Abstract
Rehabilitation is an essential aspect of symptomatic and supportive treatment for people with multiple sclerosis (MS). The number of randomised controlled trials (RCTs) for rehabilitation interventions in MS has increased over the last two decades. The design, conduct and reporting quality of some of these trials could be improved. There are, however, some specific challenges that researchers face in conducting RCTs of rehabilitation interventions, which are often ‘complex interventions’. This paper explores some of the challenges of undertaking robust clinical trials in rehabilitation. We focus on issues related to (1) participant selection and sample size, (2) interventions – the ‘dose’, content, active ingredients, targeting, fidelity of delivery and treatment adherence, (3) control groups and (4) outcomes – choosing the right type, number, timing of outcomes, and the importance of defining a primary outcome and clinically important difference between groups. We believe that by following internationally accepted RCT guidelines, by developing a critical mass of MS rehabilitation ‘trialists’ through international collaboration and by continuing to critique, challenge, and develop RCT designs, we can exploit the potential of RCTs to answer important questions related to the effectiveness of rehabilitation interventions.
Highlights
Rehabilitation is an essential aspect of symptomatic and supportive treatment for people with multiple sclerosis (MS)
We acknowledge the importance of using a variety of research methods to fully understand whether and how rehabilitation interventions work, but focus on randomised controlled trials (RCTs) since they are arguably regarded as a superior research design to determine whether a treatment is beneficial[3]
We describe some key methodological issues faced in rehabilitation trials, and draw upon examples from both within and outside the MS field, where these dilemmas have been tackled
Summary
Rehabilitation is an essential aspect of symptomatic and supportive treatment for people with multiple sclerosis (MS). This is important in rehabilitation trials where participants need to actively engage in the treatment to derive benefit. In a memory rehabilitation RCT, baseline memory assessment scores were used to highlight which memory strategies might be more useful than others, and homework exercises enabled participants to test memory strategies within their home settings to determine what adaptations needed to be made to the strategies[43].
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