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Occupational therapy for multiple sclerosis (Cochrane review) [with consumer summary]
Steultjens EMJ, Dekker J, Bouter LM, Cardol M, van de Nes JCM, van den Ende CHM
Cochrane Database of Systematic Reviews 2003;Issue 3
systematic review

BACKGROUND: Multiple sclerosis (MS) patients are referred to occupational therapy with complaints about fatigue, limb weakness, alteration of upper extremity fine motor coordination, loss of sensation and spasticity that causes limitations in performance of activities of daily living and social participation. The primary purpose of occupational therapy is to enable individuals to participate in self-care, work and leisure activities that they want or need to perform. OBJECTIVES: To determine whether occupational therapy interventions in MS patients improve outcome on functional ability, social participation and/or health related quality of life. SEARCH STRATEGY: We searched the Cochrane MS Group trials register (January 2003), the Cochane Central Register of Controlled Trials (the Cochrane Library issue 4, 2002), Medline (January 2003), Embase (December 2002), CINAHL (December 2002), AMED (December 2002), SciSearch (December 2002) and reference lists of articles. SELECTION CRITERIA: Controlled (randomized and non-randomized) and other than controlled studies addressing occupational therapy for MS patients were eligible for inclusion. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed the methodological quality of the included trials. Disagreements were resolved by discussion. A list proposed by Van Tulder 1997 was used to assess the methodological quality. For outcome measures, we calculated standardized mean differences. We analysed the results using a best-evidence synthesis based on type of design, methodological quality and the significant findings of outcome and/or process measures. MAIN RESULTS: One randomized clinical trial was identified and two other included studies were a controlled clinical trial and a study with a pre-post test design. The three studies involved 271 people in total. Two studies evaluated an energy-conservation course for groups of patients and one study evaluated a counseling intervention. The results of the energy conservation studies could be biased because of the designs used, the poor methodological quality and the small number of included patients. The high quality RCT on counseling reported non-significant results. AUTHORS' CONCLUSIONS: On basis of this review no conclusions can be stated whether or not occupational therapy improves outcomes in MS patients. The lack of (randomized controlled) efficacy studies in most intervention categories of occupational therapy demonstrates an urgent need for future research in occupational therapy for multiple sclerosis. Initially, a survey of occupational therapy practice for MS patients, including the characteristics and needs of these patients, is necessary to develop a research agenda for efficacy studies.

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