 3mo follow-up (24.3 vs. 27.2, respectively; p<0.05). 2. Patients in the inpatient group on average improved slightly, while those in the outpatient group deteriorated slightly.
Liberatore et al. 2014 Predictors of effectiveness of multidisciplinary rehabilitation treatment on motor dysfunction in multiple sclerosis Italy Pre-Post N_Initial=266, N_Final=212	Population: Mean age=45.0yr; Gender: males=96, females=116; Disease course: RRMS=43, PPMS=38, SPMS=124, PRMS=7; Median EDSS=6.0; Mean disease duration=13.9yr. Intervention: MS patients underwent a short-term (3-7wks) intensive (2hr/d, 5d/wk), individualised, goal-oriented inpatient rehabilitation program. Primary Outcome Measures: Not specified. Self-Care Outcome Measures: Motor subscale of Functional Independence Measure (mFIM). Other Outcome Measures: EDSS; Functional Systems; Fatigue Severity Scale (FSS); Paced Auditory Serial Addition Test (PASAT).	1. Following rehabilitation treatment, at discharge, a significant improvement in the mFIM values (p<0.001) was observed. 2. 121 patients (57.1%) improved in activity limitation (mFIM responders), 113 patients (53.3%) in impairment (EDSS responders), 139 patients (75.1%) in either mFIM or EDSS or both (partial responders), and 75 (35.4%) in both outcomes (full responders). 3. Regarding the partial response, a baseline moderate-severe disability assessed by mFIM increased the probability to benefit from rehabilitation (p<0.001).
Judica et al. 2011 Impact of fatigue on the efficacy of rehabilitation in multiple sclerosis Italy PCT N_Initial=186, N_Final=86	Population: Treated group (n=64): Mean age=43.2yr; Gender: males=32, females=32; Disease course: RRMS=13, PPMS=12, SPMS=39; Mean EDSS=5.8; Mean disease duration=15.5yr. Control group (n=22): Mean age=46.3yr; Gender: males=12, females=10; Disease course: RRMS=6, PPMS=4, SPMS=12; Mean EDSS=5.4; Mean disease duration=16.9yr. Intervention: MS patients underwent an intensive, short-term inpatient rehabilitation program. Patients were classified into fatigued MS (FMS) in the case of a Fatigue Severity Scale (FSS) score of ≥36, and non-fatigued MS (NFMS) for FSS<36. An untreated control group was included for comparison. Primary Outcome Measures: Not specified. Self-Care Outcome Measures: Functional Independence Measure (FIM). Other Outcome Measures: EDSS; FSS; MS Functional Composite (MSFC).	1. 46 patients were defined as fatigued and 18 as non-fatigued in the rehab treated group. In the control group, 16 patients were fatigued and 6 were non-fatigued. 2. Comparing all (FMS and NFMS) patients before and after rehabilitation, there was an increase in FIM score (p<0.0001). 3. FIM significantly increased in FMS patients before and after the rehabilitation program (p<0.0001). 4. FIM significantly increased in NFMS patients before and after the rehabilitation program (p<0.0001).
Vidmar et al. 2011 Time trends in ability level and functional outcome of stroke and multiple sclerosis patients undergoing comprehensive rehabilitation in Slovenia Slovenia Pre-Post N_Initial=225, N_Final=225	Population: MS participants (n=225): Mean age=50yr; Gender: males=74, females=151; Disease course: unspecified; Disease severity: unspecified; Disease duration: unspecified. Intervention: MS participants received comprehensive rehabilitation at the University Rehabilitation Institute in Ljubljana. Patients were divided into two groups based on time-period of admission: during 1999-2000, or from 2004-2006. Assessments were performed at admission and discharge. Primary Outcome Measures: Not specified. Self-Care Outcome Measures: Functional Independence Measure (FIM). Other Outcome Measures: None.	1. Admission motor and cognitive FIM subscale scores were on average 5 points lower in the 2004-2006 period, the average total score being approximately 10 points lower. The average difference between discharge and admission scores (rehabilitation gain) increased over time, in total by about 3 points in MS patients. 2. Progress on FIM scores at discharge was significantly different between the groups of MS patients in terms of FIM total (p<0.001), motor (p=0.001), and cognitive (p=0.001). 3. Significant differences in MS patients were observed between the time-period groups in terms of efficiency (calculated from FIM scores): total (p<0.001), motor (p=0.002), and cognitive (p<0.001), and effectiveness (calculated from FIM scores): total (p<0.001), motor (p<0.001), and cognitive (p=0.003). Both efficiency and effectiveness significantly increased over the time period observed.
Khan et al. 2010 Clinical practice improvement approach in multiple sclerosis rehabilitation: a pilot study Australia Case Series N_Initial=24, N_Final=24	Population: Mean age=51.54yr; Gender: males=10, females=14; Disease course: RRMS=5, PPMS=5, SPMS=14; Disease severity: unspecified; Mean disease duration=11.1yr. Intervention: Records for 24 consecutive MS patients presenting in a 14mo period and receiving inpatient rehabilitation were selected for data extraction with the goal of addressing the functional gains after rehabilitation. Each patient received a customized program incorporating physiotherapy, occupational therapy, speech pathology, social work, dietetics, and neuropsychology. Primary Outcome Measures: Not specified. Self-Care Outcome Measures: Barthel Index (BI); Functional Independence Measure (FIM). Other Outcome Measures: Neurological Impairment Set (NIS); Rehabilitation Complexity Scale (RCS); Northwick Park Therapy Dependency Assessment (NPTDA); Hospital Length of Stay (LOS); discharge destination.	1. Functional gains from admission to discharge for the FIM (motor: p<0.001; cognitive: p=0.005; total: p<0.001) and BI (p<0.001) were significant. 2. All patients in the rehabilitation program improved in function (FIM, BI) (p<0.001 for both) from admission to discharge, and returned home.
Grasso et al. 2009 Prognostic factors in multiple sclerosis rehabilitation Italy Pre-Post N_Initial=230, N_Final=200	Population: Mean age=49.7yr; Gender: unspecified; Disease course: unspecified; Mean EDSS=6.93; Mean disease duration=17.3yr. Intervention: MS patients were admitted to a rehabilitation ward who followed an individualized, goal-oriented, multidisciplinary rehabilitation program. Patients were grouped according to EDSS scores of 2-5.5, 6-6.5, 7-8.5. Assessments were performed at admission and discharge. Primary Outcome Measures: Not specified. Self-Care Outcome Measures: Barthel Index (BI); Rivermead Mobility Index (RMI). Other Outcome Measures: EDSS; Functional Systems.	1. Following treatment, a significant improvement in both BI and RMI values (p<0.001) was observed at discharge. 2. The mean effectiveness value of the whole sample was 16.00 on the BI and 8.60 on the RMI. 3. The BI score improved in 48% of patients, while the RMI score improved in 43.4% of patients. 4. Patients with mild and moderate MS showed an effectiveness on activities of daily living and mobility that was significantly higher compared to patients with the severe form of MS (p=0.001, p<0.05, respectively).
Khan et al. 2009 Multiple sclerosis rehabilitation outcomes: analysis of a national casemix data set from Australia Australia Case Series N_Initial=1010, N_Final=1010	Population: Whole Population (n=1010): Mean age=52.0yr; Gender: males=29.8%, females=70.2%; Disease course: unspecified; Disease severity: Australian National Subacute and Non Acute Patient (ANSNAP) casemix classification system classes 216, 217, 218, and 219 which are defined by FIM functional motor scores: 216 (FIM motor (m) scores range 63–91), 217 (FIM m=49–62), 218 (FIM m=18–48), and 219 (FIM m=14–17); Disease duration: unspecified. ANSNAP 216 (n=404): Mean age=49.2yr; Gender: males=25.7%, females=74.3%. ANSNAP 217 (n=222): Mean age=54.1yr; Gender: males=26.6%, females=73.4%. ANSNAP 218 (n=360): Mean age=53.8yr; Gender: males=34.4%, females=65.6%. ANSNAP 219 (n=24): Mean age=51.2yr; Gender: males=58.3%, females=41.7%. Intervention: De-identified data from MS patients in the Australian Rehabilitation Outcomes Centre (AROC) database were analyzed for all rehabilitation admissions to examine outcomes of inpatient rehabilitation for persons with MS. Primary Outcome Measures: Functional Independence Measure (FIM); Hospital Length of Stay (LOS); discharge destination. Self-Care Outcome Measures: FIM. Other Outcome Measures: None.	1. Classes 216–218 all showed significant improvements in FIM scores from admission to discharge (p<0.001); although class 219 showed a trend towards improvement, this was not significant. 2. FIM improvement differed significantly among the four ANSNAP classes, (p<0.001). 3. Post hoc analyses indicated that ANSNAP 216 had a smaller FIM change compared with 217 (p<0.001) and 218 (p<0.001). (These findings are expected, given that FIM admission scores are higher (indicating better function) in ANSNAP 216 and therefore have less potential for improvement). 4. FIM efficiency was also significantly higher in class 217 than in any of the other classes (p<0.001). 5. There was no significant change in FIM improvement or FIM efficiency from the first to last yr of the study.
Khan et al. 2008 Use of goal attainment scaling in inpatient rehabilitation for persons with multiple sclerosis Australia Pre-Post N_Initial=24, N_Final=24	Population: Mean age=52.0yr; Gender: males=10, females=14; Disease course: RRMS=5, PPMS=5, SPMS=14; Disease severity: unspecified; Disease duration: unspecified. Intervention: MS patients receiving comprehensive inpatient rehabilitation were assessed for clinically important functional changes. Functional assessments were performed within 48hr of admission and discharge. Primary Outcome Measures: Not specified. Self-Care Outcome Measures: Functional Independence Measure (FIM); Barthel Index (BI). Other Outcome Measures: Goal Attainment Scaling (GAS); Clinical Global Impression (CGI).	1. For the sample as a whole, there was a statistically significant change from admission to discharge on BI and FIM scores (BI: p<0.001; FIM: p<0.001). 2. There was no significant or clinically important difference in responder and non-responder scores for the BI or the FIM.
Vikman et al. 2008 Effects of inpatient rehabilitation in multiple sclerosis patients with moderate disability Sweden Pre-Post N_Initial=58, N_Final=58	Population: Cohort A (n=40): Mean age=56.3yr; Gender: males=8, females=32; Disease course: RRMS=2, PPMS=15, SPMS=21, unclassified=2; Mean EDSS=5.8; Mean disease duration=20.4yr. Cohort B (n=18): Mean age=54.7yr; Gender: males=4, females=14; Disease course: PPMS=4, SPMS=14; Mean EDSS=5.6; Mean disease duration=17.0yr. Intervention: MS patients with moderate disability received 3wks of inpatient neurorehabilitation in two cohorts, A and B. Rehabilitation consisted of physiotherapy, occupational therapy, and consultation by speech therapist, social worker, and psychologist. Cohort A was assessed on admission and discharge during a rehabilitation period. Cohort B was assessed 3wks before admission, on admission and at discharge. Primary Outcome Measures: Not specified. Self-Care Outcome Measures: Barthel Index (BI). Other Outcome Measures: 36 Item Short-Form questionnaire (SF-36); Functional Assessment of Multiple Sclerosis (FAMS); Fatigue Severity Scale (FSS); Beck Depression Inventory (BDI); Multiple Sclerosis Functional Composite (MSFC); Grippit; Box and Block Test (B&B); Nine Hole Peg Test (9HPT); Clinical Outcome Variables (COVS); Berg Balance Scale (BBS); Timed 25-Foot Walk Test (T25FWT).	1. No significant changes were observed in any cohort for personal care ability as measured by the BI.
