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Occupational Therapy Interventions in Adults with Multiple Sclerosis or Amyotrophic Lateral Sclerosis: A Scoping Review

Luis de-bernardi-ojuel.

1 Department of Public Health, History of Medicine and Gynecology, University Miguel Hernández, 03550 Alicante, Spain; moc.liamg@leujoidranrebedsiul (L.D.-B.-O.); se.hmu@ilonam (M.G.-d.-l.-H.)

Laura Torres-Collado

2 Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain

3 Alicante Institute for Health and Biomedical Research, ISABIAL-UMH, 03010 Alicante, Spain

Manuela García-de-la-Hera

Associated data.

All data is presented in this article. Researchers can contact authors regarding any request about the data.

This scoping review aims to describe occupational therapy interventions carried out with multiple sclerosis (MS) and amyotrophic lateral sclerosis (ALS) patients in occupational therapy. A peer review of the literature was conducted in different databases: Pubmed, Scopus, Web of Science and Embase, and in some occupational therapy journals. A search of the literature published was carried out before December 2019. The inclusion criteria were as follows: (1) articles evaluating the intervention of occupational therapy in MS or ALS including experimental, randomized, nonrandomized and exploratory studies; (2) written in English or Spanish; (3) adult population (over 18 years old). The initial search identified 836 articles of which we included 32 divided into four areas of intervention: fatigue-targeted interventions, cognitive interventions, physical interventions and others. Only 16 studies were carried out exclusively by occupational therapists. Most occupational therapy interventions are aimed at fatigue and physical rehabilitation. The majority of the studies in our review included MS patients, with little representation from the ALS population. These interventions have shown an improvement in perceived fatigue, manual dexterity, falls prevention and improvement in cognitive aspects such as memory, communication, depression and quality of life in the MS and ALS populations.

1. Introduction

Multiple sclerosis (MS) and amyotrophic lateral sclerosis (ALS) are neurodegenerative diseases of the nervous system [ 1 , 2 ]. These diseases have a medium to high prevalence, but recently published epidemiological studies have shown an increasing incidence and prevalence of MS and ALS in different populations worldwide [ 3 , 4 , 5 ]. Globally, in the case of MS, the incidence is 2.5 per 100,000 inhabitants, while in ALS it is between 0.6 and 3.8 per 100,000 inhabitants, although the age of onset is later than in MS [ 3 , 6 ]. Though the origin of the diseases is unknown, previous studies have ruled out risk factors such as geographical latitude or ethnicity [ 7 ], while other studies suggest that having a family member with these diseases can increase the risk of developing them [ 8 ]. However, the mechanisms and causes for their development are not completely understood.

These diseases affect not only quality of life but also physical and cognitive aspects, increasing fatigue and the probability of suffering from depression [ 9 ]. They can include multiple symptoms such as muscle stiffness, paralysis of the lower and upper limbs, sensory dysfunction, visual problems, ataxia, dysarthria or dysphagia [ 10 ] as well as cognitive impairment and psychological problems in the affected persons [ 2 , 11 , 12 ]. These diseases have a multidimensional impact on a person´s life, and their symptoms imply a significant loss of autonomy which greatly affects their occupational performance [ 11 ].

The treatment of these diseases is carried out by multidisciplinary teams [ 11 , 13 ] and it can be pharmacological [ 14 ] and/or nonpharmacological. In nonpharmacological treatment, there are specific interventions aimed at physical rehabilitation such as electro-stimulation or Proprioceptive Neuromuscular Facilitation (PNF) [ 15 ]; there are also interventions to maintain daily life skills and others aimed at psychological or cognitive rehabilitation with the participation of occupational therapist [ 11 , 13 ]. Regarding cognitive intervention, Lincoln et al., carried out a comparative study based on attention and memory which resulted in an improvement in memory and lifestyle in the experimental group compared to the control group [ 16 ].

Some previous occupational therapy studies have proposed psychosocial promotion interventions [ 17 , 18 ] such as the Community Reintegration for Socially Isolated Patients (CRISP) occupation-based intervention, which used education and self-management strategies in MS patients, performing socializing and recreation activities to improve self-efficacy and to reduce perceptions of loneliness [ 18 ]. Other studies have proposed cognitive rehabilitation interventions to maintain everyday tasks [ 19 ], meal preparation and finance management [ 20 ]. Finally, it should be pointed out that the majority of the studies led by occupational therapist in the treatment of MS were based on Packer and colleagues’ fatigue management intervention. These studies were carried out for both inpatients [ 21 ] and outpatients [ 22 ] and they all sought to maintain or improve the patients´ occupational performance and quality of life, and to improve muscle strength, energy levels as well as other more cognitive aspects [ 11 ].

