Sept. 29, 2003
Laurie Barclay, MD
J Neurol Neurosurg Psychiatry. 2003;74:1225-1230
Reviewed by Gary D. Vogin, MD
Adding a multidisciplinary team including rehabilitation benefits relapsed multiple sclerosis (MS) patients compared with receiving intravenous steroids alone, according to the results of a randomized trial published in the September issue of the Journal of Neurology, Neurosurgery and Psychiatry.
"There is evidence to support both the use of intravenous methylprednisolone (IVMP) in MS relapse and physiotherapy in the management of MS, but no studies have investigated the combination of steroids and rehabilitation together," write Jenny Craig, from the Walton Centre for Neurology and Neurosurgery in Liverpool, U.K., and colleagues. "The experimental hypothesis was that steroid therapy for MS patients in relapse combined with focused multidisciplinary team care was more beneficial than steroid therapy alone."
Forty subjects (27 women) with a definite MS relapse severe enough to warrant IVMP, 1 g daily for three days, were randomized to a treatment group receiving planned coordinated multidisciplinary team assessment and treatment or to a control group managed according to standard protocol.
At baseline, both groups were similar in demographics, Expanded Disability Status Scale (EDSS), Guy's Neurological Disability Scale (GNDS), Amended Motor Club Assessment (AMCA), Barthel Index (BI), Human Activity Profile (HAP), and Short Form Item 36 Health Survey (SF-36).
At three months, the treatment group fared better than the control group in terms of GNDS (P = .03), AMCA (P = .03), HAPM (P < .01), HAPA (P = .02), and BI (P = .02).
The authors recommend changes in the design of future studies, including conducting the study as part of a multicenter trial, provided that standard care and focused multidisciplinary team care are standardized between centers; longer follow-up period up to 12 months; and use of a second blinded investigator to establish AMCA score.
"This randomized, controlled trial is the first to show that planned, focused multidisciplinary team care during steroid treatment of MS relapse is beneficial," the authors write. "The findings suggest that introducing a problem focused, team integrated approach to the steroid management of MS relapse in the acute setting, including access to appropriate levels of therapy, is of benefit to patients in terms of motor function, disability, and aspects of health related quality of life."
Serono Pharmaceuticals UK helped support the research therapists. The
authors report no conflicts of interest.
Copyright © 2003, Medscape