Grasso et al. 2005 Prognostic factors in multidisciplinary rehabilitation treatment in multiple sclerosis: an outcome study Italy Pre-Post N_Initial=230, N_Final=230	Population: Mean age=49.42yr; Gender: male/female ratio=1:1:7 (not specified further); Disease course: unspecified; Mean EDSS=6.93; Mean disease duration=16.90yr. Intervention: All patients were enrolled in an individualized, goal oriented, multidisciplinary inpatient program based on activities of daily living (ADL). The program took place twice-daily, each session being 45min long, for 6d/wk, for 10wks. Primary Outcome Measures: Not specified. Self-Care Outcome Measures: Barthel Index (BI); Rivermead Mobility Index (RMI). Other Outcome Measures: EDSS; Functional Systems.	1. Both BI and RMI scores increased significantly from admission to discharge (p<0.001). 2. All patient subgroups (basal EDSS score < 6, score 6-6.5, and score > 6.5) showed significant differences between basal and discharge functional values as well as in treatment effectiveness, on the BI and RMI (p<0.002). 3. The basal EDSS score was negatively associated with the effectiveness of the treatment, both on BI and RMI (p<0.001). 4. Patients without severe cognitive impairment had a probability of improvement in RMI twice as high compared to other patients (p<0.05). 5. Patients without severe sphincteric disturbances had probability of improvement in ADL nearly twice as high as that of other patients (p<0.01).
Liu et al. 2003 Does neurorehabilitation have a role in relapsing-remitting multiple sclerosis? UK Case Series N_Initial=90, N_Final=90	Population: RRMS group (n=90): Mean age=33.4yr; Gender: unspecified; Mean EDSS=6.9; Mean disease duration=6.4yr. PPMS group (n=80): Mean age=46.0yr; Gender: unspecified; Mean EDSS=7.3; Mean disease duration=10.3yr. SPMS group (n=402): Mean age=45.5yr; Gender: unspecified; Mean EDSS=7.1; Mean disease duration=18.4yr. Intervention: MS patients received relatively short-stay, goal-orientated, patient-centred multidisciplinary inpatient rehabilitation. The primary study group of RRMS patients were compared to PPMS and SPMS groups. Assessments were performed at admission and after rehabilitation. Primary Outcome Measures: Not specified. Self-Care Outcome Measures: Barthel Index (BI); Functional Independence Measure (FIM). Other Outcome Measures: EDSS; Visual Analog Scale (VAS).	1. Disability scores in RRMS patients were significantly better at discharge than admission (p<0.0001 all comparisons; mean change of +4.5 points for BI and +15.6 points for FIM), which was significantly greater than the other MS subtypes.
Freeman et al. 1999 Inpatient rehabilitation in multiple sclerosis: Do the benefits carry over into the community? UK Pre-Post N_Initial=50, N_Final=44	Population: Mean age=44.8yr; Gender: males=21, females=29; Disease course: PPMS=7, SPMS=42; Mean EDSS=6.7; Mean disease duration=11.6yr. Intervention: Patients with progressive MS undergoing inpatient rehabilitation were followed for 12mo after discharge. Assessments were undertaken on admission (A), at discharge, and subsequently at 3mo intervals for 1yr (1Y). Primary Outcome Measures: Functional Independence Measure (FIM); London Handicap Scale (LHS). Self-Care Outcome Measures: FIM. Other Outcome Measures: EDSS; Kurtzke's Functional Systems; 36-item Short Form Health Survey Questionnaire (SF-36); 28-item General Health Questionnaire (GHQ).	1. Improvement was seen across all measures during the inpatient stay. These gains declined in varying patterns after discharge. 2. The FIM scores steadily lowered, remaining only marginally above baseline at the 9 and 12mo assessments. 3. No tests of statistical significance were reported in this study.
Di Fabio et al. 1998 Extended outpatient rehabilitation: Its influence on symptom frequency, fatigue, and functional status for persons with progressive multiple sclerosis US PCT N_Initial=46, N_Final=33	Population: Treatment group (n=20): Mean age=49yr; Gender: males=5, females=15; Disease course: PPMS or SPMS; EDSS range: 5-8; Mean disease duration=17yr. Waiting List group (n=26): Mean age=50yr; Gender: males=7, females=19; Disease course: PPMS or SPMS; EDSS range=5-8; Mean disease duration=15yr. Intervention: Participants were non-randomly assigned to either the treatment or waiting list group. The treatment group received outpatient rehabilitation services for 5hr, 1d/wk, over 1yr. Both groups received comparable pharmacologic management. Primary Outcome Measures: MS-Related Symptom Checklist; Rehabilitation Institute of Chicago Functional Assessment Scale (RIC-FAS). Self-Care Outcome Measures: RIC-FAS. Other Outcome Measures: None.	1. When adjusted for the functional level at the initial assessment, the mean RIC-FAS score for the treatment group at the 1yr assessment was 60% compared with 57% for the waiting list group. 2. Mean effect sizes at the 1yr follow-up, adjusted for differences in baseline values, indicated less loss of functional status in the treatment group compared with the waiting list group (-0.07 vs. -0.70 for treatment and waiting list groups, respectively). 3. With regard to functional status, the waiting list subjects who dropped out of the study had significantly lower RIC-FAS scores compared with those who completed the study.
Rossiter et al. 1998 Integrated care pathways in multiple sclerosis rehabilitation: completing the audit cycle UK Pre-Post N_Initial=125, N_Final=125	Population: Cohort 1 (n=39): Gender: males=41%, females=59%. Cohort 2 (n=43): Gender: males=36%, females=64%. Cohort 3 (n=42): Gender: males=27%, females=73%. For total study sample: Mean age: unspecified for all groups, but participants were similar in age status; Disease course: unspecified, but the majority were SPMS; Mean EDSS=7; Mean disease duration: unspecified. Intervention: Participants were divided into three cohorts and each received a comprehensive process of care that was being audited within the structure of an Integrated Care Pathway (ICP), so that episodes of clinical care could be documented for each of the three main sections: the process pathway, the goal categorization sheet, and the variation tracking sheet. Variations from the expected pathway of clinical care (ICP for neurorehabilitation) were documented and analyzed for each cohort in order to evaluate the effectiveness of the goal-directed therapy implementation. Primary Outcome Measures: Not specified. Self-Care Outcome Measures: Barthel Index (BI); Functional Independence Measure (FIM); Handicap Assessment Scale (HAS). Other Outcome Measures: Mean variations from process pathway; Mean length of stay; Mean number of goals set by discharge for each patient (goal achievement).	1. All three cohorts showed a mean improvement in BI, HAS, and FIM motor and cognitive subscale scores between admission and discharge, but no significant differences were found between cohorts. 2. No significant correlation between level of goal achievement and changes on outcome measure scores was found. An increase in carer involvement was recognized.
Di Fabio et al. 1997 Health-related quality of life for patients with progressive multiple sclerosis: influence of rehabilitation US PCT N_Initial=44, N_Final=31	Population: Treatment group (n=12): Mean age=44.5yr; Gender: males=2, females=10; Disease course: PPMS or SPMS; EDSS range: 5-8; Mean disease duration=17.6yr. Wait-listed group (n=19): Mean age=49.2yr; Gender: males=4, females=15; Disease course: PPMS or SPMS; EDSS range: 5-8; Mean disease duration=14.2yr. Intervention: MS patients received either outpatient care for 1yr or did not receive rehabilitation (wait-listed control). Primary Outcome Measures: Rand 36-Item Health Survey 1.0 (SF-36). Self-Care Outcome Measures: Rehabilitation Institute of Chicago Functional Assessment Scale (RIC-FAS). Other Outcome Measures: MS Quality of Life 54 Item (MSQoL-54).	1. Over the course of the year, both groups showed a decrease in physical function, as demonstrated by negative effect sizes for the RIC-FAS composite scores (including bed mobility, wheelchair propulsion, bed transfers, ambulation, and skin status). However, functional status in the wait-listed group declined more than in the treatment group (effect sizes = -0.52 vs. -0.33, respectively).
Aisen et al. 1996 Inpatient Rehabilitation for Multiple Sclerosis US Case Series N_Initial=37, N_Final=37	Population: Mean age=46.87yr; Gender: males=4, females=33; Disease course: RRMS=6, SPMS=26, PRMS=5; Mean EDSS=7.47; Mean disease duration=11.84yr. Intervention: MS patients receiving inpatient rehabilitation for functional decline were assessed retrospectively. Patients received one or two follow-up telephone assessments at intervals ranging from 6mo to 3yr after discharge. Assessment scores at admission, discharge, and follow-up were analyzed. Primary Outcome Measures: Not specified. Self-Care Outcome Measures: Functional Independence Measure (FIM). Other Outcome Measures: Kurtzke Functional Systems; EDSS.	1. For all groups combined, significant improvements between admission and discharge were seen in FIM (p=0.0001) scores. Gains were partly maintained between discharge and follow-up. 2. Significant improvements also occurred in FIM subgroupings: self-care (eating, dressing, grooming, bathing) (p=0.0001), sphincter control (bladder, bowel) (p=0.0222), and locomotion (ambulation, stair climbing, wheelchair management) (p=0.0001) for all patients. 3. Follow-up assessments obtained in 28 patients at 12 to 24mo showed statistically insignificant changes in FIM compared to the end of rehabilitation. 4. Twelve patients were assessed 24 to 36mo after discharge, whose FIM performance significantly deteriorated (p=0.008) compared to the end of rehabilitation.
Kidd et al. 1995 The benefit of inpatient neurorehabilitation in multiple sclerosis UK Pre-Post N_Initial=79, N_Final=79	Population: Mean age=48.8yr; Gender: males=30, females=49; Disease course: RRMS, SPMS, PPMS; Median DSS=7.0; Mean disease duration=12.1yr. Intervention: MS patients admitted over a 16mo period for multidisciplinary rehabilitation were studied using assessment scales as measures of disability and handicap. Primary Outcome Measures: Not specified. Self-Care Outcome Measures: Barthel Index (BI). Other Outcome Measures: Kurtzke's Disability Status Scale; Environmental Status Scale (ESS).	1. The median BI on admission was 14.0 and increased (improved) by a median of 1.0 overall (p<0.0001). It increased in 51 patients (65%), diminished in one patient (1%) and was unchanged in 27 (34%). 2. Improvement on the BI was most marked in patients in whom a reduction in impairment occurred, but also increased in progressive and stable patients. The difference in terms of changes in BI between patients in whom a reduction in impairment occurred, and progressive and stable patients, was not statistically significant (p=0.13). 3. When the BI on admission was subdivided into mild (20-16), moderate (15-11), severe (10-6) and very severe disability (5-0) the greatest change in disability occurred in the severely and moderately disabled patients.
Carey et al. 1988 Who makes the most progress in inpatient rehabilitation? An analysis of functional gain US Case Series N_Initial=6194, N_Final=6194	Population: MS participants (n=196): Mean age=46yr; Gender: unspecified; Disease course: unspecified; Disease severity: unspecified; Disease duration: unspecified. Intervention: MS patients in rehabilitation facilities were assessed in functional gains over their stay. Primary Outcome Measures: Revised Level of Rehabilitation Scale (LORS-II). Self-Care Outcome Measures: LORS-II. Other Outcome Measures: None.	1. MS patients had mean gain scores of 16 and 20 on the ADL and mobility aspects of the LORS-II, respectively (no significance reported).
Greenspun et al. 1987 Multiple sclerosis and rehabilitation outcome US Case Series N_Initial=28, N_Final=28	Population: Mean age=42yr; Gender: males=27%, females=73%; Disease course: unspecified; Severity: unspecified; Mean disease duration=12.2yr. Intervention: Patients with severe MS were admitted to an inpatient rehabilitation center, and treatment included physical, occupational, and speech therapy, as well as recreational therapy. Patients were seen daily by a physiatrist who coordinated all aspects of care. Data was gathered on admission, at discharge, and at 3mo post-discharge follow-up, over a 4yr period. Primary Outcome Measures: Not specified. Self-Care Outcome Measures: Study used an assessment which was designed to measure activities of daily living (comprised of dressing, bathing, eating, and toileting). Assessment name was not provided. Other Outcome Measures: Mobility assessment instrument (comprised of ambulating, transferring, stair climbing). Assessment name was not provided.	1. After completion of rehabilitation, the proportion of patients independent in dressing, eating, toileting, and bathing increased. 2. At 90d follow-up, 82%, 73%, 85%, and 91% of patients were independent in dressing, bathing, toileting, and eating.

