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upon recovery (NMSS, 2010). Periods between relapses are when the disease progresses.
Eighty-five percent of individuals with MS are diagnosed with this form of MS.
Approximately 50% of those diagnosed with RRMS will progress into secondaryprogressive MS (SPMS) within five years (NMSS, 2010). After the individual
experiences the initial relapsing-remitting course, they will experience occasional relapses
with minor remissions and plateaus. The next form is primary-progressive MS (PPMS).
This form is characterized by a progression of disability from the onset with no plateaus
and remissions (NMSS, 2010). This form is most likely the most debilitating form and
quite uncommon with only 10% diagnosed with this form (NMSS, 2010). The final type
of MS is progressive-relapsing MS (PRMS) and is the least common with only 5%
diagnosed. PRMS is characterized by the progression from onset with acute relapses with
or without full recovery.
The onset of MS usually occurs between the ages of 20 and 45 years and is more
prevalent in women (Foti, 2013). It is estimated that there are currently approximately
350,000 cases in the United States. MS is a progressive disease that greatly impacts the
quality of life (QOL) of individuals diagnosed with it. Even though there is currently no
cure, there are many ways that as practitioners we can help manage the symptoms and
improve the QOL in this population.
Summary of Key Findings:
Summary of Levels I, II and III:
Education: Research strongly supports that interventions focusing on education can help
improve the QOL in individuals diagnosed with MS. Particularly groups focusing on
various forms of health promotion have been found to be effective. For instance, groups
focusing on lifestyle management and physical activity have shown to increase QOL,
participation in physical activities, and perceived impact of MS (Ennis, Thain, Boggild,
Baker, & Young, 2006; Feys et al., 2012). Furthermore, education-based interventions
have shown to increase the self-efficacy of individuals living with MS. Programs focusing
on teaching self-efficacy strategies and energy conservation techniques have shown
improved self-efficacy, health behaviors, and QOL (Mathiowetz, Finlayson, Matuska,
Chen, & Luo, 2005; Stuifbergen, Becker, Blozis, Timmerman, & Kullberg, 2013).
Exercise: Though clinicians may not commonly use exercise as an intervention for those
with MS due to high levels of fatigue and poor balance, it has been shown to have a
significant impact on the QOL of individuals living with MS (Huisinga, Filipi, & Stergio,
2011; Kargarfard, Etemadifar, Baker, Mehrabi, & Hayatbakhsh, 2012; Ozge, Serkan,
Egemen, & Album, 2012; Tarakci, Yeldan, Huseyinsinoglu, Zenginler, & Eraksoy, 2013).
In addition, researchers have found exercise to actually improve fatigue levels in
individuals with MS. Aquatic exercise and light elliptical training both led to lower scores
of the Modified Fatigue Impact Scale (Huisinga et al., 2011; Kargarfard et al., 2012).
Another main symptom stemming from MS is balance difficulties, and exercise has also
shown to have a positive impact on this. Interventions focusing on strengthening,
flexibility, and balance exercises have significantly improved scores on the Berg Balance
Test (Ozge et al., 2012; Tarakci et al., 2013).
Rehabilitation: Clinicians working in rehabilitation services have a great opportunity to
improve the QOL in persons with MS. Though research is not clear on what type of
services is best for this population, research utilizing three different types of clinicians
(i.e., occupational therapist, physiotherapist, speech therapist) have been found effective
to improving QOL (Patti et al., 2002; Vikman, Fielding, Lindmark, & Fredrikson, 2008).
Vikman et al. (2008) found that interventions as short as three weeks can improve scores
in QOL assessments in an inpatient setting.
Psychosocial: One important aspect of interventions is that they do not only focus on the
physical deficits of the client. Depression is common in those with MS and is correlated
with a lower QOL (Hart, Fonareva, Merluzzi, & Mohr, 2005). However, researchers have
found that treating the depression of individuals with MS does not create a higher QOL
(Hart et al., 2005).
Summary of Level IV and V:
No level IV or V studies were utilized in this review.
Contributions of Qualitative Studies:
No qualitative studies were utilized in this review.
interventions for this population. Research has shown that exercise groups and education
programs offered in the community or rehabilitation settings can be beneficial in reducing
common symptoms of MS and increasing QOL. Programs ranging from three weeks to
twelve weeks have proven to be effective. These programs should focus on self-efficacy,
energy conservation, health promotion, core balance, strengthening, and functional
activities.
