The effectiveness of neurological rehabi anon in multiple sclerosis

The difficulties inherent in demonstrating the effectiveness of an intervention that is as all-inclusive and poorly defined as neurorehabilitation, especially in a condition as unpredictable and variable as Multiple Sclerosis (MS), are not to be underestimated. They require strict adherence to rigorous methodology and, in particular, the consistent use of a range of clinically appropriate and scientifically sound measures of outcome . Incorporating this approach, it is possible to evaluate rehabilitation at four different levels, including (1) the broadest concept of service delivery; (2) packages of comprehensive care ; (3) individual components of the package; and finally, (4) the intrinsic elements of the rehabilitation process . Most recent studies have focused on in-patient rehabilitation and have demonstrated benefits across disability, handicap, and quality of life in patients with mild to severe disability. Such benefits persist following discharge into the community . Studies evaluating service delivery and components of the rehabilitation package are in progress, but few investigators have taken on the intrinsic elements or `black box' of rehabilitation . These recent studies underline the fact that the evaluation of rehabilitation is feasible . Such studies are important, not simply to justify funding but to ensure continuing improvement of the way in which MS is managed. Address all correspondence and requests for reprints to : Alan J . Thompson, Professor of Clinical Neurology and Neurorehabilitation, Institute of Neurology Queen Square, London WCIN 3BG ;email : A.Thompson@ion .ucl .ac.uk.