Author Year, Title, Country, Research Design, PEDro, Sample Size,

Methods

Self-Care Activity Results

Nedeljkovic et al. 2016

Multidisciplinary rehabilitation and steroids in the management of multiple sclerosis relapses: a randomized controlled trial

Serbia

RCT

PEDro=5

N_Initial=49, N_Final=37

Population: Intervention Group (IG; n=17): Mean age=41.3yr; Gender: males=6, females=11; Disease course: RRMS; Mean EDSS=4.5; Mean disease duration=104.5mo. Control Group (CG; n=20): Mean age=39.4yr; Gender: males=5, females=15; Disease course=RRMS; Mean EDSS=4.0; Mean disease duration=80.6mo.

Intervention: Subjects were randomized to a multidisciplinary inpatient rehabilitation program (IG) or standard care (CG) after receiving intravenous methylprednisolone (1g/d, 5d). Rehabilitation was comprised of physiotherapy (1h/d, 5d/wk) and occupational therapy (30min/d, 3d/wk) for a total of 3wks. Outcomes were assessed at baseline, 1mo, and 3mo.
Primary Outcome Measures: Not specified.

Self-Care Outcome Measures: Functional Independence Measure (FIM).

Other Outcome Measures: EDSS; Beck Depression Inventory (BDI); Multiple Sclerosis Quality of Life-54 (MSQoL-54).

1. On the FIM motor, there was a significant improvement between baseline and 1mo that was sustained up to 3mo in both groups (p<0.001). There was no significant difference between groups at baseline (p=0.288), 1mo (p=0.102), or 3mo (p=0.217).

2. On the FIM cognition, there was no significant difference found between baseline and 1mo or 3mo in either group. There was no significant difference between groups at baseline (p=0.228), 1mo (p=0.284), or 3mo (p=0.657).

