Friday, April 10, 2015

Telerehabilitation for persons with multiple sclerosis?

Cochrane: Does telerehabilitation achieve better outcomes in persons with multiple sclerosis compared with traditional face-to-face intervention? What types of telerehabilitation interventions are effective, in which setting and influence which specific outcomes?

Multiple sclerosis (MS) is a common disease of the nervous system among young adults, with no cure and causing long-term disability. Rehabilitation provides treatments and therapies to lessen the impact of any disability and improve function. Despite recent advances in MS care including rehabilitation, many people with MS are unable to access these developments due to limited mobility, fatigue and related issues, and costs associated with travel.Telerehabilitation is a newer approach to delivering rehabilitation programmes at the patient’s home or in the community, using telecommunication technology such as phone lines, video technology, internet applications and others. A wide range of telerehabilitation interventions are trialed in persons with multiple sclerosis, however, evidence for their effectiveness is still unclear.

Study characteristics
This review looked for evidence on how telerehabilitation interventions work in adults with MS. We searched widely for randomised controlled trials (RCTs), a particular kind of study where participants are placed in treatment groups by chance (that is, randomly) because in most settings these provide the highest quality evidence. We were interested in studies that compared a telerehabilitation programme with standard or minimal care, or with different kinds of rehabilitation programmes.

Key results
We found nine relevant RCTs covering 531 participants (469 included in the analyses), evaluating a wide variety of telerehabilitation interventions in persons with MS. The telerehabilitation interventions evaluated were complex, with more than one rehabilitation component and included physical activity, educational, behavioural and symptom management programmes. These interventions had different purposes and used different technologies, so a single overall definite conclusion was not possible. The methodological quality of the included studies is low and varied among the studies.

Quality of evidence
There was 'low-quality' evidence from the included RCTs to support the benefit of telerehabilitation in reducing short-term disability and managing symptoms such as fatigue in adults with MS. We found limited evidence to support the benefit of telerehabilitation interventions in improving disability, reducing symptoms and improving quality of life in the longer term. Furthermore, the interventions and outcomes being investigated in the included studies were different to each other. No studies reported any serious harm from telerehabilitation and there was no information on the associated costs.
There is a need for further research to assess the effects of the range of telerehabilitation techniques and to establish the clinical and cost effectiveness of these interventions in people with MS. The evidence in this review is up to date to July 2014.
Authors' conclusions: 
There is currently limited evidence on the efficacy of telerehabilitation in improving functional activities, fatigue and quality of life in adults with MS. A range of telerehabilitation interventions might be an alternative method of delivering services in MS populations. There is insufficient evidence to support on what types of telerehabilitation interventions are effective, and in which setting. More robust trials are needed to build evidence for the clinical and cost effectiveness of these interventions.