Structured Abstract
Multiple Sclerosis Structured Abstract - MS #3
Inpatient treatment to improve functional status
CITATION: Francabandera, F. L., Holland, N. J., Wiesel-Levison, P., & Scheinberg, L. C. (1988). Multiple sclerosis rehabilitation: Inpatient vs. outpatient. Rehabilitation Nursing, 13(5), 251-253.
LEVEL OF EVIDENCE: IA2a
RESEARCH OBJECTIVE/QUESTION
"The goals of the study were (a) to compare the effects of inpatient and outpatient rehabilitation upon functional status, need for home assistance, and subsequent use of inpatient care, and (b) to assess the cost-effectiveness of the two approaches as reflected in home assistance needs and cost of subsequent acute care hospitalization" (p. 251).
DESIGN
|
x |
RCT |
|
Single Case |
|
Case Control |
| |
Cohort |
|
Before-After |
|
Cross Sectional |
Clients were stratified and randomly assigned to either inpatient or outpatient therapy treatment. They were reassessed at 3-month intervals for 2 years.
SAMPLING PROCEDURE
Patients at a MS hospital who agreed to participate and met inclusion criteria.
SAMPLE
|
N = 73 |
Mean age = NR |
Male = NR |
Female = NR |
NR = Not reported
Recruited were clients with a definite diagnosis of MS who: had a severe disability as measured by Kurtzke's expanded disability status score (EDSS) range 6-9; at least three specific rehabilitation goals; were not institutionalized and able to return home after treatment; and insurance to cover either inpatient or outpatient treatment.
OUTCOMES
|
x |
Life roles |
x |
Tasks |
x |
Activities |
| |
Abilities/habits |
|
Capacities |
OUTCOME AREAS
|
Outcome Area |
Measures |
Reliability |
Validity |
|
Functional Status (ambulatory status and level of independence in self-care) |
Incapacity Status Scale (ISS) |
Cronbach's alpha = .93, intraclass correlation coefficient = .94 |
Factor analysis and correlation with home care need |
|
Need for home assistance (# of hours of assistance for ADL both paid and unpaid) |
Structured interview |
NR |
NR |
NR=Not Reported
INTERVENTION
Description
Inpatient - usually two 45-minute PT sessions and one 45-minute OT session per day. Bladder management, speech therapy, social services as needed; equipment needs.
Outpatient - Amount of time for OT/PT not mentioned. Home training by nurse. All others as above.
Who delivered
Appropriate therapist
Setting
Inpatient - Clinic
Outpatient - Clinic and home
Frequency
Did not specify
Duration
Did not specify
RESULTS
Initial ISS scores significantly different. ANCOVA to control for this.
- Significant difference between ISS scores (F(1,70) = 4.3, p < .05) at 3 month follow-up.
- No significant difference (F(1,70) = .17) between inpatient and outpatient for home assistance.
- Have not completed other follow-ups in this article.
CONCLUSIONS
Biases - masking, recall, dropouts
- Therapists not blinded to groups assignment
- ISS was a self-report measure for some clients at follow-up.
- 11 clients lost to follow-up. No measurement of their differences reported.
COMMENTARY
Occupational therapy as part of an inpatient treatment is marginally better than OT as part of an outpatient treatment. Both are about equal in cost-effectiveness.
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.
