Recommendations for Rehabilitation in People with MS Thomas Henze, Nittenau / Germany

Transcription

1 Recommendations for Rehabilitation in People with MS Thomas Henze, Nittenau / Germany EMSP European Multiple Sclerosis Platform (2013). All rights reserved.

2 Comprehensive MS treatment Immunotherapies Rehabilitation Symptomatic Treatment Physical activity and sports

3 Definition Rehabilitation is a problem-solving educational process aimed at reducing disability and handicap (participation) experienced by someone as a result of disease or injury. (DT Wade 1992)

4 Symptoms Visual defects Restricted mobility Spasticity Ataxia Tremor Bladder-/Bowel dysfunction Pain Cognitive deficits Depression Fatigue Dysarthria Dysphagia

5 Symptoms Drug treatment Visual defects Restricted mobility + Spasticity + Ataxia (+) Tremor (+) Bladder-/Bowel dysfunction + Pain + Cognitive deficits Depression + Fatigue (+) Dysarthria Dysphagia

6 Symptoms Drug treatment Rehabilitation Visual defects Restricted mobility + + Spasticity + + Ataxia (+) (+) Tremor (+) (+) Bladder-/Bowel dysfunction + + Pain + (+) Cognitive deficits + Depression + Fatigue (+) + Dysarthria + Dysphagia +

7 Significance of symptoms Restricted acitivities of daily living Symptoms Restrictions in social background Secondary functional deficits and complications Restricted quality of life ICF: Functioning Activity Participation

8 MS Barometer 2011 What percentage of PwMS currently receives rehabilitation services as in-patients? 0 100

9 Rehabilitation has moved from professional artistry to an evidence-based, scientific approach over the last years [Richardson 2002]

10 MS + Rehabilitation (PubMed)

11 Progress in Neurorehabilitation growing knowledge concerning neuroplasticity better understanding of biochemical factors promoting learning and neural remodelling (neurotrophic factors, neurotransmitters, neural cell precursors, ) Advances in the understanding of the mechanisms of memory, executive and other cognitive dysfunctions

12 Progress in Neurorehabilitation new therapeutic interventions Development of the ICF, i.e. of ICF MS Core Sets Goal assessment and outcome measures Health-related QoL Shared Decision Making (SDM) Code of Good Practice Efficacy data of multimodal rehab

13 New interventions concerning mobility and arm function physical exercise cognitive function and psychology fatigue bladder and bowel dysfunction dysphagia and dysarthria occupational therapy...

14 Effects of Multimodal Rehabilitation 'strong evidence for short-term gains at the level of activity (disability) and participation with inpatient rehabilitation limited evidence for short-term improvement in symptoms and activity with high intensity outpatient rehabilitation which translates into better participation and QoL strong evidence for longer-term gains in QoL with lower-intensity programmes over a longer period

15 Lokomat Training 12 x Robot-assisted gait training (n=15) or conventional gait training (walking, transfer, balance; n= 17), EDSS 5 7 no difference between both groups concerning the 6 min. walking test, 10 m walking test and Timed-Up and Go at the end of treatment both groups better than at start Schwartz et al., MSJ 2012

16 Lokomat Training Robot-assisted gait training (n = 26) or conventional gait training with a PT (n = 23), 9 x 30 min., EDSS 3 6,5 no significant difference between both groups concerning gait velocity, level of activity (accelerometer) and QoL at the end of treatment both groups better than at start Vaney et al., NNR 2012

17 Bladder dysfunction Rehabilitation RCT (in-patient out-patient) Treatment group (n=24): 3 day voiding charts, strict fluid balance, post void residual volume, sonography, urodynamics; information, pelvic floor training, bladder training, intermittent self catheterisation, use of prophylactic medication Control group (n= 34): Waiting list significant amelioration (p=0.001) for continence, physical activity, social activity, QoL, UDI-6, NDS [Bladder subscale], AUA Symptom Index, IIQ7) after 6 weeks Khan et al., JNNP 2010

18 published 2012 Rewiever Board: Pierre Ketelaer, Jürg Kesselring 32 contributors from 11 European countries editor T. Henze

19 Content Definition of the symptom, problem or disability, and its frequency available interventions and treatment techniques including recent studies and developments on the most important / accepted treatments. no complete enumeration of all existing studies but of the relevant interventions, especially EBM or expert opinion enabling an overview on the currently best treatment of the symptom / disability no intention to elaborate consensus guidelines!

20 Content Multiple Sclerosis MS rehabilitation symptoms and interventions definition, MS management, the person with MS and its needs, QoL, Code of Good Practice definition, ICF, goal assessment and outcome measures, service delivery, interdisciplinary team, rehab at different stages, efficacy of rehab, mechanisms of rehab mobility, arm function, physical exercise, cognitive impairment, bladder, bowel + sexual dysfunction, fatigue, speech and swallowing dysfunction, OT, vocational rehab, nursing, social counselling

21 Goals Presentation of basic topics and special interventions of modern MS rehabilitation Support of the Code of Good Practice in terms of facilitating a comprehensive MS rehab and offering orientation for developing MS rehab in single countries and centers

22 EMSP RIMS Close cooperation with RIMS (Rehabilitation in MS), the network of MS Centres in Europe, created in 1991 and affiliating numerous MS Centres spread throughout more than 20 European countries

23 Recommendations for Rehabilitation in People with MS Thomas Henze, Nittenau / Germany