The effectiveness of occupational therapy and physiotherapy in multiple sclerosis patients with ataxia of the upper limb and trunk

Abstract

Objective: The aim of the study was to evaluate the effectiveness of therapy intervention in reducing impairment and disability due to upper limb and trunk ataxia in chronic multiple sclerosis (MS). Design: The change in performance scores of two patient groups - an inpatient group who received two weeks' therapy intervention and an outpatient 'control' group awaiting a similar admission - were compared. Subjects: Thirty-seven (out of a total of 62) patients with clinically definite or laboratory-supported definite MS, with ataxia of the upper limbs and/or trunk, and who had stable or slowly progressive disease. Intervention: The (inpatient) treatment group (n = 28) received eight half-hour sessions each of occupational therapy and physiotherapy over eight consecutive working days. Treatment approaches used were aimed at improving dynamic posture and appropriate adaptation of the environment. The control group (n = 9) received no intervention. Assessments: Patients were assessed the day before therapy began and the day after it ended: the control group were assessed at the same (two-week) interval. Assessments used included the Jebsen Test of Hand Function (JTHF), the Kurtzke Functional Systems Scale (FSS) and Expanded Disability Status Scale (EDSS), the Northwick Park Index of activities of daily living (NPI), and patient and assessor visual analogue scales. Assessors were independent of patient treatment. Results: There were no significant differences between the two groups at entry to the study with respect to age, sex and scores on the FSS (exception bowel function). The NPI scores were not significantly different except for walking and feeding, whereas the control group was slightly better (Mann-Whitney U-test; p = 0.048; p = 0.037). No significant difference between the change scores of the two groups was found on the JTHF and FSS neurological scores. The treatment group showed significant improvement compared to controls in the NPI scores and on the self and assessor visual analogue scales. Conclusion: The findings support the clinical impression that therapy used to improve dynamic posture and methods of performing functional tasks can result in improvement of functional ability in patients with MS where spontaneous improvement would not otherwise be expected.