The efficacy of inpatient rehabilitation in multiple sclerosis.

Inpatient rehabilitation is advocated as an important intervention in the symptomatic management of MS. It is however costly, its effectiveness has not been established, and little is known about the long term carryover of benefit. The basis of this thesis is the design of two closely linking studies which evaluate the effectiveness of inpatient rehabilitation of patients in the progressive phase of MS. A stratified randomised wait-list controlled trial was undertaken. Sixty six patients were assessed at zero and six weeks with validated measures of impairment, disability, handicap, quality of life and emotional well-being. At baseline both groups were comparable in all variables. At the end of six weeks, although the level of impairment in both groups remained the same, those who participated in rehabilitation (average of 25 days) significantly improved their level of disability (p<0.001) and handicap (p<0.01) compared to those in the wait-list control group. A longitudinal study investigated the duration of benefit of change. Fifty consecutive patients were assessed, using the same outcome measures as the first trial, on admission, discharge, and three monthly intervals for one year. Twelve month data was collected for 92% of patients. Summary measures were calculated to determine the length of time taken for each individual to return to their baseline level. Over the study period, neurological status declined. Improvements were maintained in disability and handicap for six months, emotional well-being for seven months, and quality of life (physical component) for ten months. The conclusions are that despite unchanging impairment, inpatient rehabilitation results in reduced disability and handicap in patients with progressive MS. These benefits are maintained, in part, following discharge into the community, despite worsening neurological status. Carryover of benefits does, however, decline over time. Publications relevant to this thesis Freeman, J.A. , Langdon, D.W. , Hobart, J.C. , and Thompson, A.J. Healthrelated quality of life in people with multiple sclerosis undergoing inpatient rehabilitation. Journal of Neurologic Rehabilitation 10 (3): 185-194, 1996. Freeman, J.A. , Hobart, J.C. , and Thompson, A.J. Outcomes based research in neurorehabilitation: the need for multidisciplinary team involvement. Disability and Rehabilitation 18 (2): 106-110, 1996. Hobart,J.C. , Freeman,J.A. , and Lamping,D.L. Physician and patient-oriented outcomes: which to measure? Current Opinion in Neurology 9: 441-444, 1996 Freeman,J.A. , Langdon,D.W. , Hobart,J.C. and Thompson,A.J. The impact of inpatient rehabilitation on progressive multiple sclerosis. Annals of Neurology 1997, in press. Freeman, J.A. and Thompson, A.J. Is inpatient rehabilitation effective in multiple sclerosis? In: MS: clinical challenges and controversies, edited by Thompson, A.J., Polman, C O. , and Hohlfeld, R. London: Martin Dunitz, 1997, in press. Freeman,J.A. , Langdon,D.W. , Hobart,J.C. and Thompson,A.J. Long term effects of neurorehabilitation in multiple sclerosis: a longitudinal trial. Journal of Neurology ^9Q7, in press (Abstract).