Rehabilitation for people with multiple sclerosis: an overview of Cochrane Reviews

Background Multiple sclerosis (MS) is a major cause of chronic, neurological disability, with a significant long‐term disability burden, often requiring comprehensive rehabilitation. Objectives To systematically evaluate evidence from published Cochrane Reviews of clinical trials to summarise the evidence regarding the effectiveness and safety of rehabilitation interventions for people with MS (pwMS), to improve patient outcomes, and to highlight current gaps in knowledge. Methods We searched the Cochrane Database of Systematic Reviews up to December 2017, to identify Cochrane Reviews that assessed the effectiveness of organised rehabilitation interventions for pwMS. Two reviewers independently assessed the quality of included reviews, using the Revised Assessment of Multiple Systematic Reviews (R‐AMSTAR) tool, and the quality of the evidence for reported outcomes, using the GRADE framework. Main results Overall, we included 15 reviews published in the Cochrane Library, comprising 164 randomised controlled trials (RCTs) and four controlled clinical trials, with a total of 10,396 participants. The included reviews evaluated a wide range of rehabilitation interventions, including: physical activity and exercise therapy, hyperbaric oxygen therapy (HBOT), whole‐body vibration, occupational therapy, cognitive and psychological interventions, nutritional and dietary supplements, vocational rehabilitation, information provision, telerehabilitation, and interventions for the management of spasticity. We assessed all reviews to be of high to moderate methodological quality, based on R‐AMSTAR criteria. Moderate‐quality evidence suggested that physical therapeutic modalities (exercise and physical activities) improved functional outcomes (mobility, muscular strength), reduced impairment (fatigue), and improved participation (quality of life). Moderate‐quality evidence suggested that inpatient or outpatient multidisciplinary rehabilitation programmes led to longer‐term gains at the levels of activity and participation, and interventions that provided information improved patient knowledge. Low‐qualitty evidence suggested that neuropsychological interventions, symptom‐management programmes (spasticity), whole body vibration, and telerehabilitation improved some patient outcomes. Evidence for other rehabilitation modalities was inconclusive, due to lack of robust studies. Authors' conclusions The evidence suggests that regular specialist evaluation and follow‐up to asse