Journal of Rehabilitation Medicine 51-9 | Page 68

J Rehabil Med 2019; 51: 692–697 ORIGINAL REPORT MULTIDISCIPLINARY REHABILITATION FOR ADULTS WITH NEUROMYELITIS OPTICA SPECTRUM DISORDERS: A PILOT STUDY Dong-Mei SUO, MD 1,2 , Lin-lin LIU, MSc 3 , Kun JIA, MSc 1 , Lin-jie ZHANG, MD 1 , Li-Min LI, MD 1 , Jing WANG, MD 1 , Yuan QI, MSc 1 , Hai-jie LIU, MD 2 , Chun-Xiao WAN, MD 2 and Li YANG, MD 1 From the 1 Department of Neurology and Tianjin Neurological Institute, 2 Department of Rehabilitation, Tianjin Medical University General Hospital, and 3 Department of Paediatrics, Tianjin Hospital of ITCWM Nankai Hospital, Tianjin, China Objective: To provide detailed data on the effects of multidisciplinary rehabilitation for patients with neuromyelitis optica spectrum disorder with mode- rate to severe disability. Design: A pilot randomized control study. Subjects/patients: A total of 39 patients with neuro- myelitis optica spectrum disorder were randomized into intervention or control groups. Methods: The intervention group received multidis- ciplinary rehabilitation 5 times/week for 4 weeks in a hospital, and the patients were guided to con- tinue community- or home-based rehabilitation for 3 months. The control group did not receive any specific rehabilitation intervention. Disability was assessed using the Extended Disability Status Scale (EDSS) and Functional Systems (FS) scores after 4 weeks of rehabilitation and 3 months of follow-up. Results: The mean EDSS score was 7.5 at admissi- on for both groups. Improvements (p<0.05) in the EDSS score and domains of bowel, bladder and mo- tor functions (pyramidal and walking function) were noted in the multidisciplinary rehabilitation group after 4 weeks. After 3 months, the patients in the usual care group showed improvement in EDSS sco- re and walking ability score; however, no significant changes in other variables were noted. Conclusion: These results suggest that multidiscipli- nary rehabilitation potentially promotes motor fun- ctional recovery in patients with neuromyelitis op- tica spectrum disorders. Key words: neuromyelitis optica spectrum disorders; multi- disciplinary rehabilitation; disability. Accepted Jul 17, 2019; E-pub ahead of print Aug 16, 2019 J Rehabil Med 2019; 51: 692–697 Correspondence address: Li Yang, Department of Neurology and Tian- jin Neurological Institute, Tianjin Medical University General Hospital, Tianjin 300052, China. E-mail: [email protected] N euromyelitis optica (NMO) is an inflammatory disease of the central nervous system that selec- tively targets the optic nerve and spinal cord (1). In 2007, the term NMO spectrum disorders (NMOSD) was introduced to include AQP4-IgG-seropositive patients with limited or inaugural forms of NMO (e.g. first-attack longitudinally extensive transverse my- elitis (LETM) or recurrent or bilateral optic neuritis) who were at high risk of future attacks (2). NMOSD LAY ABSTRACT The aim of this study is to investigate the effects of multidisciplinary rehabilitation for patients with neuro- myelitis optica spectrum disorders who have moderate to severe disability. In 39 patients with neuromyelitis optica spectrum disorders, disability was assessed after 4 weeks of rehabilitation and 3 months of follow-up. In the patients who underwent multidisciplinary rehabilita- tion, bowel and bladder and motor functions (pyramidal and walking function) were improved compared with those with usual care. These results confirm the short- term effectiveness of multidisciplinary rehabilitation in patients with neuromyelitis optica spectrum disorders in terms of improving impairment. The results also sug- gest that multidisciplinary rehabilitation is a safe and feasible therapy for adults with neuromyelitis optica who have severe disability. is relatively frequent worldwide. In Asia, NMOSD represents approximately 50% of all demyelinating disorders (3). NMOSD displays a relapsing-remitting course (2), and severe disability remained after im- munotherapy with recurring relapse (4). Moreover, a large number of studies have shown that patients with multiple sclerosis, the most common demyelinating disorder of the central nervous system, can benefit from rehabilitation therapy (5–8). However, evidence regarding the benefits of rehabilitation in patients with NMOSD remains insufficient. EDSS is the standard for evaluating the clinical tre- atment of multiple sclerosis, while NMO and multiple sclerosis (MS) are both demyelinating diseases of the central nervous system. However, few studies have used the Expanded Disability Status Scale (EDSS) to evaluate disability after multidisciplinary rehabilitation (MDR) in patients with NMOSD. In addition, the effect of MDR treatment on NMOSD is unclear. Hence, the aims of this study were: (i) to evaluate the effective- ness of MDR rehabilitation therapy in patients with NMOSD; and (ii) to explore which functional systems may benefit from MDR in patients with NMOSD. MATERIALS AND METHODS Participants and clinical parameters A total of 39 consecutive patients with NMOSD were recruited from the Neurology Department of Tianjin Medical University This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm doi: 10.2340/16501977-2587 Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977