Societal Needs: Individuals diagnosed with MS experience a progressive loss of function
that leads to high healthcare costs; thus, it is important for practitioners to help them
maintain their independence as long as possible. Furthermore, it is just as important for
practitioners to help individuals maintain their QOL levels as their disease progresses.
The research studies also noted that individuals with MS have shown reduced physical
activity and reduced self-efficacy. By addressing these factors, occupational therapists can
also improve the QOL of individuals with MS and assist in reducing caregiver burden.
Healthcare delivery and policy: Often exercise and physical activity are thought to be
contraindicated for individuals with MS; however, the research suggests there are
numerous benefits. Exercise and physical activity can not only help manage symptoms
brought on by MS, but also the individual's overall QOL. Other healthcare practitioners
and physicians need to be made known not only of those benefits, but also the
applicability and usefulness of OT in this type of intervention.
Education and training of OT students: Occupational therapists working in a variety of
settings with individuals diagnosed with MS are primarily concerned with the physical
impairments; however, other impairments cannot be ignored. Current OT students need to
be educated on the importance of holistic treatment that includes psychosocial aspects and
factors affecting QOL. Evidence-based practice in regards to appropriate and efficient
interventions need to be taught as well.
Refinement, revision, and advancement of factual knowledge or theory: Future studies
should focus on examining the long-term effects of interventions aimed at impacting QOL
in individuals living with MS. While a few studies completed a follow-up on their
participants, most of the studies did not make an attempt to identify how long the effects
of their interventions lasted; therefore, creating the need for future research. Furthermore,
future studies should attempt to determine what the minimum frequency and duration of
an intervention focused on improving QOL should be.
Review Process:
Explored focus question possibilities based on topic of interest
Exclusion Criteria:
Search Strategies:
Categories
Patient/Client Population
Intervention
Outcomes
Number of
Articles Selected
II
III
IV
Other
Qualitative Studies
0
11
TOTAL:
Limitations of the Studies Appraised:
Levels I, II, and III
Small sample sizes
Lack of male participation in studies
Many of the participants were self-selected; therefore, indicating willingness to
comply with the guidelines of the intervention
Potential of training effects from multiple administrations of various assessments
The studies did not look at the long-term effects of the interventions
High rates of attrition due to exacerbations of the disease
Many of the studies were conducted outside of the United States, thus their
methods could have been different
Levels IV and V
No level IV or V studies were utilized.
Other
N/A
Patti, D., Ciancio, M. R., Reggio, E., Lopes, R., Palermo, F., Cacopardo, M., &
Reggio, A. (2002). The impact of outpatient rehabilitation on quality of life in
multiple sclerosis. Journal of Neurology, 249(8), 1027-1033. doi: 10.1007/s00415002-0778-1
Stuifbergen, A. K., Becker, H., Blozis, S., Timmerman, G., & Kullberg, V. (2003). A
randomized clinical trial of a wellness intervention for women with multiple
sclerosis. Archives of Physical Medicine and Rehabilitation, 84(4), 467-476.
doi:10.1053/apmr.2003.50028
Tarakci, E., Yeldan, I., Huseyinsinoglu, B. E., Zenginler, Y., & Eraksoy, M. (2013). Group
exercise training for balance, functional status, spasticity, fatigue and quality of
life in multiple sclerosis: A randomized controlled trial. Clinical Rehabilitation,
27(9), 813-822. doi: 10.1177/0269215513481047
Vikman, T., Fielding, P., Lindmark, B., & Fredrikson, S. (2008). Effects of inpatient
rehabilitation in multiple sclerosis patients with moderate disability. Advances in
Physiotherapy, 10(2), 58-65. doi: 10.1080/14038190701288785
Other References:
Foti, D. (2013). Multiple sclerosis. In H. M. Pendleton & W. Schult-Krohn (Eds.), Pedretti's
occupational therapy: Practice skills for physical dysfunction (7th ed., pp.936-940). St.
Louis, MO: Elsevier.
National Multiple Sclerosis Society. (2010). Disease overview. In R. Kalb (Ed.), Multiple
sclerosis: A focus on rehabilitation (5th ed., pp. 5-23). Retrieved from
http://www.nationalmssociety.org/NationalMSSociety/media/MSNationalFiles/Brochures
/A-Focus-On-Rehabilitation_Final-Links.pdf