Pappalardo et al. 2016

Inpatient versus outpatient rehabilitation for multiple sclerosis patients: Effects on disability and quality of life

Italy

RCT

PEDro=6

N_Initial=146, N_Final=146

Population: Group A outpatient (n=49): Mean age=48.0yr; Gender: males=18, females=31; Disease course: PPMS=18, SPMS=31; Mean EDSS=6.5; Disease duration: unspecified. Group B inpatient (n=49): Mean age=46.0yr; Gender: males=17, females=32; Disease course: PPMS=17, SPMS=32; Mean EDSS=6.5; Disease duration: unspecified. Group C control (n=48): Mean age=45.0yr; Gender: males=18, females=30; Disease course: PPMS=18, SPMS=30; Mean EDSS=6.4; Disease duration: unspecified.

Intervention: MS patients were randomized to three groups: the outpatient treatment group (Group A), the inpatient treatment group (Group B), and the control waiting list (Group C). Assessments were performed at baseline (T0) and at 6mo follow-up (T1).
Primary Outcome Measures: Functional Independence Measure (FIM).

Self-Care Outcome Measures: FIM.

Other Outcome Measures: 36-Health Survey Questionnaire (SF-36).

1. Total FIM score improved by a minimum of 20% in 22.6% of patients in the outpatient group A and 14.6% in inpatient B (p=0.5).

2. Motor FIM sub-items improved by a minimum of 20% in 32 % of patients in the outpatient group A and 21.4% in the inpatient group B (p=0.4) while cognitive FIM sub-items showed no improvement in the outpatient group A and an improvement in 3.5% of the inpatient group B.

3. A significant difference was found in terms of total FIM score between T0 and T1 in Group A (p=0.03), in Group B (p=0.008) and Motor FIM sub-items score in Group A (p=0.02).

4. In Group C, no significant variation was found between T0 and T1 in total FIM scores and its sub-items.

5. A significant difference in total FIM scores between the three groups was found (p=0.0003). Pairwise comparisons showed a significant difference between Group A and Group C (p=0.003) and Group B vs. Group C (p=0.001).

6. Motor FIM sub-item scores were significantly different between groups (p=0.0001). Pairwise comparisons showed a significant difference between Group A and Group C (p<0.001) and Group B vs. Group C (p<0.001).

7. No significant differences in cognitive FIM sub-item scores were observed between the three groups.

Rietberg et al. 2014

Effects of multidisciplinary rehabilitation on chronic fatigue in multiple sclerosis: a randomized controlled trial

The Netherlands

RCT

PEDro=7

N_Initial=48, N_Final=44

Population: Multidisciplinary outpatient rehabilitation (MDR) group (n=23): Mean age=45yr; Gender: males=9, females=14; Disease course: RRMS=16, PPMS=2, SPMS=5; Median EDSS=3; Mean disease duration=7yr. Nurse consultation (NC) group (n=25): Mean age=47yr; Gender: males=8, females=17; Disease course: RRMS=12, PPMS=6, SPMS=7; Median EDSS=4; Mean disease duration=8yr.

Intervention: MS patients with chronic fatigue were randomized to MDR or to MS-NC groups. Assessments were performed at baseline and after intervention.
Primary Outcome Measures: Checklist Individual Strength (CIS-20R).

Self-Care Outcome Measures: Functional Independence Measure (FIM).

Other Outcome Measures: MS Impact Scale (MSIS-29); Impact on Participation and Autonomy (IPA); Modified Fatigue Impact Scale (MFIS); Fatigue Severity Scale (FSS); Disability and Impact Profile (DIP).

1. No significant between-group differences were found for the FIM from baseline to 12wks (p=0.13) or from 12wks to 24wks (p=0.34).

2. No significant within-group effects were found for multidisciplinary rehabilitation or nurse consultation with respect to the primary and secondary outcome measures from baseline to 12 or 24wks.

Salhofer-Polanyi et al. 2013

Benefits of inpatient multidisciplinary rehabilitation in multiple sclerosis

Austria

RCT

PEDro=5

N_Initial=21, N_Final=19

Population: Intervention Group (n=10): Mean age=53.8yr; Gender: males=5, females=5; Disease course: RRMS=2, PPMS=2, SPMS=6; Median EDSS=6; Mean disease duration=17.6yr. Control Group (n=9): Mean age=52.9yr; Gender: males=3, females=6; Disease course: RRMS=2, SPMS=7; Median EDSS=5.5; Mean disease duration=15.9yr.

Intervention: Subjects were randomized to a multidisciplinary inpatient rehabilitation program (intervention) or a waiting list (control). Rehabilitation was provided 5d/wk with 4-5 sessions/d, for a total of 3wks. Outcomes were assessed at baseline and after 15wks.
Primary Outcome Measures: Timed 50m Walk (T50MW); 2-min Walk Test (2MW); 6-min Walk Test (6MW); Walking Speed.

Self-Care Outcome Measures: Rivermead Mobility Index (RMI).

Other Outcome Measures: Functional Assessment in Multiple Sclerosis (FAMS); EDSS; Berg Balance Scale (BBS); Tinetti Test (TT); MS Functional Composite: 9 Hole Peg Test (9HPT), Timed 25ft Walk (T25FW), Paced Auditory Serial Addition Test (PASAT); MS Self-Efficacy Scale (MSSE); Global Clinical Impression Scale (GCIS).

1. There was no significant difference between the intervention group and the control group in mean change on the RMI (p=0.350) after treatment.

2. RMI showed some improvement in the intervention group, although without reaching statistical significance.

Khan et al. 2010

A randomised controlled trial: outcomes of bladder rehabilitation in persons with multiple sclerosis

Australia

RCT

PEDro=9

N_Initial=74, N_Final=58

Population: Treatment group (n=24): Mean age=49.9yr; Gender: males=9, females=15; Disease course: RRMS=6; PPMS=4; SPMS=14; EDSS: 0-3=5, 3.5-6.0=9, 6.5 or greater=10; Mean disease duration=12.2yr. Control group (n=34): Mean age=51.1yr; Gender: males=5, females=29; Disease course: RRMS=14, PPMS=4, SPMS=16; EDSS: 0-3=9, 3.5-6.0=21, 6.5 or greater=4; Mean disease duration=10.0yr.

Intervention: Patients were randomized to either the intervention group where they received a multifaceted, individualized, bladder rehabilitation programme, or to the control group (no intervention). Ten participants randomized to control group required some treatment during the study.

Primary Outcome Measures: Urogenital distress inventory (UDI6); Incontinence impact questionnaire (IIQ7).

Self-Care Outcome Measures: Guy's Neurological Disability Scale (GNDS – bladder subscale only).

Other Outcome Measures: AUA Symptom Index.

1. There was a statistically significant difference in change scores between the treatment and control groups with respect to the GNDS (p<0.001). The effect size was large (0.58), as per Cohen's criteria.

Khan et al. 2008

Effectiveness of rehabilitation intervention in persons with multiple sclerosis: a randomised controlled trial

Australia

RCT

PEDro=8

N_Initial=101, N_Final=98

Population: Treatment Group (n=49): Mean age=49.5yr; Gender: males=18, females=31; Disease course: RRMS=13, PPMS=7, SPMS=29; EDSS: 0-3=7, 3.5-6.0=27, 6.5+=15; Mean disease duration=10.69yr. Control Group (n=52): Mean age=51.1yr; Gender: males=11, females=41; Disease course: RRMS=18, PPMS=7, SPMS=27; EDSS: 0-3=12, 3.5-6.0=32, 6.5+=8; Mean disease duration=9.73yr.

Intervention: The treatment group underwent multidisciplinary rehabilitation and received either individualized patient (IP) or outpatient (OP) rehabilitation. IP rehabilitation: 3-6wks, 3 or more times/wk, 3h therapy/d, 2 blocks of 45min physiotherapy and occupational therapy with other blocks comprised of speech pathology, neuropsychology and social work. OP rehabilitation: Up to 6wks, 2-3times/wk, 30min sessions for physiotherapy, occupational therapy, social work and speech pathology in addition to doing stretching home exercises. The control group received no intervention, only an 8 weekly monitoring phone call for information about medical hospital visits in the previous month and received no other information.
Primary Outcome Measures: Functional Independence Measure (FIM) motor subscale.

Self-Care Outcome Measures: FIM motor and cognitive subscales.

Other Outcome Measures: Multiple Sclerosis Impact Scale (MSIS-29); General Health Questionnaire (GHQ-28).

1. There were significant differences post treatment between the treatment and control groups for FIM motor total scores (p<0.001) and FIM cognitive subscale scores (p<0.016).

2. The treatment group showed significantly greater improvement in FIM motor scores (p<.001; effect size= 1.13).

3. More patients in the treatment group had improved FIM scores throughout the study (70.8% vs. 13%) and more patients in the control group had FIM scores suggesting deterioration compared to the treatment group (58.7% vs. 16.7%). The difference in these proportions was significantly different (p<0.001).

