Abstract
Objective: To systematically review the evidence regarding rehabilitation treatments in multiple sclerosis (MS).
Methods: We systematically searched the literature (1970–2013) and classified articles using 2004 American Academy of Neurology criteria.
Results: This systematic review highlights the paucity of well-designed studies, which are needed to evaluate the available MS rehabilitative therapies. Weekly home/outpatient physical therapy (8 weeks) probably is effective for improving balance, disability, and gait (MS type unspecified, participants able to walk ≥5 meters) but probably is ineffective for improving upper extremity dexterity (1 Class I). Inpatient exercises (3 weeks) followed by home exercises (15 weeks) possibly are effective for improving disability (relapsing-remitting MS [RRMS], primary progressive MS [PPMS], secondary progressive MS [SPMS], Expanded Disability Status Scale [EDSS] 3.0–6.5) (1 Class II). Six weeks' worth of comprehensive multidisciplinary outpatient rehabilitation possibly is effective for improving disability/function (PPMS, SPMS, EDSS 4.0–8.0) (1 Class II). Motor and sensory balance training or motor balance training (3 weeks) possibly is effective for improving static and dynamic balance, and motor balance training (3 weeks) possibly is effective for improving static balance (RRMS, SPMS, PPMS) (1 Class II). Breathing-enhanced upper extremity exercises (6 weeks) possibly are effective for improving timed gait and forced expiratory volume in 1 second (RRMS, SPMS, PPMS, mean EDSS 4.5); this change is of unclear clinical significance. This technique possibly is ineffective for improving disability (1 Class II). Inspiratory muscle training (10 weeks) possibly improves maximal inspiratory pressure (RRMS, SPMS, PPMS, EDSS 2–6.5) (1 Class II).
GLOSSARY
- 6MW=
- 6-meter walk;
- AAN=
- American Academy of Neurology;
- BBS=
- Berg Balance Scale;
- BBTW=
- balance-based torso weighting;
- CI=
- confidence interval;
- CWT=
- conventional walking training;
- DGI=
- Dynamic Gait Index;
- EDSS=
- Expanded Disability Status Scale;
- ES=
- effect size;
- FEV1=
- forced expiratory volume in 1 second;
- FIM=
- Functional Independence Measure;
- FVC=
- forced vital capacity;
- HRQL=
- health-related quality of life;
- MS=
- multiple sclerosis;
- PDI=
- Pulmonary Dysfunction Index;
- PImax=
- maximal inspiratory pressure;
- PPMS=
- primary progressive multiple sclerosis;
- PT=
- physical therapy;
- RAGT=
- robot-assisted gait training;
- RD=
- risk difference;
- RPE=
- Rate of Perceived Exertion;
- RRMS=
- relapsing-remitting multiple sclerosis;
- SF-36=
- Short Form 36 Health Survey;
- SPMS=
- secondary progressive multiple sclerosis;
- SWP=
- standard weight placement;
- TUG=
- Timed Up and Go test;
- VAS=
- visual analog scale
Footnotes
Author affiliations are provided at the end of the article.
This document summarizes extensive information provided in the complete comprehensive systematic review, available as a data supplement on the Neurology® Web site (Neurology.org). Appendices e-1 through e-4 are available in the complete document; references e1 through e31 and tables e-1–e-3, cited in this document, are available at Neurology.org.
Approved by the Guideline Development, Dissemination, and Implementation Subcommittee on November 8, 2014; by the Practice Committee on February 6, 2015; and by the AANI Board of Directors on August 12, 2015.
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at Neurology.org
- Received February 23, 2015.
- Accepted in final form June 8, 2015.
- © 2015 American Academy of Neurology
Disputes & Debates: Rapid online correspondence
- Authors' response to Drs. Jones & Sutliff
- Response to AAN Guidelines for Rehabilitation in MS
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