MS and ALS have a significant impact on people´s activity and participation [ 11 , 12 ]. Recent reviews showed that occupational therapy could improve occupational performance and other outcomes in MS and ALS populations [ 23 , 24 ]. Nevertheless, these reviews focused on the effectiveness of occupational therapy intervention and contained little information about the activities performed and the role of occupational therapists in the intervention. In this sense, several key gaps in the literature impair a complete understanding of how all previously published interventions in MS and ALS with the participation of occupational therapists, were carried out. We would like to underline that this scoping review provides occupational therapists with tools to perform evidence-based interventions, due to an updated summary of previous evidence that exists on MS and ALS interventions. Thus, we aim to describe those interventions carried out with MS and ALS patients in occupational therapy. In particular, we want to answer the following question: Which interventions are performed from occupational therapy in adult people with MS or ALS?

2. Materials and Methods

A search of the literature published before December 2019 was undertaken by two independent reviewers following the recommendations of the Cochrane Manual [ 25 ], the Joanna Briggs Institute [ 26 ] and PRISMA Extension for Scoping Reviews (PRISMA-ScR) [ 27 ]. The same strategy and key words were used in the different bases: “occupational therapy” and “intervention” and “sclerosis” ( Table 1 ).

Database and search strategy.

We searched the literature in 4 databases: Pubmed, Scopus, Web of Science and Embase, and in first-quartile Occupational Therapy scientific journals according to Scimago journal rank in 2018 (American Journal of Occupational Therapy, Journal of Occupational Rehabilitation, Physical & Occupational Therapy in Pediatrics and OTJR: Occupation, Participation and Health). In addition, we performed a search in the grey literature in TESEO to identify possible unpublished studies.

The inclusion criteria were as follows: (1) articles evaluating the intervention of occupational therapy in MS or ALS including experimental, randomized, nonrandomized and exploratory studies; (2) written in English or Spanish; (3) adult population (over 18 years old). We excluded the following: (1) qualitative studies; (2) studies with no abstract, no full text or not available.

Study selection and data extraction of the information were carried out independently. We migrated the results from the databases to a Microsoft Excel spreadsheet where inclusion and exclusion decisions were recorded. The two reviewers (LB and LT) independently selected articles based on the selection criteria. Any disagreement between them regarding possible inclusion/exclusion criteria was resolved by a third reviewer (MG). LB and LT only had discrepancies regarding the inclusion of one article, and with the intervention of a third reviewer we decided to exclude it.

The search strategies identified a total of 836 articles and, after conducting the peer review, 58 articles were selected for their retrieval and evaluation of the full text. We excluded 26 articles, as they did not fulfil the inclusion criteria, leaving 32 articles for data analysis and extraction. The flow chart is shown in Figure 1 .

An external file that holds a picture, illustration, etc.
Object name is ijerph-18-01432-g001.jpg

Flowchart of the study selection process.

The 32 selected studies were conducted in different countries: in USA ( n = 12), Belgium ( n = 4), Netherlands ( n = 3), Switzerland ( n = 3), Spain ( n = 2), Italy ( n = 2), and the remaining 6 studies were conducted in Cuba, Ireland, United Kingdom, Israel, Iran and Austria. A total of 29 studies were carried out in MS patients and only three studies were carried out in ALS patients. A total of 16 studies were led exclusively by occupational therapists and the remaining studies were carried out by multidisciplinary teams, including neurologists, neuropsychologists, social workers or experts in certain fields such as assisted technology or mathematics.

The main limitations reported by included studies were small sample size, lack of long-term evaluation of the intervention, lack of randomization and low generalizability of the results. Table 2 presents the characteristics and information of the included studies: author, year, country where study was conducted, objective of study, sample, intervention, standardized proof used, main results and conclusions of study following Cochrane Manual recommendations [ 25 ].

Main characteristics of the studies included in the review.

MS: Multiple sclerosis, ALS: Amyotrophic Lateral Sclerosis, IG: Intervention group, CG: Control group, QoL: Quality of life, OT: Occupational therapy, SPT: speed of processing training, vs: versus, SMOoTh: self-management occupational therapy intervention, COPM: Canadian Occupational Performance Measure, IEME: inpatient energy management education.

