title: Rehabilitation in Multiple Sclerosis: A Systematic Review of Systematic Reviews.
abstract: OBJECTIVE
  To systematically evaluate existing evidence from published systematic reviews of clinical trials for the effectiveness of rehabilitation for improving function and participation in persons with multiple sclerosis (MS).
  
  
  METHODS
  A literature search was conducted using medical and health science electronic databases (MEDLINE, EMBASE, CINAHL, PubMed, Cochrane Library) up to January 31, 2016.
  
  
  METHODS
  Two reviewers independently applied inclusion criteria to select potential systematic reviews assessing the effectiveness of organized rehabilitation for persons with MS. Data were summarized for type of interventions, type of study designs included, outcome domains, method of data synthesis, and findings.
  
  
  METHODS
  Data were extracted by 2 reviewers independently for methodological quality using the Assessment of Multiple Systematic Reviews. Quality of evidence was critically appraised with the Grades of Recommendation, Assessment, Development, and Evaluation.
  
  
  RESULTS
  Thirty-nine systematic reviews (one with 2 reports) evaluated best evidence to date. There is "strong" evidence for physical therapy for improved activity and participation, and for exercise-based educational programs for the reduction of patient-reported fatigue. There is "moderate" evidence for multidisciplinary rehabilitation for longer-term gains at the levels of activity (disability) and participation, for cognitive-behavior therapy for the treatment of depression, and for information-provision interventions for improved patient knowledge. There is "limited" evidence for better patient outcomes using psychological and symptom management programs (fatigue, spasticity). For other rehabilitation interventions, the evidence is inconclusive because of limited methodologically robust studies.
  
  
  CONCLUSIONS
  Despite the range of rehabilitative treatments available for MS, there is a lack of high-quality evidence for many modalities. Further research is needed for effective rehabilitation approaches with appropriate study design, outcome measurement, type and intensity of modalities, and cost-effectiveness of these interventions.
authors.affiliation: Department of Rehabilitation Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. Electronic address: fary.khan@mh.org.au.
authors.forename: Fary
authors.initials: F
authors.lastname: Khan
authors.affiliation: Department of Rehabilitation Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors.forename: Bhasker
authors.initials: B
authors.lastname: Amatya
mesh_terms: D015928:Cognitive Behavioral Therapy / Q000379:methods; D005081:Exercise Therapy / Q000379:methods; D005221:Fatigue / Q000534:rehabilitation; D006801:Humans; D009103:Multiple Sclerosis / Q000534:rehabilitation*; D010353:Patient Education as Topic / Q000379:methods; D026741:Physical Therapy Modalities; D012196:Review Literature as Topic
keywords: Multiple sclerosis; Patient outcome assessment; Rehabilitation; Treatment outcome