Team-Based Rehabilitation: Functional and Quality of Life Outcomes

Table 3
Author Year, Title, Country, Research Design, PEDro, Sample Size Methods Participation Results

Papeix et al. 2015 

Evaluation of an integrated multidisciplinary approach in multiple sclerosis care: A prospective, randomized, controlled study




NInitial=50, NFinal=42

Population: Control group (n=25): Median age=50yr; Gender: males=18, females=7; Disease course: RRMS=5, PPMS=6, SPMS=14; Median EDSS=6; Median disease duration=17yr. Integrated multidisciplinary (IMD) group (n=25): Mean age=52yr; Gender: males=20, females=5; Disease course: RRMS=3, PPMS=3, SPMS=19; Median EDSS=6; Median disease duration=17yr.

Intervention: MS patients were allocated to one of two treatment strategies: (i) an IMD approach, consisting of a half-day individually tailored comprehensive assessment in the MS clinic; (ii) standard care. Assessments were performed at baseline and after 6 (M6) and 12 (M12) mo.

Primary Outcome Measures: MS Impact Scale (MSIS-29).

Participation Outcome Measures: MSIS-29.

Other Outcome Measures: EDSS; Hospital Anxiety and Depression Scale (HADS); Modified Fatigue Impact Scale (MFIS); QUALIVEEN; Visual Analog Scale (VAS). 

1.      Median MSIS-29 score (higher score corresponding to greater impact of MS) of over 6mo decreased in the control group, and increased in the IMD group. The difference between the two groups was significant (p<0.03). However, in the multivariate analysis, after adjustment of HADS-D and INTERMED score, this difference was no longer significant.

2.      Changes in MSIS-29 from baseline to M12 (0 and -5 in the control and the IMD group, respectively) were not significantly different between the two groups.


Rietberg et al. 2014 

Effects of multidisciplinary rehabilitation on chronic fatigue in multiple sclerosis: a randomized controlled trial 

The Netherlands



NInitial=48, NFinal=44

Population: Multidisciplinary outpatient rehabilitation (MDR) group (n=23): Mean age=45yr; Gender: males=9, females=14; Disease course: RRMS=16, PPMS=2, SPMS=5; Median EDSS=3; Mean disease duration=7yr. Nurse consultation (NC) group (n=25): Mean age=47yr; Gender: males=8, females=17; Disease course: RRMS=12, PPMS=6, SPMS=7; Median EDSS=4; Mean disease duration=8yr.

Intervention: MS patients with chronic fatigue were randomized to MDR or to MS-NC groups. Assessments were performed at baseline and after intervention.
Primary Outcome Measures: Checklist Individual Strength (CIS-20R).

Participation Outcome Measures: Impact on Participation and Autonomy (IPA); MS Impact Scale (MSIS-29).

Other Outcome Measures: Functional Independence Measure (FIM); Modified Fatigue Impact Scale (MFIS); Fatigue Severity Scale (FSS); Disability and Impact Profile (DIP).

1.      At 12–24wks, the IPA problem experience subscale ‘mobility’ (p=0.03) showed a significant difference in favour of the MDR group, but there were no significant between-group differences for the other IPA subscales.

2.      No significant between-group differences were found for the MSIS-29.

3.      No significant within-group effects were found for multidisciplinary rehabilitation or nurse consultation with respect to the primary and secondary outcome measures from baseline to 12 or 24wks.

Khan et al. 2008

Effectiveness of rehabilitation intervention in persons with multiple sclerosis: a randomised controlled trial




NInitial=101, NFinal=98

Population: Treatment Group (n=49): Mean age=49.5yr; Gender: males=18, females=31; Disease course: RRMS=13, PPMS=7, SPMS=29; EDSS: 0-3=7, 3.5-6.0=27, 6.5+=15; Mean disease duration=10.69yr. Control Group (n=52): Mean age=51.1yr; Gender: males=11, females=41; Disease course: RRMS=18, PPMS=7, SPMS=27; EDSS: 0-3=12, 3.5-6.0=32, 6.5+=8; Mean disease duration=9.73yr.