We observed that intervention studies conducted in MS and ALS patients could be classified into four clearly differentiated areas: fatigue, physical rehabilitation, cognitive interventions and others. The full description of these interventions are presented in Table 3 .

Characteristics of the interventions performed in the studies included in this scoping review.

* ALS intervention; OT: Occupational therapy; OTs: Occupational therapist; NS:Not stated; BCI: Brain computer interface; ACS: Activity Card Sort; ALSFRS: Amyotrophic Lateral Sclerosis Functional Rating Scale; AQ: Awareness Questionnaire; ARAT: Action Research Arm Test; BBT: Box and Block Test; BI: Barthel Index; BRIEF-A: Behavior Rating Inventory of Executive Function; BVMT-R: Brief Visuospatial Memory Test-Revised; CAHAI: Chedoke Arm and Hand Activity Inventory; CDP: Computerized dynamic posturography; CHART-R: Craig Handicap Assessment and RatingTechnique-Revised; CIS-20R: Checklist Individual Strength; CMDI: Chicago Multiscale Depression Inventory; CMSEQ: Cognitive Management Self-Efficacy Questionnaire; CMT: Contextual Memory Test; COM: Center Of Mass; COPM: Canadian Occupational Performance Measure; CRT: Coin Rotation Task; CVLT-II: California Verbal Learning Test–2nd Edition; CSQ: Cognitive Strategies Questionnaire; DASS: Depression Anxiety and Stress Scale; DIP: Disability and Impact profile; ECGP: Evaluation of the Client-Centered Process; ECSS: Energy Conservation Strategies Survey; EDSS: Expanded Disability Status Score; EMQ-R: Everyday Memory Questionnaire-Revised; FAMS: Functional Assessment of Multiple Sclerosis; FBP: Functional behavior profile; FCS: Falls Control Scale; FDT: Functional Dexterity Test; FES: Falls Efficacy Scale; FIM: Functional Independence Measure; FIS: Fatigue Impact Scale; FMS: Falls Management Scale; FPMQ: Falls Prevention and Management Questionnaire; FPSS: Fall Prevention Strategies Survey; FSMC: Fatigue Scale of Motor and Cognitive Functions; FSS: Fatigue Severity Scale; FVC: Forced Vital Capacity; GAS: Goal Attainment Scaling; GES: Generalized Self-Efficacy Scale; GPT: Grooved Pegboard Test; HADS: Hospital Anxiety and Depression Scale; IPA: Impact on Participation and Autonomy; JTT: Jebsen- Taylor Hand Function Test; LC: Letter Comparison; MAM-36: Manual Ability Measure; MCA: Measure Change Assessment; MCT: Motor Control Test; MIST: Memory for Intentions Test; MFIS: Modified Fatigue Impact Scale; MFQ: Memory Functioning Questionnaire; MQoL-it: Italian version of McGill Quality of Life Questionnaire; MSFC: Multiple Sclerosis Functional Composite; MS-SFS: Multiple Sclerosis- Specific Fatigue Scale; NEADLS: Nottingham Extended Activity of Daily Living Scale; NHPT: Nine Hole Peg Test; OSA-DLS: Occupational Self-Assessment-Daily Living Scales; PAL: Personal Activity Log; PC: Pattern Comparison; PES: Pain Effects Scale; PPT: Purdue Pegboard Test; PSQI: Pittsburgh Sleep Quality Index; MSIS-29: Multiple Sclerosis Impact Scale; PW-BI: Personal Well-Being Index; RBMT-E: Rivermead Behavioral Memory Test- Extended; RMI: Rivermead Mobility Index; SDMT: Symbol Digit Modality Test; SEA: Self-Efficacy for Performing Energy Conservation Strategies Assessment; SECQ: Self-efficacy for Energy Conservation Questionnaire; SEG: Self-Efficacy Gauge; SEPECSA: Self-Efficacy for Performing Energy Conservation Strategies Assessment; SOT: Sensory Organization Test; S-RSD: Self- Rating Scale for Depression; SRSI: Self-Regulation Skills Interview; SF-36: Study Short-Form Health Survey; TEMPA: Test d’Évaluation des Membres Supérieurs des Personnes Âgées; TDP: Two Discrimination Points; TMT: Trail Making Test; TIADL: Timed Instrumental Activities of Daily Living Test; UWSES: University of Washington Self-Efficacy Scale; VAS: Visual Analog Scale; WAIS-III: Wechsler Adult Intelligence Scale-III. Session duration is reported where available.

