Efficacy of physical therapy in multiple sclerosis as measured with the modified fatigue impact scale and ambulation index: a retrospective study.

OBJECTIVE: Evaluate the efficacy of outcome measures routinely used in a physical therapy service for Multiple Sclerosis (MS). DESIGN: We performed a retrospective review of 500 medical records of MS patients from the outpatients service of AISM Rehabilitation Centre, Genova, Italy. PATIENTS: All records of outpatients followed by AISM Rehabilitation Centre who underwent physical therapy from 2006 to 2008 were evaluated. METHODS: Modified Fatigue Impact Scale (MFIS) and Ambulation Index (AI) were reviewed for all records at the begin and at the end of the rehabilitation treatment. RESULTS: The number of assessments recorded was 295 in 209 patients. Out of the 209 patients, 133 were female and 76 were male. The mean age was 51.6 ± 11.68 years, the mean Expanded Disability Status Scale (EDSS) score was 4.98 ± 1.79, and 185 patients were ambulatory. In nonambulatory patients neither scale showed a significant increase. In ambulatory patients (275 assessments) significant changes were observed in AI, MFIS total score and subscores. CONCLUSION: Physical therapy has a positive impact on fatigue, and the MFIS seems to be a good outcome measure in ambulatory patients. The AI and MFIS seem to be not indicated for use in non-ambulatory patients.

A randomized placebo-controlled cross-over study using a low frequency magnetic field in the treatment of fatigue in multiple sclerosis.

BACKGROUND: Fatigue is one of the most common disabling symptoms in multiple sclerosis (MS). There is growing evidence in the literature for beneficial effects of magnetic fields on different MS symptoms and this has been reported to be beneficial in patients with MS, especially those with fatigue. OBJECTIVES: The aim of the study was to assess the effects on primary fatigue with a pulsed systemic low frequency magnetic field by means of clinical scales in a population of MS subjects. METHODS: Randomized double-blind cross-over trial with 50 MS subjects with primary fatigue who were recruited among those followed as outpatients at the AISM Rehabilitation Centre, Genova, Italy. Subjects were randomized into two groups: magnetic field group and sham therapy group and evaluated with the Modified Fatigue Impact Scale (MFIS), the Fatigue Severity Scale (FSS), VAS and Time Walking Test 10 meter (TWT10m.) at the time points of the study. Each group received both sham therapy and magnetic field therapy with a wash-out period of 5 months. Subjects were treated for 24 min per session, three times per week, for 8 weeks. Statistical analysis was performed using multivariate analysis. RESULTS: Results showed a statistically significant improvement in MFIS Physical Score for T0-T1 (p < 0.05) for TIME but not for TREATMENT and TIME*TREATMENT factors. No statistically significant differences were found for all other parameters considered in the study. CONCLUSIONS: Exposure to a low frequency magnetic field, within the parameters of this treatment protocol, has no advantage over sham exposure in reducing the impact of fatigue.

Management of bladder dysfunction in multiple sclerosis patients: the nurse's point of view.

It is estimated that as many as 90% of people with multiple sclerosis (MS) experience some type of urinary disturbance over the course of the disease. The importance of an interdisciplinary approach is crucial in the management of a symptom requiring the involvement of different professionals, with specific expertise in evaluation and treatment. The MS nurse is perhaps the professional most likely to be in a position to initiate the process of identifying urological dysfunction. The evaluation can be started by reviewing symptoms recorded in the patient's medical records over time. Along with the use of a urinary diary and a check of the patient's post-void residual at the time of each visit, this can aid the MS nurse in recognising which urinary dysfunction could be affecting the patient. The MS nurse can also have an important role in teaching the patient behaviour strategies that aid in both evaluating and treating urinary dysfunction. Finally, the MS nurse can be the primary instructor of techniques related to intermittent catheterisation procedures. A new topic highlighting the ever-developing role of the MS nurse is in the field of rehabilitation. This article highlights urinary symptoms experienced by people with MS and strategies used for treating them. The role of the MS nurse in managing urinary dysfunction is also discussed.