What Is The Evidence For The Effectiveness Of Therapeutic Interventions To Improve Participation Among Persons With Multiple Sclerosis?
(2013) What Is The Evidence For The Effectiveness Of Therapeutic Interventions To Improve Participation Among Persons With Multiple Sclerosis?, no. 127.
1.1 Background Multiple sclerosis (MS) is a demyelinating, degenerative disease of the central nervous system (CNS). MS is a highly variable, unpredictable and progressive disease associated with long- term disability leading to participation restriction. Rehabilitation is an important component of symptomatic and supportive treatment for MS however the evidence base for the effectiveness of interventions to improve participation is yet to be established. 1.2 Objectives The primary aim of this systematic review was to determine the evidence for the effectiveness of therapeutic interventions to improve participation in people with MS (pwMS). A secondary aim was to identify and explore the facilitators and barriers to participation for pwMS. 1.3 Search Strategy To identify relevant studies, databases CINAHL, The Cochrane Library, MEDLINE, ProQuest, PsycINFO, SPORTDiscus and Scopus were searched using defined key words. The reference lists of studies accepted in this review were also hand searched to locate further studies. 1.4 Selection Criteria Randomised controlled trials (RCTs), controlled trials (CTs) and pre-post single group trials, investigating therapeutic interventions and measuring participation or quality of life (QoL) in pwMS, published in English between 1990 to present were included in this systematic review. Study participants for consideration were adults (18 years or over) with a definite diagnosis of MS. In addition, studies that examined physical interventions that measured participation or QoL were only included in this review. 1.5 Data collection and analysis The methodological quality of the accepted studies was evaluated using the Physiotherapy Database scale (PEDro) created by the Centre for Evidence-Based Physiotherapy (2013). 1.6 Main results Eighteen studies (ten RCTs, three CTs and five pre-post single group trials) with a total of 726 participants were included in this review. Studies investigated forms of aerobic, resistance, a combination of both, multidisciplinary rehabilitation and alternative training modalities measured by generic or disease-specific QoL measures in varying levels of MS. Results varied due to differing participant characteristics, outcome measures, intervention modalities and designs. Study findings showed slight improvements in participation and QoL measures however many lacked methodological strength and were not statistically significant. Furthermore, the highest level of evidence (three studies providing Level 1a evidence) in aerobic and resistance interventions found insufficient statistically significant evidence to support improvements in participation and QoL in people with mild to severe MS. In addition, symptom exacerbation and transportation difficulties were identified to be major barriers to exercise participation within study interventions. 1.7 Conclusion Overall there are promising findings in physical interventions for improvements in participation and QoL in pwMS. Although, no evidence was found that specific exercise programmes, including type of modality, were more successful in improving participation and QoL in pwMS, than other exercise interventions. Based on the findings of this review physical rehabilitation can be beneficial compared to no intervention for maintaining or improving participation and QoL in pwMS. No significant evidence of deleterious effects of exercise interventions were found for pwMS. However, clinical recommendations cannot be made due to the lack of quality and quantity of research examining the effectiveness of physical interventions to improve participation and QoL in pwMS. Furthermore, there is an urgent need for consensus on a core set of outcome measures for participation and QoL to be used in physical interventions in pwMS.