The articles analyzed were classified into four clearly differentiated areas: (1) interventions for fatigue and energy conservation; (2) cognitive interventions; (3) physical interventions; and (4) other interventions. The fully description of OT intervention carried out in MS and ALS is shown in Table 3 .

3.1. Interventions in Fatigue and Energy Conservation

Twelve studies conducted interventions related to energy and impact on fatigue in people with MS. The results of these interventions are described in Table 2 . Seven of these studies were based on the fatigue management program developed by Packer et al. [ 28 ], which consists of a 12 h intervention for people with MS and includes a balanced lifestyle, rest, posture and efficient communication, among other aspects [ 29 , 30 , 31 , 32 , 33 , 34 , 35 ]. Another study modified Packer´s program and evaluated these interventions nonpresentially by monitoring patients either through teleconferences, applications or on the internet [ 36 ].

In addition, several authors examined the effectiveness of physiotherapy and diet interventions aimed at fatigue carried out by a multidisciplinary team, including occupational therapists [ 37 , 38 ]. Other authors proposed different intervention programs [ 39 , 40 ] based on changes in daily occupational performance and proposed strategies related to occupational balance, activity, fatigue, energy account, goals or effective communication.

We did not identify studies carried out in fatigue and energy conservation in ALS patients.

3.2. Cognitive Interventions

Six studies carried out cognitive interventions. A full description intervention appear in Table 3 .

Of these studies, two included the use of technology to facilitate communication and automated control at home [ 19 , 41 ] to evaluated the functional performance which increased significantly with PDA use [ 18 ]. The remaining studies evaluated interventions related to improvement of memory, attention, processing speed and strategies to compensate these cognitive strategies [ 20 , 42 , 43 , 44 ] with different results ( Table 2 )

Only one study was carried out in people with ALS [ 41 ]. This study evaluated the feasibility and usability of an assistive technology prototype in users who have different degrees of muscular impairment to improve interaction with environment.

3.3. Physical Interventions

Of a total of ten articles describing interventions in relation to physical condition, nine focused on MS patients and one on ALS patients, only 2 were led by occupational therapists. The results and the details of interventions are shown in Table 2 and Table 3 .

In the MS focused studies, we identified three categories: upper limb recovery, physical rehabilitation and falls prevention.

In the first category, four of the studies focused on upper limb recovery, both at the level of sensory re-education and at that of improvement in manual dexterity in MS [ 45 , 46 , 47 , 48 ]. Another study assessed an intervention program to improve the physical resistance of MS patients [ 49 ].

In the second category, two other MS focused studies aimed at physical rehabilitation were carried out using new technologies such as virtual reality [ 50 ] or images and videos [ 51 ].

Finally, the third category included two intervention studies which evaluated programs to decrease falls risk in MS patients, by sending them information related to falls and how to avoid them [ 52 ] or by giving them tape training sessions in order to improve balance reactions [ 53 ].

In relation to the ALS focused study, Gómez-Fernández et al., assessed the effectiveness of a multifactorial program by working on different aspects such as breathing, posture control or transfers using a multidisciplinary approach [ 54 ] which showed that ALS patients improved significantly on forced vital capacity.

3.4. Other Interventions

Four articles did not fit into any of the previous categories. Of these, three studies focused on MS patients.

Two of the studies focusing on MS assessed client-centered practice intervention in people with MS patients to evaluate disability, autonomy and participation in daily life with no significant effects in these outcomes [ 55 , 56 ]. Another of these studies, led by Block et al., assessed the effectiveness of health promotion in people with MS which worked on different aspects such as the empowerment of the person [ 57 ]. This study showed significant improvements in self-efficacy and ability to achieve objectives [ 57 ].

The one study focusing in ALS evaluated the impact of music therapy programs on psychological aspects such as depression and anxiety [ 58 ]. In this study, occupational therapists stimulates patients to communicate using instruments and express emotions with positive results in quality of life.

4. Discussion

This scoping review describes different occupational therapy interventions carried out in MS and ALS patients. These interventions were mainly focused on physical rehabilitation, cognitive rehabilitation and reducing fatigue. Although some of the interventions included in this review were not exclusively led by occupational therapists, they can use these interventions to facilitate the occupational therapy evidence-based interventions. This review shows that the majority of occupational therapy interventions are performed on MS patients while there is little information about ALS patients. In fact, few intervention studies led by occupational therapists have been found.

