title: Client-centred therapy in multiple sclerosis: more intensive diagnostic evaluation and less intensive treatment.
abstract: OBJECTIVE
  Despite beneficial effects on communication and process measures, client-centred practice has been shown to result in poor functional outcomes. To examine a potential explanation for poor functional outcomes, this paper aims to assess whether in client-centred therapy more time is spent on diagnostic consultation and less time on actual treatment compared to usual care.
  
  
  METHODS
  A multicentre cluster randomised controlled trial was performed. Thirteen hospitals and rehabilitation centres, 29 therapists and 269 outpatients with multiple sclerosis participated. Measurements included an inventory of diagnostic and treatment goals, the number of sessions, therapy duration and therapy intensity.
  
  
  RESULTS
  In client-centred therapy, more sessions were used for diagnostic consultation (10.9% points difference, p = 0.030); the time needed to formulate the first treatment goal was longer (11.4 days difference, p = 0.041); there was a tendency towards more goals directed to diagnostic issues (0.69 goals difference, p = 0.056), spending more hours on indirect issues (1.16 h difference, p = 0.051) and towards a longer total therapy period (1.56 months difference, p = 0.058) than in usual care.
  
  
  CONCLUSIONS
  Client-centred therapy resulted in more intensive diagnostic evaluation and less intensive treatment. This suggests that client-centred therapy should be adjusted towards a more proportional distribution of time devoted to diagnostic evaluation versus actual treatment.
authors.affiliation: Department of Rehabilitation Medicine, VU University Medical Center, PO Box 7057, NL-1007 MB Amsterdam, The Netherlands. E-mail: i.eyssen@vumc.nl.
authors.forename: Isaline C J M
authors.initials: IC
authors.lastname: Eyssen
authors.forename: Joost
authors.initials: J
authors.lastname: Dekker
authors.forename: Vincent
authors.initials: V
authors.lastname: de Groot
authors.forename: Esther M J
authors.initials: EM
authors.lastname: Steultjens
authors.forename: Dirk L
authors.initials: DL
authors.lastname: Knol
authors.forename: Chris H
authors.initials: CH
authors.lastname: Polman
authors.forename: Martijn P M
authors.initials: MP
authors.lastname: Steultjens
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003142:Communication; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000534:rehabilitation*; D009788:Occupational Therapy; D010358:Patient Participation; D018802:Patient-Centered Care / Q000379:methods* / Q000706:statistics & numerical data; D016896:Treatment Outcome