Structured Abstract
Multiple Sclerosis Structured Abstract - MS #4
Intensive inpatient therapy to improve mobility for persons with chronic multiple sclerosis
CITATION: Fuller, K. J., Dawson, K., & Wiles, C. M. (1996). Physiotherapy in chronic multiple sclerosis: A controlled trial. Clinical Rehabilitation, 10, 195-204.
LEVEL OF EVIDENCE: IA2a
RESEARCH OBJECTIVE/QUESTION
"The primary aim of this study was to investigate whether mobility at home improved after hospital inpatient physiotherapy and if there was benefit in activities of daily living" (p. 196).
DESIGN
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x |
RCT |
|
Single Case |
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Case Control |
| |
Cohort |
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Before-After |
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Cross Sectional |
"Due to the relatively small sample size anticipated there was risk that, by chance, simple randomization could have resulted in treatment groups imbalanced for potentially important variables….Therefore patients were allocated to 'early' or 'late' treatment" (p. 196). The "early" group received treatment before the "late" group. Inpatient treatment for the "early" group finished after 2 weeks, and re-evaluation of both groups occurred (9-week evaluation). Then the "late" group was admitted to an inpatient unit, treated for 2 weeks, and discharged. Another re-evaluation occurred (13-week evaluation). In this way there was a treatment group (early group) and a control group (late), yet both groups received treatment.
SAMPLING PROCEDURE
All MS clients with definite MS and a recent deterioration in their ability to walk or transfer were approached after a neurological outpatient clinic over a 1-year period. Only one refused.
SAMPLE
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N = 45 |
Mean age = 46.5 |
Male = 11 |
Female = 34 |
Definite MS Clients were identified as potentially benefiting from PT and had no other disabling medical or surgical condition.
OUTCOMES
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Life roles |
x |
Tasks |
x |
Activities |
|
x |
Abilities/habits |
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Capacities |
OUTCOME AREAS (all measurements made at clients home)
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Outcome Area |
Measures |
Reliability |
Validity |
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Disability measures with elements sensitive to mobility |
Rivermead Mobility Index, Nottingham Extended ADL Index, Barthel ADL Index, Environmental and Incapacity Status Scales |
NR |
NR |
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Screening of cognitive and psychological function |
Short-orientation-memory test, Hospital Anxiety and Depression Scale (HAD) |
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|
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Timed tests of function |
Timed 5-meter walk or transfer, timed
Nine Hole Peg Test |
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|
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Walk or transfer at home |
Videotaped and randomized to be analyzed by blinded neurophysiotherapist |
|
|
|
Patient and caregiver mobility issues |
Visual analogue scale |
|
|
NR=Not Reported
INTERVENTION
Description
All patients tested at home then randomly assigned into "early" or "late" group.
"Early" group (treatment group) received treatment of physiotherapy then both groups retested at home (9-week reevaluation).
"Late" group (control group) received physiotherapy treatment and then final retest at home (13-week reevaluation)
Who delivered
PT
Setting
Clinic
Frequency
Approximately 30 minutes a day
Duration
13 days for a total of about 7 hours of therapy
RESULTS
Kruskal Wallis or unpaired t test
- No significant difference between treatment ("early")
and control ("late") groups at first posttest for all ADL areas except Nottingham Extended ADL Index (p = .047)
- No significant difference in timed tests.
- No significant difference in video data (rater
interreliability kappa was between .19 and .48 for video analysis).
- Clients reported significant increased mobility ability
and decreased distress about mobility on visual analogue scale (p < .05 and p < .001), but no significant difference reported by care giver.
CONCLUSIONS
Biases - attention, site of treatment, sample size
A short course of physiotherapy does not significantly change the home mobility of clients with MS. However, there was a trend toward clients in the treatment group to have a greater score change than the control group after the first reevaluation at 9 weeks.
Limitations
- The treatment group received more attention than the
control group from time one to two.
- The clients were treated in the clinic and tested at
home. The home tests, however were fairly standard clinical tests and did not seem to really be influenced by being at home. It would have been better to test real home skills for mobility.
- Several of the tests were ADL tests. They may not have
been valid for testing mobility.
- Clients received only 30 minutes of therapy a day,
which is somewhat less than in other studies. Also, the type of PT was not clearly specified. It is unclear if these inpatients received any other type of therapy.
- The sample size was probably too small to show a
significant difference.
COMMENTARY
The idea of testing people in their homes is congruent with OT beliefs however, the tests used did not seem to be valid measures of home mobility. Although there was no significant difference between the two groups, there was a trend toward the treatment group improving more than the control group. This suggests that therapy may improve clients' scores.
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.
