Multidisciplinary rehabilitation for neuromyelitis optica spectrum disorders
of treatment, the trends in the FS were the same
as those at discharge, except that fatigue in the
cerebral (or mental) function score had improved
(from 2.0 to 1.0, p = 0.002; Table IV).
In the UC group, no significant differences in
the EDSS scores and FS scores were noted after
4 weeks (p > 0.05). However, significant improve-
ments in the EDSS scores, pyramidal function, and
walking function scores were noted after 3 months.
Table shows the differences in the changes in
median scores between the 2 groups at 4 weeks,
3 months and baseline.
695
DISCUSSION
This study demonstrated the benefit of MDR in
patients with disability resulting from NMOSD,
as assessed by EDSS and FS. The study also sug-
gested that MDR was effective in improving the
clinical status of patients with NMOSD in terms of
impairments. In the UC group, the EDSS score did
not change at 4 weeks and improved at 3 months,
which indicated that patients with MNOSD are taking
corticosteroids (1 month) and exhibit a certain degree
of self-healing ability (3 months) (17). The EDSS score
improved at 4 weeks after treatment in the MDR group,
which indicated that rehabilitation treatment promotes
or speeds up the patient’s recovery process. Moreover,
the results indicated that the bowel and bladder, pyra-
midal, and walking functions of patients with NMOSD
might recover after 4 weeks with MDR treatment.
To the best of our knowledge, this is the first study
investigating which FS may benefit more from MDR
treatment in an NMO population in MDR programmes.
Three previous studies (2 case reports and 1 research
article) described the rehabilitation outcomes of patients
with NMO. One case report on the effect of vibration
stimulation (VS) on NMO discovered that standing
up and walking performance improved with VS, and
this finding may support the hypothesis of neuronal
plasticity on central pattern generators by VS (18).
Plasticity is a result of the creation of new circuitry
Fig. 3. Extended Disability Status Scale (EDSS) and Functional System (FS)
scores for multidisciplinary rehabilitation (MDR) (n = 21) before and after 4
or 12 weeks of MDR treatment. Numbers are statistically reported as mean
and standard deviation (SD). ***p < 0.001; **p < 0.01; ***p < 0.05. FS-WA:
walking function. FS-PF: pyramidal functions. FS-SF: sensory functions.
FS-BB: bowel and bladder functions. FS-CF: cerebral (or mental) functions.
tistically significant baseline differences were found
between the 2 groups (p > 0.05). EDSS and FS scores
are shown in Table III and Fig. 3.
The results showed significant differences between
the 2 groups in EDSS total scores, walking ability
scores. Furthermore, the patients in the MDR group
recovered faster than those in the UC group. Neither the
patients in the MDR group nor those in the UC group
showed a statistically significant change in median
scores for sensory function.
Following the 4-week MDR treatment, a significant
improvement in the EDSS was observed compared
with that at admission in the MDR group (p < 0.001).
Moreover, in the subscale analyses, significant impro-
vements were demonstrated in bowel and bladder fun-
ction, pyramidal function, and walking function scores
in patients in the MDR group (2 to 1.5, p = 0.001; 4.0 to
3.0, p < 0.001; and 7.5 to 7.0, p = 0.003; respectively),
while sensory function and cerebral (or mental) func
tion remained unchanged (3 to 3, p = 0.083; 2.0 to 1.0,
p = 0.083; respectively). Furthermore, after 3 months
Table IV. Extended Disability Status Scale (EDSS) and Functional System (FS) scores to multidisciplinary rehabilitation (MDR) or usual
care (UC) 4 week after MDR
Between-group differences
0–4 weeks
∆score
Median (range)
0–3 months
∆score
Median (range)
4 weeks–3 months
∆score
Median (range)
EDSS and EDSS subscales UC MDR p-value UC MDR p-value UC MDR
EDSS
Walking ability
Pyramidal function
Sensory function
Bowel and bladder
Cerebral function 0
0
0
0
0
0 0.5 (0–3)
0.5 (0–2.5)
1 (0–2)
0 (0–1)
1 (0–2)
0 (0–1) < 0.001
0.014
0.002
0.876
0.450
0.356 0
0
0
0
0
0 1 (0–6)
0.5 (0–5.5)
1 (0–3)
0 (0–1)
1 (0–2)
1 (0–2) < 0.001
0.023
0.001
0.812
0.683
0.008 0
0
0
0
0
0 0
0
1
0
0
0
(0–0.5)
(0–0.5)
(0–1)
(0–1)
(0–1)
(0–1)
(0–0.5)
(0–0.5)
(0–1)
(0–1)
(0–2)
(0–1)
(0–0.5)
(0–0.5)
(0–1)
(0–0)
(0–1)
(0–1)
(0–3)
(0–3)
(0–1)
(0–1)
(0–2)
(0–1)
p-value
0.583
0.576
0.028
0.348
0.005
0.002
J Rehabil Med 51, 2019