Review article (meta-analysis)
Rehabilitation in Multiple Sclerosis: A Systematic Review of Systematic Reviews

https://doi.org/10.1016/j.apmr.2016.04.016Get rights and content

Abstract

Objectives

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

Data Sources

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

Study Selection

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

Data Extraction

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

Data Synthesis

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

Conclusions

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

Section snippets

Methods

A comprehensive search of the Cochrane Library database (including Database of Abstracts and Reviews of Effectiveness), MEDLINE, CINAHL, EMBASE, and PubMed was undertaken till January 31, 2016 for systematic reviews evaluating rehabilitation interventions currently used in the management of pwMS. The search strategy included combinations of multiple search terms for 2 themes: MS and interventions (rehabilitation). The keywords used to search for studies for this review are listed in appendix 1.

Results

The search retrieved 214 published systematic reviews evaluating rehabilitation interventions currently used in management of MS. Of these, 53 reviews met the abstract inclusion criteria and were selected for closer scrutiny. Full texts of these articles were retrieved, and both reviewers performed the final selection. One review that met the inclusion criteria was identified from the bibliographies of relevant articles. Overall, 15 reviews published in the Cochrane Library database and 24 (one

Discussion

MS is a complex condition, and pwMS frequently present with multiple deficits (motor, sensory, cognitive, behavioral, and communication issues), which require specific and coordinated longer-term multidisciplinary rehabilitative care. This review systematically summarizes the best up-to-date evidence from published systematic reviews for the effectiveness of rehabilitation interventions in MS. The findings indicate that, although a broad range of rehabilitative approaches have been trialed in

Conclusions

MS requires specialized, flexible services for comprehensive management. There is increasing awareness of the contribution of rehabilitation in early and long-term MS care. Despite the range of rehabilitative interventions in pwMS, evidence for many is still unclear because of a lack of methodologically robust trials. More research is needed to build evidence for types of rehabilitation therapy components, modalities, and the duration and setting of therapy. Future research should focus on

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

    Disclosures: none.

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