Storr et al. 2006

The efficacy of multidisciplinary rehabilitation in stable multiple sclerosis patients

Denmark

RCT

PEDro=8

N_Initial=106, N_Final=90

Population: Control group (n=52): Mean age=50.1yr; Gender: males=16, females=36; Disease course: RRMS=12 (23%), PPMS=11 (21%), SPMS=29 (56%); Median EDSS=6.5; Median disease duration=9.0yr. Intervention group (n=38): Mean age=53.0yr; Gender: males=16, females=22, Disease course: RRMS=5 (13%), PPMS=9 (24%), SPMS=24 (63%); Median EDSS=6.5; Median disease duration=9.0yr.

Intervention: Individuals were randomized either to the control group and received no rehabilitation treatment, or to the intervention group and received rehabilitation treatment from the MS rehabilitation hospital in Haslev Denmark.

Primary Outcome Measures: Functional Assessment in Multiple Sclerosis (FAMS).

Self-Care Outcome Measures: Guy's Neurological Disability Scale (GNDS).

Other Outcome Measures: Multiple Sclerosis Impairment Scale (MSIS); EDSS; Visual Analog Scale for symptoms (VAS); 10 meter walk test (TW10); Nine-Hole Peg Test (9HPT); Life Appreciation and Satisfaction Questionnaire (LASQ).

1. No significant difference was found between the control and the intervention groups on any of the outcome measures.

Craig et al. 2003

A randomised controlled trial comparing rehabilitation against standard therapy in multiple sclerosis patients receiving intravenous steroid treatment

RCT

PEDro=5

N_Initial=41, N_Final=40

Population: Control group (n=20): Mean age=42yr; Gender: males=4, females=16; Disease course: active relapsing; Mean EDSS=5.1; Mean disease duration=5.69yr. Intervention group (n=20): Mean age=38yr; Gender: males=9, females=11, Disease course: active relapsing; Mean EDSS=5.4; Mean disease duration=7.42yr.

Intervention: All MS participants were randomized to either the control group and received standard ward routine care and 3d of intravenous methylprednisolone (IVMP), or to the intervention group and received planned coordinated multidisciplinary team treatment and 3d of IVMP. Participants were assessed at baseline upon receiving IVMP treatment, at 1mo and at 3mo after the first day of IVMP.

Primary Outcome Measures: Guy's Neurological Disability Scale (GNDS); Amended Motor Club Assessment (AMCA).

Self-Care Outcome Measures: GNDS; AMCA; Barthel Index (BI).

Other Outcome Measures: Human Activity Profile (HAP); 36-Item Short Form Health Survey (SF-36).

1. The difference in the mean scores from baseline to 3mo between treatment and control groups was significant for GNDS (p=0.030), AMCA (p=0.035), and BI (p=0.018).

Patti et al. 2003

Effects of a short outpatient rehabilitation treatment on disability of multiple sclerosis patients - a randomised controlled trial

Italy

RCT

PEDro=8

N_Initial=111, N_Final=111

Population: Outpatient rehabilitation (n=58): Mean age=45.2yr; Gender: males=24, females=34; Disease course: PPMS=12, SPMS=46; Mean EDSS=6.2; Mean disease duration=17.2yr. Home exercise (n=53): Mean age=46.1yr; Gender: males=23, females=30; Disease course: PPMS=11, SPMS=42; Mean EDSS=6.1; Mean disease duration=17.2yr.

Intervention: Patients were randomized to a comprehensive rehabilitation program and a home exercise group. The patients in the comprehensive rehabilitation group received an individualized, goal-oriented program involving an interdisciplinary team, addressing a wide range of areas for 6wks (6x/wk) and a home exercise program for a further 6wks. The home exercise group received the home exercise program for 12wks. Both groups were assessed at baseline and at 12wks.

Primary Outcome Measures: Functional Independence Measure (FIM).

Self-Care Outcome Measures: FIM.

Other Outcome Measures: EDSS; Functional System Scale; Social Experience Tempelaar Checklist (SET).

1. There were significantly greater improvements for the rehabilitation program group compared to the home exercise group on FIM scores (p<0.0001); particularly in locomotion, self-care and transfers (p<0.001).

Pozzilli et al. 2002

Home based management in multiple sclerosis: results of a randomised controlled trial

Italy

RCT

PEDro=5

N_Initial=201, N_Final=188

Population: Intervention group (n=133): Mean age=47yr; Gender: males=47, females=86; Disease course: RRMS=26, PPMS=27, SPMS=80; Mean EDSS=6.0; Mean disease duration=18.4yr. Control group (n=68): Mean age=46.7yr; Gender: males=21, females=47; Disease course: RRMS=14, PPMS=14, SPMS=40; Mean EDSS=6.0; Mean disease duration=18.6yr.

Intervention: MS patients were randomized to receive either individually tailored multidisciplinary home-based medical care with regular phone support available 5d/wk (intervention group) or routine care involving multidisciplinary care coordinated through a hospital-based MS centre (control group). Assessments were performed at baseline and at 12mo.
Primary Outcome Measures: Not specified.

Self-Care Outcome Measures: Functional Independence Measure (FIM).

Other Outcome Measures: 36 item short form health survey questionnaire (SF-36); EDSS; Mini-Mental State Examination (MMSE); Fatigue Severity Scale (FSS); State Trait Anger Expression Inventory (STAXI); State Trait Anxiety Inventory (STAI); Clinical Depression Questionnaire (CDQ); cost resource assessment.

1. No significant differences between intervention and control groups were detected for the FIM.

Guagenti-Tax et al. 2000

Impact of a comprehensive long-term care program on caregivers and persons with multiple sclerosis

RCT

PEDro=5

N_Initial=73, N_Final=59 (patient-caregiver units)

Population:

Patients (n=59):

Experimental: Mean age=44.0yr; Gender: males=8 (13.3%), females=51 (86.7%); Disease course: CPMS=39 (66.7%); Mean EDSS=7.06; Mean disease duration=8.9yr.

Control: Mean age=49.0yr; Gender: males=18 (31.0%), females=41 (69.0%); Disease course: CPMS=51 (86.2%); Mean EDSS=7.24; Mean disease duration=14.2yr.

Caregivers (n=59):

Experimental: Mean age=44.9yr; Gender: males=43.3%, females=56.7%.

Control: Mean age=51.8yr; Gender: males=48.3%, females=51.7%.

Intervention: Patient-caregiver units were randomized to a comprehensive rehabilitation program or a standard care group. The comprehensive rehabilitation program consisted of 4 coordinated components: 1) twice-monthly medical day-care program, 2) a series of semi-annual workshops for persons with MS and family caregivers, 3) monthly home visits by social workers, nurses, and volunteers, 4) case management and liaison services. Patients and caregivers were assessed at baseline, 12 and 24mo.

Primary Outcome Measures: Not specified.

Self-Care Outcome Measures: Incapacity Status Scale (ISS).

Other Outcome Measures: EDSS; Number of acute hospital admissions; Perceived deficits questionnaire (PDQ); Hopkins Verbal Learning Test (HVLT); Mental Health Inventory (MHI); Sickness Impact Profile (SIP); Revised UCLA Loneliness-Companionship Scale; Questionnaire on Resource and Stress (QRS); 36-Item Short Form Health Survey (SF-36); Satisfaction with care; Length of stay.

1. There was significant decline in ISS scores (p=0.000) for all patients.

2. No interaction effects (only main effects) were reported for the above findings.

3. All patients reported an increase in satisfaction with the help they received from their caregivers for their daily routines (p=0.005) and within a reasonable time frame (p=0.039).

4. On the QRS, caregivers reported an increase in martyrdom (p=0.000).

5. Control patients reported significantly greater satisfaction with getting help with their daily routine compared to the rehabilitation patients (p=0.004).

Freeman et al. 1997

The impact of inpatient rehabilitation on progressive multiple sclerosis

RCT

PEDro=5

N_Initial=70, N_Final=66

Population: Rehabilitation group (n=32): Mean age=43.2yr; Gender: males=11, females=21; Disease course: PPMS=2, SPMS=30; Median EDSS=6.5; Mean disease duration=9.6yr. Waitlist group (n=34): Mean age=44.6yr; Gender: males=13, females=21; Disease course: PPMS=4, SPMS=30; Median EDSS=6.5; Mean disease duration=11.4yr.

Intervention: Patients were randomized to either the rehabilitation or the waitlist groups. The rehabilitation program consisted of a multidisciplinary team approach, interventions tailored to meet the individual's needs and a patient centered functional goal setting approach. The waitlist group continued with their normal routine. Interventions were 6wks. Patients were tested at baseline and at 6wks.

