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For people with multiple sclerosis, physiotherapy delivered as part of a multidisciplinary team approach, provides a range of benefits, from improving physical health to enhancing quality of life.

What is multiple sclerosis?

Multiple sclerosis (MS) is an inflammatory, degenerative neurological disease which is most commonly diagnosed between the ages of 20-40, affecting women more than men in a ratio of 2.5:1.1

Typically, MS involves a series of relapses, often making prognosis unpredictable; however, a small proportion of
people with MS (15%) have a steady progression of disability.1 Some people with MS can develop complex
patterns of disability that affect physical and social function.2 Problems with mobility, balance, fatigue,
and spasticity are also common.3

Physiotherapists provide unique contributions to the management of long-term MS symptoms and through
the improvement and maintenance of functional abilities.3, 4 Physiotherapists provide specific rehabilitation programs, facilitate self-management, and coordinate care.1, 5

For people with more complex needs, physiotherapy should ideally be delivered within a multidisciplinary
specialist team/service where regular evaluation and assessment can be provided.5, 6

There is evidence that multidisciplinary rehabilitation can improve activity and participation levels of people with MS.5

Why should physiotherapists be involved in management from the start?

The greatest potential for central nervous system adaptation and recovery occurs in the early stages of the disease.11 Physiotherapy intervention and advice closely following diagnosis can reduce disability, maximize potential for independence, improve employment sustainability, and reduce the impact the disease has on health and quality of life factors.5

Size of the problem

  • 100,000 Canadians are living with MS today7
  • This number is projected to increase to over 133,000 by 20319
  • MS is the “major cause of non-traumatic disability in young adults”7
  • Alberta has one of the highest prevalence rates in the world – approximately 340 out of every 100,000 Albertans have been diagnosed with MS8

Case Study

A multidisciplinary team at the Glenrose Hospital, including physiotherapists, physiotherapist assistants, mentors, and consultants, conducted a pilot study of the use of Exoskeleton (EKSO) gait training in people with progressive MS. The EKSO is a robotic skeleton with motors at the hip and knee that can assist people with leg weakness to practice walking. Its use has been tested previously in people following spinal cord injury and stroke. The Glenrose team decided to conduct a study to see if it was feasible to use the device with people with balance, gait, and endurance problems due to MS.

The pilot study included a small number of people with MS and was not designed to test if EKSO use led to clinically-important improvements. However, the pilot study demonstrated that EKSO use was safe and feasible for this patient group. The team plans to explore the possibility of future studies using this robotic technology and hopes to enable people with MS to use the EKSO clinically as part of their treatment.

Physiotherapy intervention

There is a strong body of evidence demonstrating that exercise used as part of a rehabilitation program can increase activity and improve the health and well-being of people with MS.12

In addition, there is evidence that physiotherapists, as part of a specialist neuro-rehabilitative service, have a key role in managing specific symptoms of MS including pain, spasticity, and the prevention of secondary complications such as contracture.5, 6 Results from randomized controlled clinical trials of exercise programs in MS have demonstrated benefits in muscle strength, cardiovascular fitness, aerobic thresholds and activity levels, and functional improvements, such as walking ability.11, 12, 13 Exercise is generally highly valued by patients who report improvements in mood and quality of life.4, 14

Cost of MS

  • Up to 80% of people diagnosed with MS in Canada are unemployed15
  • The mean total cost per MS patient annually in Canada is $37,672 (CAD, 2009)
  • 46% in direct health costs
  • 33% for cost of MS treatments
  • 34% in sick leave and retirement10
  • Total out-of-pocket expenses for Canadians with MS is expected to have grown from $126 million in 2011 to $170 million in 20319

References

  1. Browne  P, Chandraratna D, Angood C, Tremlett H, Baker C, Taylor BV, Thompson AJ. Atlas of multiple sclerosis 2013: A growing global problem with widespread inequity. Neurology. 83(11), 1022–1024. http://doi.org/10.1212/WNL.0000000000000768
  2. Goksel Karatepe A, Kaya T, Gunaydn R, Demirhan A, Ce P Gedizlioglu M. Quality of life in patients with multiple sclerosis: The impact of depression, fatigue and disability. International Journal of Rehabilitation Research. 2011 Dec 1, [cited Dec 27 2017];34(4):290-298.
  3. Compston A, Coles A. Multiple Sclerosis. The Lancet. 2008; 372(9648): 1502-17. http://linkinghub.elsevier.com/retrieve/pii/S0140673608618207
  4. Halabchi F, Alizadeh Z, Sahraian MA, Abolhasani, M. Exercise prescription for patients with multiple sclerosis; potential benefits and practical recommendations. 2017 BMC Neurology, 17, 185. http://doi.org/10.1186/s12883-017-0960-9
  5. Khan F, Amatya B. Rehabilitation in multiple sclerosis: A systematic review of systematic reviews. Archives of Physical Medicine & Rehabilitation. 2017 Feb; 98(2): 353-367.
  6. Martinez-Assucena A, Marnetoft S, Rovira T, Hernandez-San Miguel J, Bernabeu M, and Martinelli-Gispert-Sauch M. Rehabilitation for multiple sclerosis in adults(II);management and impact on impairment, functioning and quality of life: an overview. Critical reviews in physical and rehabilitation medicine January 2010; 22(1-4):179-240
  7. MS Society of Canada. About MS. n.d. https://mssociety.ca/about-ms
  8. Alberta Health, Government of Alberta Report. The Way Forward: Alberta’s Multiple Sclerosis Partnership. November 2014
  9. Amankwah N, Marrie RA, Bancej C, Garner R, Manuel DG, Wall R et al. Multiple sclerosis in Canada 2011 to 2031: results of a microsimulation modelling study of epidemiological and economic impacts. Health Promot chronic Dis Prev Can. 2017 Feb; 37(2):37-48.
  10. Karampampa K, Gustavsson A, Miltenburger C, Kinundu CM and Selchen DH. Treatment experience, burden, and unmet needs (TRIBUNE) in multiple sclerosis: the costs and utilities of MS patients in Canada. J Popul Ther Clin Pharmacol 2012;19(1):e11-25. Epub 2102 Jan 10
  11. MS Australia. Strength  and  cardiorespiratory  exercise for people with multiple sclerosis (MS). MS Practice - for health professionals. MS Australia; n.d.URL: http://www.msaustralia.org.au/publications-health-professionals.asp
  12. Turner AP, Kivlahan DR, Haselkorn JK. Exercise and quality of life among people with multiple sclerosis: looking beyond physical functioning to mental health and participation in life. Arch Phys Med Rehabil. 2009 Mar;90(3):420-8.
  13. Snook EM, Motl RW. Effect of exercise training on walking mobility in multiple sclerosis: a meta-analysis. Neurorehabil Neural Repair. 2009 Feb;23(2):108-16.
  14. Döring A, Pfueller CF, Paul F, Dörr J. Exercise in multiple sclerosis – an integral component of disease management. The EPMA Journal 2012: 3(1):2. Doi:10.1007/s13167-011-0136-4.

Acknowledgement

Adapted and used with permission of the Chartered Society of Physiotherapy