Analysis of an intensive neurorehabilitation therapy in MS: a clinical trial

Background: Disease-modifying therapies have not eliminated the need for neurorehabilitation in multiple sclerosis (MS). Objective: To evaluate the efficacy of an intensive neurorehabilitation program in MS. Methods: 30 patients with MS (McDonald et al) received an intensive neurorehabilitation program six hours daily for four weeks. Each patient had one-to-one physiotherapist/occupational/speech-language therapists. The evaluations were made by a laboratory team, who do not participate in the program, by: Scripps Neurological Rating Scale(SNRS), Expanded Disability Status Scale (EDSS), Ambulatory Index, 9 hole-peg-test, PASAT-3, Fatigue Impact Scale (FIS), Environmental Status Scale & quality of life scale (MSQLI-54). Results: 30 MS patients (22 progressive and 8 relapsing), 19 female/11 male, mean age 40.43 plus or minus 11,46 years, 13.40 plus or minus 7,76 years of evolution, completed the program. The evaluation of impairment/disability was: SNRS initial 53/final 68.08 (p=0.000; EDSS initial 5.8( plus or minus 1.51)/flnal 5.08 ( plus or minus 2.10) p=0.0001. Functional Systems demonstrated; pyramidal initial 3.97/final 3.15 p=0.001; Cerebellar initial 2.57/final 1.26 p=0.000; brain stem initial 1.57/final 0.78 p=0.001; Sensorial initial 1.40/final 1.00 p=0.023; bowel and bladder initial 1.53/final 0.44, p=0.000; visual initial 0.70/final 0.48, NS; cerebral initial 0.47/final 0.23, NS; and others (spasticity) initial 1.07/final 0.38, p=0.000. Ambulatory Index initial 27.40( plus or minus 28.54)/final 23.95( plus or minus 24.82) p=0.393; 9 hole-peg-test dominant hand initial 31.38( plus or minus 8.26)/final 27.54( plus or minus 6.71) p=0.008 and 9 holepeg-test hand non-dominant initial 38.01/final 30.39 p=0.014; PASAT-3 initial 21.14/final 29.29 p=0.018. Environmental Status Scale initial 17.06/final 16.53 NS; Fatigue initial 47.18/final 30.58 p=0.005. MSQLI-54 demonstrated an improvement in Physical Health, initial 46.11( plus or minus 12.32)/57.32( plus or minus 14.37) p=0.008 and Mental Health, initial 51.64( plus or minus 21.6S)/62.46( plus or minus 20.50) p=0.026. Conclusions: An intensive one-to-one neurorehabilitation program demonstrated in 4 weeks an improvement of impairment, disability, fatigue and QoL, in MS not reached by any of the disease-modifying therapies.