Primary Outcome Measures: Not specified.

Self-Care Outcome Measures: Functional Independence Measure (FIM).

Other Outcome Measures: EDSS; London Handicap Scale (LHS).

1. The rehabilitation group had significantly greater improvements compared to the waitlist group for overall FIM motor score (p<0.001) and on the subscales of: self-care (p<0.0001), transfers (p<0.001), and sphincter control (p<0.001).

Francabandera et al. 1988

Multiple Sclerosis Rehabilitation: Inpatient vs. Outpatient

RCT

PEDro=4

N_Initial=84, N_Final=84

Population: Inpatient group (n=42). Outpatient group (n=42). Demographic data not reported. Inclusion criteria: severe disability (EDSS 6-9) and not institutionalized.

Intervention: MS patients were randomized to either inpatient or outpatient rehabilitation. An individualized plan of care was instituted for each patient. An average of two 45min physical therapy sessions and one occupational therapy session per day was scheduled for each patient. Bladder management, speech therapy, and social services were provided as needed. Equipment needs were assessed, and appropriate devices were recommended and ordered. Assessments were performed at baseline and after 3, 6, 9, and 12mo.
Primary Outcome Measures: Incapacity Status Scale (ISS).

Self-Care Outcome Measures: ISS.

Other Outcome Measures: None.

1. There was a statistically significant difference in ISS between the inpatient and outpatient groups at the 3mo follow-up (24.3 vs. 27.2, respectively; p<0.05).

2. Patients in the inpatient group on average improved slightly, while those in the outpatient group deteriorated slightly.

Liberatore et al. 2014

Predictors of effectiveness of multidisciplinary rehabilitation treatment on motor dysfunction in multiple sclerosis

Italy

Pre-Post

N_Initial=266, N_Final=212

Population: Mean age=45.0yr; Gender: males=96, females=116; Disease course: RRMS=43, PPMS=38, SPMS=124, PRMS=7; Median EDSS=6.0; Mean disease duration=13.9yr.

Intervention: MS patients underwent a short-term (3-7wks) intensive (2hr/d, 5d/wk), individualised, goal-oriented inpatient rehabilitation program.
Primary Outcome Measures: Not specified.

Self-Care Outcome Measures: Motor subscale of Functional Independence Measure (mFIM).

Other Outcome Measures: EDSS; Functional Systems; Fatigue Severity Scale (FSS); Paced Auditory Serial Addition Test (PASAT).

1. Following rehabilitation treatment, at discharge, a significant improvement in the mFIM values (p<0.001) was observed.

2. 121 patients (57.1%) improved in activity limitation (mFIM responders), 113 patients (53.3%) in impairment (EDSS responders), 139 patients (75.1%) in either mFIM or EDSS or both (partial responders), and 75 (35.4%) in both outcomes (full responders).

3. Regarding the partial response, a baseline moderate-severe disability assessed by mFIM increased the probability to benefit from rehabilitation (p<0.001).

Judica et al. 2011

Impact of fatigue on the efficacy of rehabilitation in multiple sclerosis

Italy

PCT

N_Initial=186, N_Final=86

Population: Treated group (n=64): Mean age=43.2yr; Gender: males=32, females=32; Disease course: RRMS=13, PPMS=12, SPMS=39; Mean EDSS=5.8; Mean disease duration=15.5yr. Control group (n=22): Mean age=46.3yr; Gender: males=12, females=10; Disease course: RRMS=6, PPMS=4, SPMS=12; Mean EDSS=5.4; Mean disease duration=16.9yr.

Intervention: MS patients underwent an intensive, short-term inpatient rehabilitation program. Patients were classified into fatigued MS (FMS) in the case of a Fatigue Severity Scale (FSS) score of ≥36, and non-fatigued MS (NFMS) for FSS<36. An untreated control group was included for comparison.
Primary Outcome Measures: Not specified.

Self-Care Outcome Measures: Functional Independence Measure (FIM).

Other Outcome Measures: EDSS; FSS; MS Functional Composite (MSFC).

1. 46 patients were defined as fatigued and 18 as non-fatigued in the rehab treated group. In the control group, 16 patients were fatigued and 6 were non-fatigued.

2. Comparing all (FMS and NFMS) patients before and after rehabilitation, there was an increase in FIM score (p<0.0001).

3. FIM significantly increased in FMS patients before and after the rehabilitation program (p<0.0001).

4. FIM significantly increased in NFMS patients before and after the rehabilitation program (p<0.0001).

Vidmar et al. 2011

Time trends in ability level and functional outcome of stroke and multiple sclerosis patients undergoing comprehensive rehabilitation in Slovenia

Slovenia

Pre-Post

N_Initial=225, N_Final=225

Population: MS participants (n=225): Mean age=50yr; Gender: males=74, females=151; Disease course: unspecified; Disease severity: unspecified; Disease duration: unspecified.

Intervention: MS participants received comprehensive rehabilitation at the University Rehabilitation Institute in Ljubljana. Patients were divided into two groups based on time-period of admission: during 1999-2000, or from 2004-2006. Assessments were performed at admission and discharge.
Primary Outcome Measures: Not specified.

Self-Care Outcome Measures: Functional Independence Measure (FIM).

Other Outcome Measures: None.

1. Admission motor and cognitive FIM subscale scores were on average 5 points lower in the 2004-2006 period, the average total score being approximately 10 points lower. The average difference between discharge and admission scores (rehabilitation gain) increased over time, in total by about 3 points in MS patients.

2. Progress on FIM scores at discharge was significantly different between the groups of MS patients in terms of FIM total (p<0.001), motor (p=0.001), and cognitive (p=0.001).

3. Significant differences in MS patients were observed between the time-period groups in terms of efficiency (calculated from FIM scores): total (p<0.001), motor (p=0.002), and cognitive (p<0.001), and effectiveness (calculated from FIM scores): total (p<0.001), motor (p<0.001), and cognitive (p=0.003). Both efficiency and effectiveness significantly increased over the time period observed.

Khan et al. 2010

Clinical practice improvement approach in multiple sclerosis rehabilitation: a pilot study

Australia

Case Series

N_Initial=24, N_Final=24

Population: Mean age=51.54yr; Gender: males=10, females=14; Disease course: RRMS=5, PPMS=5, SPMS=14; Disease severity: unspecified; Mean disease duration=11.1yr.

Intervention: Records for 24 consecutive MS patients presenting in a 14mo period and receiving inpatient rehabilitation were selected for data extraction with the goal of addressing the functional gains after rehabilitation. Each patient received a customized program incorporating physiotherapy, occupational therapy, speech pathology, social work, dietetics, and neuropsychology.
Primary Outcome Measures: Not specified.

Self-Care Outcome Measures: Barthel Index (BI); Functional Independence Measure (FIM).

Other Outcome Measures: Neurological Impairment Set (NIS); Rehabilitation Complexity Scale (RCS); Northwick Park Therapy Dependency Assessment (NPTDA); Hospital Length of Stay (LOS); discharge destination.

1. Functional gains from admission to discharge for the FIM (motor: p<0.001; cognitive: p=0.005; total: p<0.001) and BI (p<0.001) were significant.

2. All patients in the rehabilitation program improved in function (FIM, BI) (p<0.001 for both) from admission to discharge, and returned home.

Grasso et al. 2009

Prognostic factors in multiple sclerosis rehabilitation

Italy

Pre-Post

N_Initial=230, N_Final=200

Population: Mean age=49.7yr; Gender: unspecified; Disease course: unspecified; Mean EDSS=6.93; Mean disease duration=17.3yr.

Intervention: MS patients were admitted to a rehabilitation ward who followed an individualized, goal-oriented, multidisciplinary rehabilitation program. Patients were grouped according to EDSS scores of 2-5.5, 6-6.5, 7-8.5. Assessments were performed at admission and discharge.
Primary Outcome Measures: Not specified.

Self-Care Outcome Measures: Barthel Index (BI); Rivermead Mobility Index (RMI).

Other Outcome Measures: EDSS; Functional Systems.

1. Following treatment, a significant improvement in both BI and RMI values (p<0.001) was observed at discharge.

2. The mean effectiveness value of the whole sample was 16.00 on the BI and 8.60 on the RMI.

3. The BI score improved in 48% of patients, while the RMI score improved in 43.4% of patients.

4. Patients with mild and moderate MS showed an effectiveness on activities of daily living and mobility that was significantly higher compared to patients with the severe form of MS (p=0.001, p<0.05, respectively).

