Critically appraised paper: Multidisciplinary inpatient rehabilitation for multiple sclerosis may delay declines in health-related quality of life over 6 months [synopsis]

Question: Does inpatientmultidisciplinaryrehabilitation improvehealth-related quality of life in patients with multiple sclerosis (MS)? Design: Pragmatic, randomised controlled trial with concealed allocation and 6-month follow-up. Setting: Two hospitals providing MS-specialised rehabilitation in Denmark. Participants: Patients with MS who were referred for 4 weeks of inpatient rehabilitation, aged 18 to 65 years,with an ExpandedDisability Status Scale score 7.5, and familiarity with a personal computer (to complete online questionnaires at 6 months) were eligible for inclusion. Patients diagnosed in the last 6 months or who had experienced a relapse in the last 3 months were excluded. Randomisation of 427 participants allocated 214 to the treatment group and 213 to the control group. Interventions: The treatment group received immediate admission (within 2 weeks of randomisation) for multidisciplinary inpatient rehabilitation.Rehabilitationconsistedof anaverageof3.5hours (range1.9 to6.9) of personalised therapy per day, for 4weeks (20 days), from a team comprising a neurologist, neuropsychologist, physiotherapist, occupational therapist, dietician, nurse, and socialworker, allwith specialised knowledge ofMS. The control group was assigned to a 6-month waiting list, which was sooner than the usual admissionwaiting list of 12months at the time of the study.Outcomemeasures: The primary outcomes were change from baseline at 6 months in MS-specific health-related quality of life questionnaires: the Functional Assessment of Multiple Sclerosis and the Multiple-Sclerosis Impact Scale-29 (Physical and Psychological). Secondaryoutcomeswere generic health-relatedquality of life instruments: EQ-5D-5L Index and 15D Index. Results: A total of 413 participants (n = 209 treatment, n = 204 control) were included in the intention-totreat analysis. At 6 months, there were significant between-group differences in favour of the treatment group in the Multiple Sclerosis Impact Scale-29 Psychological component (mean difference –2.7 points, 95% CI –5.6 to –0.1) and the 15D Index (mean difference 0.017 points, 95% CI 0.005 to 0.030). No other between-group differences were significant. Post-hoc analysis showed that a larger proportion of patients in the treatment group at 6 months were unchanged or improved from baseline in the Functional Assessment of Multiple Sclerosis, Multiple-Sclerosis Impact Scale-29 Psychological and the 15D Index. Conclusion: Four weeks of specialised, multidisciplinary inpatient rehabilitation had small and inconsistent effects on parameters of healthrelated quality of life in people with MS at 6 months. This study provides some evidence that inpatient rehabilitation may reduce declines in healthrelated quality of life over 6 months.