OBJECTIVE: The study was to determine whether a single inpatient admission for physiotherapy in chronic multiple sclerosis (MS) improved mobility and related activities of daily living in the home environment. DESIGN: Forty-five patients with chronic progressive multiple sclerosis who had a recent history of deterioration in gait or transfer ability were studied. They were assigned either to "early" or "late" treatment to obtain two balanced groups, one of which had received physiotherapy and the other which had not, on reassessment at week nine. SETTING: Treatment was administered in a specialized neurorehabilitation unit. Assessment was in the patient's own home. Outcome: Outcome measures were standard indices of mobility, activities of daily living (ADL), timed tests of mobility, subjective visual analogue scores (patient and carer) and rating of randomized video clips of home mobility. Assessments were carried out at home by a physiotherapist who was independent of treatment and management. RESULTS: There was no statistical difference between the score changes (at week nine) of "early" (treated) and "late" (untreated) groups for disability, mobility or video ratings. Patient visual analogue data showed a perceived reduction in mobility-related distress (p < 0.001) predicted in part by pretreatment anxiety levels. The study could have been too small to detect a small (10%) change in the Rivermead Mobility Index. CONCLUSIONS: Although we failed to detect objective improvement in mobility or related ADL following inpatient physiotherapy, patients clearly felt a reduction in distress associated with mobility problems. Better selection of patients or specific goal-directed intervention based at home including psychological factors may improve efficacy. The study also yielded pilot data which may be of value for determining sample sizes in future studies.

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