Khan et al. 2009

Multiple sclerosis rehabilitation outcomes: analysis of a national casemix data set from Australia

Australia

Case Series

N_Initial=1010, N_Final=1010

Population: Whole Population (n=1010): Mean age=52.0yr; Gender: males=29.8%, females=70.2%; Disease course: unspecified; Disease severity: Australian National Subacute and Non Acute Patient (ANSNAP) casemix classification system classes 216, 217, 218, and 219 which are defined by FIM functional motor scores: 216 (FIM motor (m) scores range 63–91), 217 (FIM m=49–62), 218 (FIM m=18–48), and 219 (FIM m=14–17); Disease duration: unspecified. ANSNAP 216 (n=404): Mean age=49.2yr; Gender: males=25.7%, females=74.3%. ANSNAP 217 (n=222): Mean age=54.1yr; Gender: males=26.6%, females=73.4%. ANSNAP 218 (n=360): Mean age=53.8yr; Gender: males=34.4%, females=65.6%. ANSNAP 219 (n=24): Mean age=51.2yr; Gender: males=58.3%, females=41.7%.

Intervention: De-identified data from MS patients in the Australian Rehabilitation Outcomes Centre (AROC) database were analyzed for all rehabilitation admissions to examine outcomes of inpatient rehabilitation for persons with MS.

Primary Outcome Measures: Functional Independence Measure (FIM); Hospital Length of Stay (LOS); discharge destination.
Self-Care Outcome Measures: FIM.

Other Outcome Measures: None.

1. Classes 216–218 all showed significant improvements in FIM scores from admission to discharge (p<0.001); although class 219 showed a trend towards improvement, this was not significant.

2. FIM improvement differed significantly among the four ANSNAP classes, (p<0.001).

3. Post hoc analyses indicated that ANSNAP 216 had a smaller FIM change compared with 217 (p<0.001) and 218 (p<0.001). (These findings are expected, given that FIM admission scores are higher (indicating better function) in ANSNAP 216 and therefore have less potential for improvement).

4. FIM efficiency was also significantly higher in class 217 than in any of the other classes (p<0.001).

5. There was no significant change in FIM improvement or FIM efficiency from the first to last yr of the study.

Khan et al. 2008

Use of goal attainment scaling in inpatient rehabilitation for persons with multiple sclerosis

Australia

Pre-Post

N_Initial=24, N_Final=24

Population: Mean age=52.0yr; Gender: males=10, females=14; Disease course: RRMS=5, PPMS=5, SPMS=14; Disease severity: unspecified; Disease duration: unspecified.

Intervention: MS patients receiving comprehensive inpatient rehabilitation were assessed for clinically important functional changes. Functional assessments were performed within 48hr of admission and discharge.
Primary Outcome Measures: Not specified.

Self-Care Outcome Measures: Functional Independence Measure (FIM); Barthel Index (BI).

Other Outcome Measures: Goal Attainment Scaling (GAS); Clinical Global Impression (CGI).

1. For the sample as a whole, there was a statistically significant change from admission to discharge on BI and FIM scores (BI: p<0.001; FIM: p<0.001).

2. There was no significant or clinically important difference in responder and non-responder scores for the BI or the FIM.

Vikman et al. 2008

Effects of inpatient rehabilitation in multiple sclerosis patients with moderate disability

Sweden

Pre-Post

N_Initial=58, N_Final=58

Population: Cohort A (n=40): Mean age=56.3yr; Gender: males=8, females=32; Disease course: RRMS=2, PPMS=15, SPMS=21, unclassified=2; Mean EDSS=5.8; Mean disease duration=20.4yr. Cohort B (n=18): Mean age=54.7yr; Gender: males=4, females=14; Disease course: PPMS=4, SPMS=14; Mean EDSS=5.6; Mean disease duration=17.0yr.

Intervention: MS patients with moderate disability received 3wks of inpatient neurorehabilitation in two cohorts, A and B. Rehabilitation consisted of physiotherapy, occupational therapy, and consultation by speech therapist, social worker, and psychologist. Cohort A was assessed on admission and discharge during a rehabilitation period. Cohort B was assessed 3wks before admission, on admission and at discharge.
Primary Outcome Measures: Not specified.

Self-Care Outcome Measures: Barthel Index (BI).

Other Outcome Measures: 36 Item Short-Form questionnaire (SF-36); Functional Assessment of Multiple Sclerosis (FAMS); Fatigue Severity Scale (FSS); Beck Depression Inventory (BDI); Multiple Sclerosis Functional Composite (MSFC); Grippit; Box and Block Test (B&B); Nine Hole Peg Test (9HPT); Clinical Outcome Variables (COVS); Berg Balance Scale (BBS); Timed 25-Foot Walk Test (T25FWT).

1. No significant changes were observed in any cohort for personal care ability as measured by the BI.

Grasso et al. 2005

Prognostic factors in multidisciplinary rehabilitation treatment in multiple sclerosis: an outcome study

Italy

Pre-Post

N_Initial=230, N_Final=230

Population: Mean age=49.42yr; Gender: male/female ratio=1:1:7 (not specified further); Disease course: unspecified; Mean EDSS=6.93; Mean disease duration=16.90yr.

Intervention: All patients were enrolled in an individualized, goal oriented, multidisciplinary inpatient program based on activities of daily living (ADL). The program took place twice-daily, each session being 45min long, for 6d/wk, for 10wks.

Primary Outcome Measures: Not specified.

Self-Care Outcome Measures: Barthel Index (BI); Rivermead Mobility Index (RMI).

Other Outcome Measures: EDSS; Functional Systems.

1. Both BI and RMI scores increased significantly from admission to discharge (p<0.001).

2. All patient subgroups (basal EDSS score < 6, score 6-6.5, and score > 6.5) showed significant differences between basal and discharge functional values as well as in treatment effectiveness, on the BI and RMI (p<0.002).

3. The basal EDSS score was negatively associated with the effectiveness of the treatment, both on BI and RMI (p<0.001).

4. Patients without severe cognitive impairment had a probability of improvement in RMI twice as high compared to other patients (p<0.05).

5. Patients without severe sphincteric disturbances had probability of improvement in ADL nearly twice as high as that of other patients (p<0.01).

Liu et al. 2003

Does neurorehabilitation have a role in relapsing-remitting multiple sclerosis?

Case Series

N_Initial=90, N_Final=90

Population: RRMS group (n=90): Mean age=33.4yr; Gender: unspecified; Mean EDSS=6.9; Mean disease duration=6.4yr. PPMS group (n=80): Mean age=46.0yr; Gender: unspecified; Mean EDSS=7.3; Mean disease duration=10.3yr. SPMS group (n=402): Mean age=45.5yr; Gender: unspecified; Mean EDSS=7.1; Mean disease duration=18.4yr.

Intervention: MS patients received relatively short-stay, goal-orientated, patient-centred multidisciplinary inpatient rehabilitation. The primary study group of RRMS patients were compared to PPMS and SPMS groups. Assessments were performed at admission and after rehabilitation.
Primary Outcome Measures: Not specified.

Self-Care Outcome Measures: Barthel Index (BI); Functional Independence Measure (FIM).

Other Outcome Measures: EDSS; Visual Analog Scale (VAS).

1. Disability scores in RRMS patients were significantly better at discharge than admission (p<0.0001 all comparisons; mean change of +4.5 points for BI and +15.6 points for FIM), which was significantly greater than the other MS subtypes.

Freeman et al. 1999

Inpatient rehabilitation in multiple sclerosis: Do the benefits carry over into the community?

Pre-Post

N_Initial=50, N_Final=44

Population: Mean age=44.8yr; Gender: males=21, females=29; Disease course: PPMS=7, SPMS=42; Mean EDSS=6.7; Mean disease duration=11.6yr.

Intervention: Patients with progressive MS undergoing inpatient rehabilitation were followed for 12mo after discharge. Assessments were undertaken on admission (A), at discharge, and subsequently at 3mo intervals for 1yr (1Y).
Primary Outcome Measures: Functional Independence Measure (FIM); London Handicap Scale (LHS).

Self-Care Outcome Measures: FIM.

Other Outcome Measures: EDSS; Kurtzke's Functional Systems; 36-item Short Form Health Survey Questionnaire (SF-36); 28-item General Health Questionnaire (GHQ).

1. Improvement was seen across all measures during the inpatient stay. These gains declined in varying patterns after discharge.

2. The FIM scores steadily lowered, remaining only marginally above baseline at the 9 and 12mo assessments.

3. No tests of statistical significance were reported in this study.

Di Fabio et al. 1998

Extended outpatient rehabilitation: Its influence on symptom frequency, fatigue, and functional status for persons with progressive multiple sclerosis

PCT

N_Initial=46, N_Final=33

Population: Treatment group (n=20): Mean age=49yr; Gender: males=5, females=15; Disease course: PPMS or SPMS; EDSS range: 5-8; Mean disease duration=17yr. Waiting List group (n=26): Mean age=50yr; Gender: males=7, females=19; Disease course: PPMS or SPMS; EDSS range=5-8; Mean disease duration=15yr.

