Structured Abstract
Multiple Sclerosis Structured Abstract - MS #9
A cooling garment does not reduce fatigue and improve ability to walk-in clients with multiple sclerosis
CITATION: Syndulko, K., Woldanski, A., Baumhefner, R. W., & Tourtellotte, W. W. (1995). Preliminary evaluation of lowering tympanic temperature for the symptomatic treatment of multiple sclerosis. Journal of Neurological Rehabilitation, 9, 205-215.
LEVEL OF EVIDENCE: IB3a
RESEARCH OBJECTIVE/QUESTION
"Are there differences in cooling effectiveness between an active, pumped coolant flow garment compared to a passive coolant garment?…" "Is there objective evidence for the cumulative symptomatic improvement in MS with daily cooling of six weeks duration" (p. 206).
DESIGN
|
x |
RCT |
|
Single Case |
|
Case Control |
| |
Cohort |
|
Before-After |
|
Cross Sectional |
Clients randomly assigned into treatment or control group. Three weeks of home program, then 3 weeks of twice-daily cooling (treatment group) or sham cooling (control group) at home. At 6 weeks, the sham cooling became real cooling. The clients were evaluated every week and reevaluated 3 weeks after the end of the study.
SAMPLING PROCEDURE
Clients recruited from local community.
SAMPLE
|
N = 20 |
Mean age = NR |
Male = 10 |
Female = 10 |
NR = Not reported
Clients were persons with definite MS, heat liability, sensory and cognitive functioning intact, and time to do the study.
OUTCOMES
|
x |
Life roles |
|
Tasks |
|
Activities |
|
x |
Abilities/habits |
x |
Capacities |
OUTCOME AREAS
|
Outcome Area |
Measures |
Reliability |
Validity |
|
Vision |
Jaeger chart |
NR |
NR |
|
Dexterity |
Manipulation with large pegs |
|
|
|
Upper- and lower- extremity speed |
Hand/foot tapping |
|
|
|
Standing balance, tandem gait |
|
|
|
|
Neuropsychological tests |
The Selective Reminding Test, Digit Modalities Test, Word List Generation |
NR |
NR |
|
Every 3 weeks added speech, upper- and lower- extremity tracking, pattern visual evoked potential testing |
|
|
|
|
Neurological examination |
Kurtzke Expanded Disability Status Scale and Incapacity Status Scale. |
|
|
|
Beck Depression Inventory, Fatigue Severity Scale, Daily log |
|
|
|
NR=Not Reported
INTERVENTION
Description
- HH (high high) cooling: Received 6 weeks of twice-daily high
cooling in conjunction with a home program of balance and coordination exercises.
Who delivered
Client
Setting
Home
Frequency
Twice daily cooling sessions of undetermined length.
Duration
6 weeks
RESULTS
- Repeated measures ANOVA
- There was no significant difference between sham and control for any measurements.
- Subjective reports by 8 out of 12 participants reported functional improvements including a boost in energy. Seven reported long-term benefits in reduced fatigue and an ability to ambulate further distances.
CONCLUSIONS
Biases - none
There are few objective changes in performance after cooling, although clients report a subjective improvement.
Limitations
- Small sample size.
- Evaluator not blinded to status of the clients.
- Participants not blinded to control versus treatment conditions.
- Three clients dropped out.
- Length of time and degree of temperature needed to effect change is not known.
- Inadequate sham control.
- Treatment may not have been long enough.
COMMENTARY
This study does not support the use of cooling garments for clients with MS. However, the size of the sample suggests that the effect may be small and require a large sample to detect. Also, previous studies on persons with MS have suggested that improvements often do not occur at the impairment level, but at the activity level. Subjective reports were positive for many of the clients.
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.
