A Cochrane review [Abstract] 1 included 10 studies (9 RCTs and 1 controlled clinical trial) with a total of 954 patients and 73 caregivers. All trials compared multidisciplinary (MD) rehabilitation in the treatment group with a control group of some sort.There was 'strong evidence' that despite no change in the level of impairment, inpatient MD rehabilitation can produce short-term gains at the levels of activity (disability) and participation for patients with MS. There is ‘moderate evidence' to support inpatient or outpatient rehabilitation programmes (compared with control wait-list groups) in improving disability; and bladder related activity and participation outcomes up to 12 months following MD rehabilitation intervention. For outpatient and home-based rehabilitation programmes there was 'limited evidence' for short-term improvements in symptoms and disability with high intensity programmes, which translated into improvement in participation and quality of life. For low intensity programmes conducted over a longer period there was 'strong evidence' for longer-term gains in quality of life; and also 'limited evidence' for benefits to carers. Although some studies reported potential for cost-savings, there is no convincing evidence regarding the long-term cost-effectiveness of these programmes. It was not possible to suggest best 'dose' of therapy or supremacy of one therapy over another. This review highlights the limitations of RCTs in rehabilitation settings and need for better designed randomized and multiple centre trials.
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in patients, treatments, outcomes and follow-up) and imprecise results (small study size for each comparison)
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