Intervention: The treatment group underwent multidisciplinary rehabilitation and received either individualized patient (IP) or outpatient (OP) rehabilitation. IP rehabilitation: 3-6wks, 3 or more times/wk, 3h therapy/d, 2 blocks of 45min physiotherapy and occupational therapy with other blocks comprised of speech pathology, neuropsychology and social work. OP rehabilitation: Up to 6wks, 2-3times/wk, 30min sessions for physiotherapy, occupational therapy, social work and speech pathology in addition to doing stretching home exercises. The control group received no intervention, only an 8 weekly monitoring phone call for information about medical hospital visits in the previous month and received no other information.
Primary Outcome
Measures: Functional Independence Measure (FIM) motor subscale.

Participation Outcome Measures: Multiple Sclerosis Impact Scale (MSIS-29).

Other Outcome Measures: General Health Questionnaire (GHQ-28).

1.      There were no differences between the treatment and control group scores on the MSIS-29.

Kos et al. 2007

Multidisciplinary fatigue management programme in multiple sclerosis: a randomized clinical trial




NInitial=51, NFinal=40

Population: Group A (n=28): Mean age=42.9yr; Gender: males=8, females=20; Disease course: RRMS=20, PPMS=2, CPMS=2; Disease severity: unspecified; Mean disease duration=6.1yr. Group B (n=23): Mean age=44.5yr; Gender: males=8, females=15; Disease course: RRMS=14, PPMS=3, CPMS=4; Disease severity: unspecified; Mean disease duration=8.2yr.

Intervention: MS patients were randomly allocated to group A, who only received the 4wk multidisciplinary fatigue management programme (MFMP), or group B receiving a placebo intervention programme first and the MFMP after 6mo. In both groups, assessment was performed at baseline, 3wks and 6mo after the programmes.
Primary Outcome Measures: Modified Fatigue Impact Scale (MFIS).

Participation Outcome Measures: Impact on Participation and Autonomy (IPA).

Other Outcome Measures: Fatigue Severity Scale (FSS); Multiple Sclerosis Self-Efficacy Scale (MSSE); Mental Health Inventory (MHI).

1.      No significant impact of treatment on IPA was reported.

Craig et al. 2003

A randomised controlled trial comparing rehabilitation against standard therapy in multiple sclerosis patients receiving intravenous steroid treatment




NInitial=41, NFinal=40

Population: Control group (n=20): Mean age=42yr; Gender: males=4, females=16; Disease course: active relapsing; Mean EDSS=5.1; Mean disease duration=5.69yr. Intervention group (n=20): Mean age=38yr; Gender: males=9, females=11, Disease course: active relapsing; Mean EDSS=5.4; Mean disease duration=7.42yr.

Intervention: All MS participants were randomized to either the control group and received standard ward routine care and 3d of intravenous methylprednisolone (IVMP), or to the intervention group and received planned coordinated multidisciplinary team treatment and 3d of IVMP. Participants were assessed at baseline upon receiving IVMP treatment, at 1mo and at 3mo after the first day of IVMP.

Primary Outcome Measures: Guy’s Neurological Disability Scale (GNDS); Amended Motor Club Assessment (AMCA).

Participation Outcome Measures: Human Activity Profile (HAP).

Other Outcome Measures: Barthel Index (BI); 36-Item Short Form Health Survey (SF-36).

1.      The difference in the mean scores from baseline to 3mo between treatment and control groups was significant for the HAP (both maximum scores and adjusted score; p=0.004, p=.019).

Freeman et al. 1997

The impact of inpatient rehabilitation on progressive multiple sclerosis




NInitial=70, NFinal=66

Population: Rehabilitation group (n=32): Mean age=43.2yr; Gender: males=11, females=21; Disease course: PPMS=2, SPMS=30; Median EDSS=6.5; Mean disease duration=9.6yr. Waitlist group (n=34): Mean age=44.6yr; Gender: males=13, females=21; Disease course: PPMS=4, SPMS=30; Median EDSS=6.5; Mean disease duration=11.4yr.

