Structured Abstract
Multiple Sclerosis Structured Abstract - MS #6
A cooling suit to improve function for multiple sclerosis patients who are sensitive to heat
CITATION: Coyle, P. K., Krupp, L. B., Doscher, C., Deng, Z., & Milazzo, A. (1996). Clinical and immunological effects of cooling in multiple sclerosis. Journal of Neurologic Rehabilitation, 10, 9-15.
LEVEL OF EVIDENCE: IB1a
RESEARCH OBJECTIVE/QUESTION
"The purpose of this study was to evaluate whether objective clinical and immune changes occurred in MS patients who underwent core body temperature cooling compared to placebo treatment" (p. 10).
DESIGN
|
x |
RCT |
|
Single Case |
|
Case Control |
| |
Cohort |
|
Before-After |
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Cross Sectional |
Clients underwent a treatment with a cooling garment or a placebo cooling garment. Clients acted as their own control and were randomly assigned order.
SAMPLING PROCEDURE
Not reported, appeared to be a convenience sample.
SAMPLE
|
N = 11 |
Mean age = 44(8) |
Male = 6 |
Female = 5 |
All participants were ambulatory, with a mean EDSS score of 2.7 (6). All participants reported being heat sensitive.
OUTCOMES
| |
Life roles |
|
Tasks |
x |
Activities |
|
x |
Abilities/habits |
x |
Capacities |
OUTCOME AREAS
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Outcome Area |
Measures |
Reliability |
Validity |
|
Clinical performance (visual acuity, timed walk, muscle strength, and coordination) |
Standardized clinical evaluation |
NR |
NR |
NR=Not Reported
INTERVENTION
Description
Treatment - participants wore a commercial cooling garment of a vest and head cap. They wore this until their core body temperature had decreased by 1 degree C.
Placebo - Similar to treatment except the garment only lowered the core body temperature by less than .5 degree C.
Who delivered
Clinician
Setting
Clinic
Frequency
1 session each of placebo and treatment for each participant. Sessions lasted 45 min each, were conducted 1 week apart, and occurred at the same time of day. Assignment to treatment or control first was determined by coin flip.
Duration
1 week
RESULTS
2-way ANOVA and t-test used to compare proportion of participants improving as results of treatment vs. placebo cooling.
- Visual acuity improved significantly from pre- to posttest for treatment but not for placebo (p = .0237).
- Timed walk improved significantly from pre- to posttest for treatment but not for placebo (p = .001).
- Muscle strength improved significantly from pre- to posttest for treatment but not for placebo (p = .001).
- Coordination did not improve significantly from pre- to posttest for treatment or placebo (not significant). However 3 out of 8 improved in the treatment, whereas none of the sham participants improved.
CONCLUSIONS
Biases - masking, sample size
Cooling the core body temperature by 1 degree C seems to result in improved performance in clients with MS.
Limitations
- Evaluators were not blinded to the condition the
COMMENTARY
OT relevant research. Suggests that OT treatment preceded by the use of a cooling suit may be beneficial. Further research with a larger sample, more measurements, and longer time periods needed. Cooling may promote greater function in heat-sensitive 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.
