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Rehabilitation in Multiple Sclerosis: A Systematic Review of Systematic Reviews

  • Fary Khan
    Correspondence
    Corresponding author Fary Khan, MBBS, MD, FAFRM (RACP), Department of Rehabilitation Medicine, Royal Melbourne Hospital, 34-54 Poplar Rd, Parkville VIC 3052, Australia.
    Affiliations
    Department of Rehabilitation Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia

    Department of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia

    School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
    Search for articles by this author
  • Bhasker Amatya
    Affiliations
    Department of Rehabilitation Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia
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      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.

      Keywords

      List of abbreviations:

      AMSTAR (Assessment of Multiple Systematic Reviews), GRADE (Grades of Recommendation, Assessment, Development, and Evaluation), MDR (multidisciplinary rehabilitation), MS (multiple sclerosis), pwMS (persons with multiple sclerosis)
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      Linked Article

      • Current Evidence Does Not Support Exercise Therapy for Perceived Fatigue in Multiple Sclerosis
        Archives of Physical Medicine and RehabilitationVol. 97Issue 11
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          Recently, Khan and Amatya1 conducted a comprehensive systematic review of systematic reviews to summarize the evidence for the effectiveness of rehabilitation interventions to improve function and participation in people with multiple sclerosis (MS). In general, they have managed to do so in a neat and concise way. However, their conclusion about the effectiveness of exercise therapy for fatigue needs reconsideration.
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