Clinical Outcomes Following Application of a Clinical Practice Guideline for Persons with Multiple Sclerosis in a Multi-Discipline Rehabilitation Facility

Background: The Multiple Sclerosis (MS) clinical practice guideline (CPG) was created to assist the rehabilitation clinician in performing a thorough evaluation and develop an evidence-based plan of care. The development of a CPG was conducted to fit the unique mission, situation, and needs of Sheltering Arms Rehabilitation Hospital, its employees, and the community. The development and assimilation of this information represents a significant commitment to excellence in serving individuals living with MS across the rehabilitation across a spectrum of care, for a multitude of services. Persons with MS have variant disability levels and can present to rehabilitation services in acute care, home health, inpatient rehab, outpatient rehab and recreational fitness. The CPG was intended to provide the clinician in each setting, guidance on a thorough assessment and evidence- based plan of care, including an appropriate transition through the rehabilitation spectrum, into a long term fitness program. 

Objectives: A retrospective analysis of clinical outcomes related to outpatient Physical Therapy (PT), Occupational Therapy (OT) and Speech Language Pathology (SLP), following implementation of a MS CPG.  

Methods: Patients were first grouped by gait velocity; Group 1: 0 – 0.39 m/sec, Group 2: >0.4 m/sec. Analysis of outcome measures were then performed within these groups. Group 1 outcome measures included: Trunk Impairment Scale, gait velocity, Multiple Sclerosis Impact Scale-29, 9-Hole PEG test, Grip strength, and National Outcomes Measurement System (NOMS). Group 2 outcome measures included: Berg Balance Scale, gait velocity, Multiple Sclerosis Impact Scale-29, 9-Hole PEG test, Grip strength, 6-minute walk test, and National Outcomes Measurement System (NOMS).

Results: The data presented demonstrates excellent outcomes through the application of a CPG.

Conclusions: Even with a heterogeneous patient population, consistency of practice and continuum of care is important in overall health and well-being of persons living with MS.