背景:对多学科康复(MDR)的有效性以及多发性硬化症(MS)患者的症状和需求如何与MDR干预措施的多样性相互作用的研究仍然是一个难题,通常被称为黑匣子。
方法:我们进行了一项部分交叉随机对照试验,并在1(出院)时进行了随访,6和12个月。根据他们的康复目标,入院前将每位患者分为5个主要关注区域(MFA)中的1个:弹性,认知功能,能源,身体功能,和个人需求。多发性硬化功能评估(FAMS)仪器评分是主要结果。
结果:MFA组年龄不同(P=0.036),MS类型(P=.002),扩展残疾状况量表评分(P<.001),自诊断以来的时间(P=.002),和FAMS在基线(P<.001),以及MDR服务的组成和数量。出院时,在所有5个MFA组中发现了显著的FAMS改善(FAMS变化>10.4,P<0.05),但受影响的子维度和改善的持久性在MFA组之间有所不同。在6个月的随访中,FAMS的受控差异估计值为9.9(P=.001),5.6(P=.196),8.5(P=.008),-1.4(P=.548),弹性和17.9(P=.012),认知功能,能源,身体功能,和个人需求团体,分别。
结论:这项研究表明,住院患者MDR改善了MS患者的功能和与健康相关的生活质量;学位,和持久性的好处是相关联的患者的主要重点领域的康复,这表明了目标设定过程在MDR中的重要性。
BACKGROUND: The study of the effectiveness of multidisciplinary rehabilitation (MDR) and how the symptoms and needs of individuals with multiple sclerosis (MS) interplay with the diversity of MDR interventions is still a conundrum, often referred to as a black box.
METHODS: We conducted a partial crossover randomized controlled trial with follow-ups at 1 (discharge), 6, and 12 months. Based on their rehabilitation goals, each patient was categorized into 1 of 5 main focus areas (MFAs) prior to admission: Resilience, Cognitive Function, Energy, Physical Function, and Personal Needs. The Functional Assessment of Multiple Sclerosis (FAMS) instrument scores were the primary outcome.
RESULTS: MFA groups varied in age (P = .036), MS type (P = .002), Expanded Disability Status Scale score (P < .001), time since diagnosis (P = .002), and FAMS at baseline (P < .001), as well as in composition and quantity of MDR services. At discharge, significant FAMS improvements were found in all 5 MFA groups (FAMS change > 10.4, P < .05), but the affected subdimensions and persistence of improvements varied among MFA groups. At the 6-month follow-up, estimates of controlled differences in FAMS were 9.9 (P =.001), 5.6 (P = .196), 8.5 (P = .008), -1.4 (P = .548), and 17.9 (P = .012) for the Resilience, Cognitive Function, Energy, Physical Function, and Personal Needs groups, respectively.
CONCLUSIONS: This study demonstrated that inpatient MDR improves functioning and health-related quality of life in people with MS; the type, degree, and persistence of the benefits are associated with a patient\'s main focus area of rehabilitation, which signifies the importance of the goal-setting process in MDR.