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Occupational therapy and multiple sclerosis


Clinical bottom line

This systematic review suggests occupational therapy related treatments have some effect in MS, but it is such a mix of trial designs (most likely to be biased), interventions and outcomes that it makes any conclusion dangerous.


NA Baker, L Tickle-Degnen. The effectiveness of physical, psychological, and functional interventions in treating clients with multiple sclerosis: a meta-analysis. American Journal of Occupational Therapy 2001 55: 324-331.


The review used electronic and hand searching for studies looking at the effectiveness of occupational therapy in MS. Occupational therapy had to be the primary method of treatment, or have some intervention that was within a practitioner's abilities. Adequacy of trial design was not an inclusion criterion, so non-randomised studies like cohorts, pre- and post intervention, and single case studies were included. A grading system of evidence levels was designed just for this study.


There were 23 included studies. Perhaps seven of these were randomised, but none examined the same intervention as another. Interventions used ranged from TENS, to outpatient rehabilitation, to fatigue management programmes, and cooling. Most studies were small, ranging from 1 to 73 patients.


The authors claim that some aspects of the interventions look promising, but in truth this is such a mix od trial designs, interventions, outcomes and size as to give heterogeneity a bad name and make any sensible conclusion impossible. It emphasises that systematic review and meta-analysis cannot make silk purses from sow's ears.