Can inpatient multidisciplinary rehabilitation improve health-related quality of life in MS patients on the long term - The Danish MS Hospitals Rehabilitation Study.

BACKGROUND: Inpatient multidisciplinary rehabilitation (MDR) can improve health-related quality of life (HRQoL) in multiple sclerosis (MS) patients. However, the evidence of a long-term benefit is limited. OBJECTIVES: To investigate the long-term effectiveness of inpatient MDR on HRQoL in MS patients. METHODS: We conducted a randomized controlled partial crossover trial with 427 MS patients. RESULTS: Statistical significant long-term improvements in HRQoL were found in three of the six outcome measures at 12-month follow-up. Three in four suggested minimal clinically important differences (MCIDs) were unmet. CONCLUSION: These results indicate that the administration of inpatient MDR may lead to long-lasting improvements in HRQoL in MS patients.

Longer term effectiveness of inpatient multidisciplinary rehabilitation on health-related quality of life in MS patients: a pragmatic randomized controlled trial - The Danish MS Hospitals Rehabilitation Study.

BACKGROUND: There is insufficient evidence to support the effectiveness of multidisciplinary rehabilitation on the health-related quality of life (HRQoL) of MS patients. OBJECTIVES: To evaluate the longer term effectiveness of inpatient multidisciplinary rehabilitation on the HRQoL of MS patients. METHODS: The study was a two-hospital, pragmatic, randomized controlled trial with a 6-month follow-up. Patients aged 18-65 years with MS and Expanded Disability Status Scale scores ≤7.5 were randomly assigned (1:1) to 4 weeks of inpatient multidisciplinary rehabilitation (20 days of scheduled rehabilitation) or 6 months on a wait list. The outcome measures were Functional Assessment in Multiple Sclerosis (FAMS), Multiple Sclerosis Impact Scale-29 (MSIS-29), EQ-5D-5L and 15D. RESULTS: We randomized 213 patients to the wait-list control group and 214 patients to the treatment group. Trends in favour of the treatment group were observed across all measures. However, the difference was significant in only two of the six measures. The treatment effect was -2.7 (95% CI: -5.6 to (-0.1)), p = 0.046) for the MSIS-29 Psychological and 0.017 (95% CI: 0.005-0.030, p = 0.008) for the 15D. FAMS, which we used to calculate the sample size, was not significant. CONCLUSION: The results indicated that inpatient multidisciplinary rehabilitation is effective in improving the HRQoL of MS patients after 6 months.

Study protocol: to investigate effects of highly specialized rehabilitation for patients with multiple sclerosis. A randomized controlled trial of a personalized, multidisciplinary intervention.

BACKGROUND: Multiple sclerosis (MS) is a complex, chronic and progressive disease and rehabilitation services can provide important support to patients. Few MS rehabilitation programs have been shown to provide health improvements to patients in a cost-effective manner. The objective of this study is to assess the effects in terms of changes measured by a variety of standardized quality of life, mastery, coping, compliance and individual goal-related endpoints. This combination provides the basis for analyzing the complexity of MS and outcomes of a personalized rehabilitation. METHODS/DESIGN: Patients with MS referred to hospital rehabilitation services will be randomized to either early admission (within two months) or usual admission (after an average waiting time of eight months). They will complete a battery of standardized health outcome instruments prior to randomization, and again six and twelve months after randomization, and a battery of goal-related outcome measures at admission and discharge, and again one, six and twelve months after randomization. DISCUSSION: The results of the study are expected to contribute to further development of MS rehabilitation services and to discussions about the design and content of such services. The results will also provide additional information to health authorities responsible for providing and financing rehabilitation services. TRIAL REGISTRATION: Current Controlled Trials (ISRCTN05245917).

[Effective rehabilitation of hospitalized patients with multiple sclerosis]. / Rehabilitering under indlæggelse af patienter med multipel sklerose har effect.

Globally, the number of people suffering from multiple sclerosis (MS) is more than two million, and MS is characterized by increasing symptom development over time. The socio-economic costs are enormous. Therefore, effective management of MS is of great importance. Multidisciplinary rehabilitation (MR) seeks to prevent and stop loss of function and trains the patients to deal with symptoms and challenges that will arise in the future. Because there is a need for high-quality evidence of the effectiveness of MR, the MS hospitals in Denmark have initiated the largest study of its kind on MR.

Validation of the danish version of functional assessment of multiple sclerosis: a quality of life instrument.

The functional assessment of multiple sclerosis (FAMS) is a disease-specific instrument that describes functional status of individuals with multiple sclerosis. The instrument was originally developed in the US and has been adapted to different languages including Danish. This study is a validation of the Danish version of FAMS in a sample of individuals referred to a four-week rehabilitation program at either of the two Multiple Sclerosis Rehabilitation centers in Denmark. FAMS data were obtained through self-completed questionnaires from 190 individuals who attended the rehabilitation centers after referral by their general practitioner or specialist neurologist. The validation of the FAMS included assessment of data quality, scale assumptions, acceptability, construct validity, and reliability. Responsiveness was assessed by comparing individual FAMS scores at admission with the discharge score for groups of respondents who reported no change, improvement, or deterioration in their ability to cope with their illness. The Danish version of FAMS appears to be an acceptable, valid, and reliable measure of current health and functional status of individuals with multiple sclerosis.