Structured Abstract
Multiple Sclerosis Structured Abstract - MS #2
Inpatient rehabilitation to benefit persons with multiple sclerosis
CITATION: Freeman, J. A., Langdon, D. W., Hobart, J. C., & Thompson, A. J. (1997). The impact of inpatient rehabilitation on progressive multiple sclerosis. Annals of Neurology, 42, 236-244.
LEVEL OF EVIDENCE: IA1a
RESEARCH OBJECTIVE/QUESTION
This study was conducted to determine the effectiveness of inpatient rehabilitation on multiple sclerosis.
DESIGN
|
x |
RCT |
|
Single Case |
|
Case Control |
| |
Cohort |
|
Before-After |
|
Cross Sectional |
Participants were stratified by severity level (Kurtzke's Expanded Disability Status Scale [EDSS] score) into mild, moderate, and severe levels. Then they were randomly assigned to either a treatment group or a wait list group. All participants were evaluated after assignment and again 6 weeks later.
SAMPLING PROCEDURE
Recruited from a clinic at a hospital prior to entry into an inpatient program. Random assignment to groups. 279 consecutive patients in an 18-month period. 112 admitted for inpatient, 70 met criteria for study. No significant difference was reported between the treatment and control group.
SAMPLE
|
N = 66 |
Mean age = 44 |
Male = 28 |
Female = 42 |
OUTCOMES
|
x |
Life roles |
x |
Tasks |
x |
Activities |
| |
Abilities/habits |
x |
Capacities |
OUTCOME AREAS
|
Outcome area |
Measure |
Reliability |
Validity |
|
Impairment |
Kurtzke's Functional System's Scales (FS) and EDSS |
Single rater ICC = .92 |
NR |
|
Disability |
Motor domain of the Functional Independence Measure (FIMsm) |
Mentioned but not reported |
Mentioned but not reported |
|
Handicap (physical independence, mobility, occupation, social integration, orientation, and economic self-sufficiency) |
London Handicap Scale (LHS) |
Mentioned but not reported |
Mentioned but not reported |
NR=Not Reported
INTERVENTION
Description
Treatment group:
Multidisciplinary interventions tailored to meet individual needs, client-centered functional goal-setting approach. Emphasized quality of life. (n = 32)
Control Group: Wait-listed (n = 34)
Who delivered
Medical, nursing, and occupational and physical therapy
85% were assessed by a neuropsychologist
64% by speech language pathologist
48% by social worker
Setting
Inpatient
Frequency
Two 45-minute physiotherapy and one 45-minute OT session.
Duration
Avg. of 20 days
RESULTS
Impairment (EDSS and FS); Wilcoxian rank sum test
- No significant difference between pre- and posttests for either group.
- No significant difference between the two groups (p = .42)
- Small effect size and 95% confidence interval suggests that there was indeed minimal change.
Disability (FIMsm); Wilcoxian rank sum test
- Significant difference in change score between treatment (tx) and control group for:
self-care (p = < .0001)
transfers (p < .001)
wheelchair locomotion
tx number = 15
control number = 14
p = .0315
- Effect sizes for total disability chance score:
tx = .21; mean = 3.9
control = -.16; mean = -2.97
Kaziz and colleagues effect size = mean change/standard deviation of the initial distribution of scores.
Handicap (LHS)
- Overall handicap change score is significant p = .01
effect size = .23; mean = 2.76
control: effect size = -.27; mean = -2.71 (t test).
- No significance achieved for individual dimensions: mobility p = .078; physical independence p = .2591; occupation p = .1782; social interaction p =. 1138; orientation p = .0692; economic self-sufficiency p = .9880 (Wilcoxon rank sum test).
CONCLUSIONS
Biases - attention, sample size, dropouts, Expectation
Although inpatient treatment does not seem to reduce the impairment, it does seem to improve disability and handicap in clients with progressive MS.
Limitations
- Treatment group may have improved due to attention paid.
- Sample size was too small to demonstrate a difference in handicap.
- Four participants dropped out. No analysis of their similarity/difference to the sample.
- Evaluators not blinded to group status.
COMMENTARY
OT as part of an inpatient multiple discipline team using a client-centered approach is effective in reducing disability and handicap for clients with MS.
Terminology used in this document is based on two systems of classification current at the time the evidence-based literature reviews were completed: Uniform Terminology for Occupational Therapy Practice-Third Edition (AOTA, 1994) and International Classification of Functioning, Disability and Health (ICIDH-2) (World Health Organization [WHO], 1999). More recently, the Uniform Terminology document was replaced by Occupational Therapy Practice Framework: Domain and Process (AOTA, 2002), and modifications to ICIDH-2 were finalized in the International Classification of Functioning, Disability and Health (WHO, 2001).
This work is based on the evidence-based literature review completed by Nancy Baker, ScD, OTR, and Linda Tickle-Degnen, PhD, OTR/L, FAOTA.
For more information about the Evidence-Based Literature Review Project, contact the Practice Department at the American Occupational Therapy Association, 301-652-6611, x 2040.
Copyright 2003 American Occupational Therapy Association, Inc. All rights reserved. This material may be reproduced and distributed without prior written consent.