Intervention: Patients were randomized to either the rehabilitation or the waitlist groups. The rehabilitation program consisted of a multidisciplinary team approach, interventions tailored to meet the individual’s needs and a patient centered functional goal setting approach. The waitlist group continued with their normal routine. Interventions were 6wks. Patients were tested at baseline and at 6wks.

Primary Outcome Measures: Not specified.

Participation Outcome Measures: London Handicap Scale (LHS).

Other Outcome Measures: EDSS; Functional Independence Measure (FIM).

1.      The rehabilitation group had significantly greater improvements compared to the waitlist group in overall level of handicap (p<0.01).

Lexell et al. 2014

Self-perceived performance and satisfaction with performance of daily activities in persons with multiple sclerosis following interdisciplinary rehabilitation



NInitial=43, NFinal=43

Population: Mean age=51yr; Gender: males=16, females=27; Disease course: RRMS=16.3%, PPMS=9.3%, SPMS=74.4%, PRMS=unspecified; Mean EDSS=6.5; Mean disease duration=16.5yr.

Intervention: Participants took part in an individualized, goal-oriented, and interdisciplinary rehabilitation program.
Primary Outcome Measures:
Canadian Occupational Performance Measure (COPM).

Participation Outcome Measures: COPM.

Other Outcome Measures: None.

1.      At admission, participants reported a variety of problems with daily activities on the COPM subgroups of self-care, productivity, and leisure.

2.      At discharge, performance on those activities increased significantly in 42% of the participants (significance is inferred at a 2 or more point increase in score).

3.      At discharge, satisfaction with performing those activities increased by 2 or more score points in 56% of the participants.

Freeman et al. 1999

Inpatient rehabilitation in multiple sclerosis: Do the benefits carry over into the community?



NInitial=50, NFinal=44

Population: Mean age=44.8yr; Gender: males=21, females=29; Disease course: PPMS=7, SPMS=42; Mean EDSS=6.7; Mean disease duration=11.6yr.

Intervention: Patients with progressive MS undergoing inpatient rehabilitation were followed for 12mo after discharge. Assessments were undertaken on admission (A), at discharge, and subsequently at 3mo intervals for 1yr (1Y).
Primary Outcome Measures: Functional Independence Measure (FIM); London Handicap Scale (LHS).

Participation Outcome Measures: LHS.

Other Outcome Measures: EDSS; Kurtzke's Functional Systems; 36-item Short Form Health Survey Questionnaire (SF-36); 28-item General Health Questionnaire (GHQ).

1.      Improvement was seen across all measures during the inpatient stay. These gains declined in varying patterns after discharge.

2.      The LHS scores steadily lowered, remaining only marginally above baseline at the 9 and 12mo assessments.

3.      No tests of statistical significance were reported in this study.

Kidd et al. 1995

The benefit of inpatient neurorehabilitation in multiple sclerosis



NInitial=79, NFinal=79

Population: Mean age=48.8yr; Gender: males=30, females=49; Disease course: RRMS, SPMS, PPMS; Median DSS=7.0; Mean disease duration=12.1yr.

Intervention: MS patients admitted over a 16mo period for multidisciplinary rehabilitation were studied using assessment scales as measures of disability and handicap.
Primary Outcome Measures: Not specified.

Participation Outcome Measures: Environmental Status Scale (ESS).

Other Outcome Measures: Kurtzke’s Disability Status Scale; Barthel Index (BI).

1.      The ESS was scored in 52 patients. It improved in 23 patients (44%), worsened in 13 (25%) and was unchanged in 16 (31%). The median ESS was 19.0 on admission and on discharge although overall the degree of change was significant (p=0.05).

2.      Improvement was greatest in those in whom a reduction in impairment occurred, and was less marked in stable and progressive patients. The difference in terms of changes in ESS between patients in whom a reduction in impairment occurred, and progressive and stable patients, was statistically significant (p=0.01).