Intervention: Participants were non-randomly assigned to either the treatment or waiting list group. The treatment group received outpatient rehabilitation services for 5hr, 1d/wk, over 1yr. Both groups received comparable pharmacologic management.

Primary Outcome Measures: MS-Related Symptom Checklist; Rehabilitation Institute of Chicago Functional Assessment Scale (RIC-FAS).

Self-Care Outcome Measures: RIC-FAS.

Other Outcome Measures: None.

1. When adjusted for the functional level at the initial assessment, the mean RIC-FAS score for the treatment group at the 1yr assessment was 60% compared with 57% for the waiting list group.

2. Mean effect sizes at the 1yr follow-up, adjusted for differences in baseline values, indicated less loss of functional status in the treatment group compared with the waiting list group (-0.07 vs. -0.70 for treatment and waiting list groups, respectively).

3. With regard to functional status, the waiting list subjects who dropped out of the study had significantly lower RIC-FAS scores compared with those who completed the study.

Rossiter et al. 1998

Integrated care pathways in multiple sclerosis rehabilitation: completing the audit cycle

Pre-Post

N_Initial=125, N_Final=125

Population: Cohort 1 (n=39): Gender: males=41%, females=59%. Cohort 2 (n=43): Gender: males=36%, females=64%. Cohort 3 (n=42): Gender: males=27%, females=73%.

For total study sample:

Mean age: unspecified for all groups, but participants were similar in age status; Disease course: unspecified, but the majority were SPMS; Mean EDSS=7; Mean disease duration: unspecified.

Intervention: Participants were divided into three cohorts and each received a comprehensive process of care that was being audited within the structure of an Integrated Care Pathway (ICP), so that episodes of clinical care could be documented for each of the three main sections: the process pathway, the goal categorization sheet, and the variation tracking sheet. Variations from the expected pathway of clinical care (ICP for neurorehabilitation) were documented and analyzed for each cohort in order to evaluate the effectiveness of the goal-directed therapy implementation.

Primary Outcome Measures: Not specified.

Self-Care Outcome Measures: Barthel Index (BI); Functional Independence Measure (FIM); Handicap Assessment Scale (HAS).

Other Outcome Measures: Mean variations from process pathway; Mean length of stay; Mean number of goals set by discharge for each patient (goal achievement).

1. All three cohorts showed a mean improvement in BI, HAS, and FIM motor and cognitive subscale scores between admission and discharge, but no significant differences were found between cohorts.

2. No significant correlation between level of goal achievement and changes on outcome measure scores was found. An increase in carer involvement was recognized.

Di Fabio et al. 1997

Health-related quality of life for patients with progressive multiple sclerosis: influence of rehabilitation

PCT

N_Initial=44, N_Final=31

Population: Treatment group (n=12): Mean age=44.5yr; Gender: males=2, females=10; Disease course: PPMS or SPMS; EDSS range: 5-8; Mean disease duration=17.6yr. Wait-listed group (n=19): Mean age=49.2yr; Gender: males=4, females=15; Disease course: PPMS or SPMS; EDSS range: 5-8; Mean disease duration=14.2yr.

Intervention: MS patients received either outpatient care for 1yr or did not receive rehabilitation (wait-listed control).

Primary Outcome Measures: Rand 36-Item Health Survey 1.0 (SF-36).

Self-Care Outcome Measures: Rehabilitation Institute of Chicago Functional Assessment Scale (RIC-FAS).

Other Outcome Measures: MS Quality of Life 54 Item (MSQoL-54).

1. Over the course of the year, both groups showed a decrease in physical function, as demonstrated by negative effect sizes for the RIC-FAS composite scores (including bed mobility, wheelchair propulsion, bed transfers, ambulation, and skin status). However, functional status in the wait-listed group declined more than in the treatment group (effect sizes = -0.52 vs. -0.33, respectively).

Aisen et al. 1996

Inpatient Rehabilitation for Multiple Sclerosis

Case Series

N_Initial=37, N_Final=37

Population: Mean age=46.87yr; Gender: males=4, females=33; Disease course: RRMS=6, SPMS=26, PRMS=5; Mean EDSS=7.47; Mean disease duration=11.84yr.

Intervention: MS patients receiving inpatient rehabilitation for functional decline were assessed retrospectively. Patients received one or two follow-up telephone assessments at intervals ranging from 6mo to 3yr after discharge. Assessment scores at admission, discharge, and follow-up were analyzed.
Primary Outcome Measures: Not specified.

Self-Care Outcome Measures: Functional Independence Measure (FIM).

Other Outcome Measures: Kurtzke Functional Systems; EDSS.

1. For all groups combined, significant improvements between admission and discharge were seen in FIM (p=0.0001) scores. Gains were partly maintained between discharge and follow-up.

2. Significant improvements also occurred in FIM subgroupings: self-care (eating, dressing, grooming, bathing) (p=0.0001), sphincter control (bladder, bowel) (p=0.0222), and locomotion (ambulation, stair climbing, wheelchair management) (p=0.0001) for all patients.

3. Follow-up assessments obtained in 28 patients at 12 to 24mo showed statistically insignificant changes in FIM compared to the end of rehabilitation.

4. Twelve patients were assessed 24 to 36mo after discharge, whose FIM performance significantly deteriorated (p=0.008) compared to the end of rehabilitation.

Kidd et al. 1995

The benefit of inpatient neurorehabilitation in multiple sclerosis

Pre-Post

N_Initial=79, N_Final=79

Population: Mean age=48.8yr; Gender: males=30, females=49; Disease course: RRMS, SPMS, PPMS; Median DSS=7.0; Mean disease duration=12.1yr.

Intervention: MS patients admitted over a 16mo period for multidisciplinary rehabilitation were studied using assessment scales as measures of disability and handicap.
Primary Outcome Measures: Not specified.

Self-Care Outcome Measures: Barthel Index (BI).

Other Outcome Measures: Kurtzke's Disability Status Scale; Environmental Status Scale (ESS).

1. The median BI on admission was 14.0 and increased (improved) by a median of 1.0 overall (p<0.0001). It increased in 51 patients (65%), diminished in one patient (1%) and was unchanged in 27 (34%).

2. Improvement on the BI was most marked in patients in whom a reduction in impairment occurred, but also increased in progressive and stable patients. The difference in terms of changes in BI between patients in whom a reduction in impairment occurred, and progressive and stable patients, was not statistically significant (p=0.13).

3. When the BI on admission was subdivided into mild (20-16), moderate (15-11), severe (10-6) and very severe disability (5-0) the greatest change in disability occurred in the severely and moderately disabled patients.

Carey et al. 1988

Who makes the most progress in inpatient rehabilitation? An analysis of functional gain

Case Series

N_Initial=6194, N_Final=6194

Population: MS participants (n=196): Mean age=46yr; Gender: unspecified; Disease course: unspecified; Disease severity: unspecified; Disease duration: unspecified.

Intervention: MS patients in rehabilitation facilities were assessed in functional gains over their stay.
Primary Outcome Measures: Revised Level of Rehabilitation Scale (LORS-II).

Self-Care Outcome Measures: LORS-II.

Other Outcome Measures: None.

1. MS patients had mean gain scores of 16 and 20 on the ADL and mobility aspects of the LORS-II, respectively (no significance reported).

Greenspun et al. 1987

Multiple sclerosis and rehabilitation outcome

Case Series

N_Initial=28, N_Final=28

Population: Mean age=42yr; Gender: males=27%, females=73%; Disease course: unspecified; Severity: unspecified; Mean disease duration=12.2yr.

Intervention: Patients with severe MS were admitted to an inpatient rehabilitation center, and treatment included physical, occupational, and speech therapy, as well as recreational therapy. Patients were seen daily by a physiatrist who coordinated all aspects of care. Data was gathered on admission, at discharge, and at 3mo post-discharge follow-up, over a 4yr period.
Primary Outcome Measures: Not specified.

Self-Care Outcome Measures: Study used an assessment which was designed to measure activities of daily living (comprised of dressing, bathing, eating, and toileting). Assessment name was not provided.

Other Outcome Measures: Mobility assessment instrument (comprised of ambulating, transferring, stair climbing). Assessment name was not provided.

1. After completion of rehabilitation, the proportion of patients independent in dressing, eating, toileting, and bathing increased.

2. At 90d follow-up, 82%, 73%, 85%, and 91% of patients were independent in dressing, bathing, toileting, and eating.

Team-Based Rehabilitation: Functional and Quality of Life Outcomes

Knowledge . Innovation . Talent . Everywhere

Knowledge . Innovation . Talent . Everywhere

Next Event at KITE

Find Us

Media contacts

Who we are

Affiliated with