While MS is highly variable, most patients experience functional losses and increasing impairment over time. Many people with MS face obstacles accessing rehabilitative services because of inadequate referrals and/or inadequate third-party coverage. Therefore, the National MS Society determined that a statement by its expert medical advisors was necessary to support the use of rehabilitative interventions and thus promote physician referral to these services and third-party coverage of them.

A number of studies have demonstrated positive outcomes of rehabilitation in people with MS, and data support the use of rehabilitative interventions for a number of specific MS impairments. Patients with MS who received multidisciplinary rehabilitation in addition to IV steroids demonstrated increased improvement in functional status, mobility, quality of life, and disability over those who received steroids alone.1 A study of the effect of inpatient rehabilitation on individuals with relapsing/remitting (RR) MS suggested that inpatient rehabilitation is useful for patients with incomplete recovery from relapses who have accumulated moderate to severe disability.2 Another study showed a significant decrease in length of stay in a rehabilitation inpatient unit for patients who were given more intensive rehabilitation therapies.3

Patients with progressive MS who received outpatient rehabilitation experienced reductions in fatigue and MS-related symptoms.4,5 Furthermore, a physiotherapy program conducted at home or in a hospital outpatient clinic resulted in significant improvements in mobility, subjective wellbeing, and mood in patients with chronic MS.6 This study suggests that ongoing physiotherapy might be necessary for sustaining improvement in mobility or prevention of deterioration. Other studies demonstrated positive impact of multidisciplinary rehabilitative care on the daily life of patients with multiple sclerosis.7,8

In studies regarding access to rehabilitation services by people with disabilities, respondents report difficulty in accessing services, largely due to insurance coverage limitations.9 Many insurance policies and state/federal regulations require that rehabilitation services be ‘restorative’ rather than oriented to maintenance of function and prevention of avoidable disability and complications. However, for individuals with chronic, progressive, or disabling conditions such as MS, maintenance therapy is critical. It is crucial for preserving overall health and functioning, maintaining independence, avoiding institutionalization, and preventing secondary medical conditions and the associated need for costly hospitalizations that may include surgeries.

While additional research is needed, recent findings—along with expert opinion and clinical experience—demonstrate the value of rehabilitation in MS. Physicians should prescribe appropriate rehabilitation therapies for their patients with MS and insurers should cover these therapies.

Process
The clinical care committee of the MAB of the National MS Society identified the need to develop and periodically update a formal position about rehabilitation as a necessary component of quality healthcare for people with MS at all stages of the disease. The MAB convened a multidisciplinary task force of MS experts to develop recommendations. The task force conducted a comprehensive review of the literature and compiled professional opinion based on the literature and clinical practice. The MAB’s Executive Committee provided final review and approval of the document.

Use of the Recommendations
The National MS Society rehabilitation and MS statement is an educational and advocacy tool. It will be a component of the Society’s professional education programs and will be used to promote increased access to rehabilitative therapies through legislative and regulatory determinations. It will serve as a communication device for interactions with insurers, both nationally and locally. It supports self-advocacy for persons with MS and will encourage them to talk with their healthcare providers and insurers about whether rehabilitation is indicated.

Role of the National Multiple Sclerosis Society
The mission of the National MS Society is to end the devastating effects of multiple sclerosis. Various strategies are employed to do so, including professional education and advocacy. As a representative body and advocate for people with MS and medical/health professionals who provide their care, the Society is positioned to provide structure and support for the development of an expert opinion document to facilitate access to rehabilitative therapies for disease management. The National MS Society has a nationwide network of chapters and regular contact with persons with MS and their families as well as with healthcare professionals. This extensive network and process for dissemination of information will ensure that the recommendations regarding rehabilitation and MS will be communicated to providers, insurers, and people with MS.