Enhancing the Care of Veterans with Multiple Sclerosis Using a Comprehensive Physiatric Approach

Background: Multiple sclerosis (MS) is a chronic lifelong disease that causes a wide array of symptoms and disabilities. Most patients and clinicians focus their attention on assessing the motor and sensory deficits of MS and providing appropriate disease modifying treatments (DMTs).  However, the commonly seen symptoms that significantly impact the patient’s quality of life are often dealt with on a secondary basis or overlooked altogether.  Physicians specialized in Physical Medicine and Rehabilitation (physiatrists) are trained in providing comprehensive care to patients with neurological conditions such as MS, in order to maximize their function, independence and quality of life.  Physiatrists are qualified in managing neurogenic bowel and bladder, spasticity, fatigue, neuropathic pain, cognitive deficits, wound prevention/management and evaluation for appropriate assistive devices for mobility and activities of daily living (ADLs). 

Objectives: To assess the role of a physiatrist in providing comprehensive care to veterans with MS.

Methods: The MS Center of Excellence (MSCOE) at the VA New Jersey Healthcare System has incorporated physiatrists into the comprehensive care they provide to the veterans with MS in both the inpatient and outpatient setting.

Results: Our interdisciplinary team includes a physiatrist with board certification in Spinal Cord Injury medicine, an MS certified social worker, MS certified nurses and an MS virtual care RN coordinator.  The team uses a comprehensive checklist to assess each initial MS patient in order to help identify and address each of the usual symptoms and issues associated with MS. After the assessment, appropriate treatment recommendations are made and most often include initiation of a regular bowel program, evaluation and provision of appropriate rehabilitation and equipment needs and medication management for fatigue, neuropathic pain, spasticity and prevention of wounds. If indicated, the appropriate referrals are made to other team members within our MSCOE including neurology (for initiation or maintenance of appropriate DMTs), neuro-urology (for neurogenic bladder management), mental health, physical/occupational therapy, nutrition, and the fitness/exercise program. Their caregiver’s needs are assessed and home visits are made by members of the team for those veterans enrolled in our home services program.   The MS patients have reported a very high satisfaction rate in the services they have received often citing that the MS issues being evaluated in the clinic have never been addressed before by any other healthcare provider that they have encountered.

Conclusions: Veterans with MS are daily dealing with the secondary complications of their disease that significantly impact their independence and health related quality of life and a physiatrist led interdisciplinary team is a valuable means to optimize the comprehensive care of these patients.