Translating Evidence into Practice: A Physical Rehabilitation Clinical Practice Guideline for Persons with Multiple Sclerosis

Background: Clinical practice guidelines (CPGs) are historically developed to reduce variability in care and promote evidence-based practice to maximize outcomes, while preserving patient individuality.

Objectives: To promote comprehensive, evidence-based physical rehabilitation care within our organization for persons with Multiple Sclerosis (MS), through the development and systematic application of an interdisciplinary clinical practice guideline.  

Methods: An interdisciplinary team, comprised of physical therapy (PT), occupational therapy (OT), speech language pathology (SLP), registered dietitian (RD), exercise physiology, recreational therapy (RT), social work (SW), inpatient nursing professionals, and medical psychologist with particular interest in persons with MS, received training in evidence appraisal for CPG development. The document is organized by the International Classification of Function (ICF) Model which was developed by the World Health Organization (WHO) and World Health Assembly in 2001. The purpose of the ICF is to provide a unifying framework for classifying the health components of functioning and disability and is composed of three broad categories: 1) Body structure & Function, 2) Activities & Participation, and 3) Environmental factors. A rehabilitation algorithm for the assessment includes outcome measures and sets the framework for developing a prioritized patient problem list. This problem list is then combined with patient goals to develop an evidence-based treatment plan. Interventions are defined with evidence-based recommendations. The balance and gait intervention sections have an additional algorithm based on outcome measure performance to aid the clinician in selecting the appropriate technology or tool to assist in maximizing the principles of motor learning, neuroplasticity and motor control. Transitions of care and community integration are also included in this model, with recommended service screens for RT, Fitness and Dietary services.

Results: An 84-page clinical practice guideline for Nursing, Medical Psychology, PT, OT, SLP, RD, RT, and SW services which is applicable for persons with MS across disability status and levels of care. 

Conclusions: A CPG for the physical rehabilitation treatment of persons with MS is critical to optimize function, quality of life and access to services and may be a model of service delivery for other healthcare providers across the nation.