Controlled randomised crossover trial of the effects of physiotherapy on mobility in chronic multiple sclerosis

Objectives-To determine whether physiotherapy can improve mobility in chron ic multiple sclerosis and whether there is a difference between treatment a t home and as a hospital outpatient? Methods-A randomised controlled crossover trial was undertaken in patients with chronic multiple sclerosis who had difficulty walking and were referre d from neurology clinics: allocation was to one of six permutations of thre e 8 week treatment periods separated by 8 week intervals: treatments consis ted of physiotherapy at home, as an outpatient, or "no therapy". The main o utcome measures were based on independent assessments at home and included mobility related disability (primary outcome: the Rivermead mobility index) , gait impairments, arm function, mood, and subjective patient and carer ra tings. Therapy was assessed by recording delivery, achievement of set targe ts, patient and carer preference, and cost. Results-On the Rivermead mobility index (scale 0-15) (primary outcome) ther e was a highly significant (p<0.001) treatment effect of 1.4-1.5 units favo uring hospital or home based therapy over no therapy: this was supported by other measures of mobility, gait, balance, and the assessor's global "mobi lity change" score: there was no major difference between home and hospital . Carers preferred home treatment but neither they nor patients discerned g reater benefit there. Estimated costs of home physiotherapy were <pound>25/ session and those at hospital were pound 18 (including pound7 patient trave l costs). Conclusion-A course of physiotherapy is associated with improved mobility, subjective wellbeing, and improved mood in chronic multiple sclerosis compa red with no treatment but benefit may only last a few weeks: there is littl e to choose between home and hospital based therapy but the first is more c ostly, mainly due to skilled staff travelling time.