Effects of rehabilitation on functional independence in daily life, exercise tolerance and quality of life in patients with relapsing-remitting multiple sclerosis

Abstract

Objective: to evaluate the efficacy of a comprehensive rehabilitation program on functional independence in daily life, exercise tolerance and quality of life (QoL) in patients with relapsing-remitting multiple sclerosis (RRMS) in remission.Material and methods. 38 patients with RRMS were analyzed (33 women and 5 men; age – 41.6±7.7 years; EDSS – 4.0 [3.5; 5.0] points, duration of MS – 8.0 [3.0; 21.0] years). The patients received comprehensive rehabilitation in a hospital for 2.5 weeks. The examination was carried out before and after the rehabilitation program. Independence in daily activities was assessed using the Functional Independence Scale, the Get Up and Go Test and the Berg Balance Scale. Exercise tolerance was determined using a cardiopulmonary exercise test (CPET) on a cycle ergometer. The following parameters were measured: oxygen consumption during exercise (VO2 peak oxygen uptake), percentage from the predicted VO2 peak (% pred VO2 peak) and maximal workload in metabolic units (MET). Walking speed was measured according to the Davis protocol in the SMART-D laboratory (Italy). QoL was determined using the SF-36 questionnaire, which assesses physical functioning (PF), general health (GH), vital activity (VT) and social functioning (SF). Cognitive functioning was assessed using the Montreal Cognitive Scale (MoCA) and depression using the Beck Depression Inventory (BDI). Results. After completion of the rehabilitation course, there was a significant increase in VO2 peak (from 18.8±3.8 to 20.4±4.3 ml/kg/min), % pred VO2 peak (from 59±13 to 63±14%), maximal workload (from 5.4±1.2 to 5.8±1.2 MET), maximal heart rate (from 140±14 to 147±13) and walking speed (from 0.84±0.29 to 0.97±0.28 m/s). At the same time, despite an improvement the patients did not reach the age- and gender adjusted reference values for exercise tolerance. QoL indicators also increased, reaching or exceeding the populational values obtained for the Russian population: PF – from 45 to 52.2; GH – from 51 to 52; VT – from 45 to 50; SF – from 62.5 to 75. The number of points on the BDI also decreased significantly (from 9 to 6), and the increase on the MoCA scale had tendency to significant difference (p=0.064). Conclusion. A comprehensive rehabilitation program in patients with RRMS in remission helps to increase exercise tolerance and improve functional independence and QoL.