Effective rehabilitation interventions and participation among people with multiple sclerosis: An overview of reviews

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Read Full Text: Effective rehabilitation interventions and participation among people with multiple sclerosis: An overview of reviews
Journal: Annals of Physical and Rehabilitation Medicine
Year Published: 2022

Multiple Sclerosis (MS) is the most common cause of non-traumatic disability in people aged 10–65 years.

As rehab professionals, we know that exercise is a mainstay of treatment for these clients.

Exercise in MS has shown beneficial effects against fatigue and spasticity as well as motor, cognitive, and mood functions—and, most importantly it is being explored whether it could be disease-modifying.

That said, there are other important interventions complementary to exercise—like mindfulness and education—that should be considered for people with MS to improve their quality of life.

Today, we will look at a massive summary of reviews on this topic (72 articles were included!). This article outlines multiple types of rehab interventions for MS—and the strength of the evidence supporting each.

After we review the article, we are excited to welcome to the podcast Sarah Adam, OTD, an occupational therapist with MS who has taken her pursuit of adaptive sports to the elite level, recently earning a silver medal in wheelchair rugby at the 2024 Paralympic Games in Paris. The first-ever woman to play on Team USA’s wheelchair rugby team, Sarah also made history as the first woman to score a point during an Olympic wheelchair rugby game. We clearly have so much to learn from Sarah, and I know it’s going to inspire your OT practice!

Quick intro to MS and rehab

MS is already a leading cause of non-traumatic disability for adults—and its prevalence is on the rise. According to a recent study, MS affects 30% more people worldwide today than it did in 2013. MS is around 3x more common in women than men.

As a reminder, MS is classified into these variants:

  • Benign
  • Relapsing-remitting (the most common variant)
  • Progressive-relapsing
  • Primary progressive
  • Secondary progressive

Treatment for MS involves disease-modifying pharmacology (primarily aimed at reducing relapse rates).

But, due to the complexity of MS, multidisciplinary rehab is also an essential part of treatment.

Rehabilitation for people with MS should target and be tailored to the disease phase, taking into account the ICF domain factors.

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While there have been past reviews of rehab for MS (I actually covered this 2019 overview of Cochrane Reviews), I believe that—given the rapidly developing nature of research in this area—it’s time for an update.

Intent of this research

The authors sought to provide an overview of quantitative and qualitative systematic reviews.

The objective was to systematically synthesize and evaluate the evidence for rehabilitation for people with MS to inform future clinical guidelines.

What were their methods?

A Joanna Briggs Institute methodology was used.

Systematic reviews were eligible for inclusion if they involved people with MS who were over the age of 18. All rehabilitation approaches were eligible.

The area of outcomes was reported according to the ICF framework for quantitative reviews, as were details on the strength of the evidence.

What were their results?

72 systematic reviews were included in this overview. 66 were quantitative and 6 were qualitative.

So as to not overwhelm the reader, I am going to present only the studies that had strong to moderate evidence. To begin, I will drill into what the authors specifically said about occupational therapy.

Occupational therapy for MS

The researchers found that of the modalities studied in this article (which included activity of daily living training, computer-based cognitive training, memory training, and strength training), only strength training showed an effect on endurance, strength, and gait.

They recommended that OT focus on:

  • Full-body training in combination with:
    • Goal-setting
    • Patient education
    • Home exercises

Additional rehab interventions for MS

Again, here I am only presenting the studies that the author listed as having either strong or moderate evidence.

Multidisciplinary approaches (Amatya, 2019; Khan, 2017)
Physiotherapy

Physical Activity

Telerehabilitation

Cognitive and psychological interventions

Mind body interventions (Momsen, 2021)
Fatigue management

Modalities

Patient Education (Wendebourg, 2017)

Vocational rehabilitation

Employment adaptations and support (Dorstyn, 2019)

Article discussion/conclusion

There was strong evidence for the effectiveness of multidisciplinary, cognitive, and exercise approaches—as well as physical therapy and occupational therapy that include full-body training.

Additionally, the researchers found that employment significantly influences quality of life; thus, vocational rehab should be initiated early.

While all of the modalities listed above can impact quality of life, exercise has the potential to be disease-modifying. Exercise should be individually prescribed and tailored as “medication,” as symptoms are usually unaffected by traditional medical treatment.

Furthermore, the exercise-postponement theory suggests that long-term moderate-to-high-intensity exercise may postpone the onset of a clinical diagnosis of MS and diminish disease activity.

It’s important to note that exercise and face-to-face, cognitive-inspired education programs were more effective than medication in ameliorating fatigue.

(There are multiple other therapist recommendations, but hopefully this gives you a good idea of the highpoints!)

What questions/thoughts does this article raise for you?

:tada: Let us know your thoughts below to be entered in a $100 drawing! And, stay tuned for the podcast discussion with Sarah Adam, to be released next Thursday, November 7!

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