4.1. Fatigue Interventions and Energy Conservation

This study shows that certain occupational therapy interventions for MS and ALS patients could be effective in improving different outcomes. The majority of the studies identified in this scoping review were fatigue interventions carried out in MS patients. In our search we found that studies principally focused on fatigue are based on the Packer et al. program [ 28 ]. This fatigue program is a six-week energy conservation course, which was designed for adults suffering from fatigue as a symptom of chronic disease [ 28 ]. In this program occupational therapists educated participants in the benefits of breaking up high-energy tasks by incorporating rest periods into their daily activities [ 28 ]. In addition, we observed several studies that included the Packer et al. energy conservation course with some adaptations. Lamb et al. found that patients using self-study material in nonpresential sessions, and who had missed some sessions, obtained similar benefits regarding energy and fatigue management to those whose sessions were guided by a professional and who fully completed the intervention [ 31 ]. Similarly, Sauter et al., adapted the fatigue management program to the German population and showed improvements in users´physical and mental fatigue. Subsequent studies [ 33 , 34 ] modified the Packer et al. fatigue management course [ 28 ] so that it could be delivered by teleconference and online for people with MS who had problems accessing treatment, leading to an improvement in fatigue and quality of life [ 33 , 34 ]. The therapy showed significant improvements in fatigue management even when participants were guided via technological devices [ 29 , 30 , 31 , 32 , 33 , 34 , 35 ]. In a similar way, D´hooghe et al., developed a course related to a fatigue management program using a smartphone to provide monitoring, motivational messaging and the establishment of objectives [ 36 ]. The results showed that this type of intervention can be complementary to conventional treatment to reduce fatigue [ 36 ]. Overall, according to the previous evidence, the use of new technologies seems to be a good treatment option.

Conversely, other studies explored fatigue management using different multidisciplinary interventions related to personal care. Rietberg et al. evaluated an intervention carried out by multidisciplinary professions including physical therapy, social work and occupational therapy which applied fatigue management strategies and personal care as compared with only nurse consultation and found that multidisciplinary rehabilitation did not lead to a more effective reduction of self-reported fatigue [ 37 ]. In the same line, Kos et al. evaluated a multidisciplinary fatigue management program intervention comparing it with an intervention program based on sleep advice and relaxation exercises [ 38 ]. It should be pointed out that neither of the two multidisciplinary interventions explored by these authors showed significant results. This could be because chronic fatigue does not improve significantly over time in MS patients only with personal care advice [ 37 ]. All interventions were conducted solely by occupational therapists, except for the multidisciplinary interventions and the D´hooghe et al. program [ 36 ], in which technology experts collaborated with occupational therapists.

Other authors have proposed other intervention programs [ 39 , 40 ] based on changes in daily occupational performance such as rest management and the proposal of strategies in relation to the management of instrumental activities such as childcare or shopping, that suggest significant improvements in performance, perceived fatigue and individual satisfaction [ 39 , 40 ].

It must be emphasized that fatigue is one of the most frequently reported symptoms in MS patients and can affect their occupational performance [ 59 ]. In this sense, a recent review [ 60 ] showed that patient-reported outcomes (PROs) are increasingly used in MS treatment. PROs not only describes symptoms, function and health status in MS patients but also evaluates the impact of this disease and assess the concerns on MS patient´s life [ 60 ].

Fatigue intervention in the included studies was found to be effective in reducing fatigue, managing fatigue symptoms and improving different aspects such as health-related quality of life [ 12 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 39 , 40 ]. Thus, it is essential that occupational therapy interventions should include fatigue intervention in daily practice with MS and ALS patients.

4.2. Cognitive Interventions

With regard to cognitive interventions, we identified six studies in MS and ALS treatment of which three were conducted exclusively by occupational therapists. In MS interventions, Tony Gentry et al., evaluated a program with PDAs that resulted in an improvement of the person´s functional performance and satisfaction using PDA as a compensation for cognitive deficits [ 19 ]. The remaining cognitive interventions [ 20 , 42 , 43 , 44 ] were related to improving memory, attention, processing speed and strategies to compensate this deficit. Among them, Goverover et al., evaluated the effectiveness of a cognitive strategies program, through visual supports when memorizing words, which showed improvements in memory, learning, depressive symptomatology and quality of life [ 20 ]. Only one cognitive intervention was identified for ALS. Schettini et al., evaluated the reliability of an assistive technology device for home automation control and communication, and there were no significant improvements. This could be due to the fact that the sample included only eight people, which may be too small to provide strong evidence [ 41 ].

Overall, although cognitive interventions in MS and ALS have scarcely been analyzed, these studies show that cognitive interventions in this type of population have significant beneficial effects in functional performance, depression and quality of life [ 12 , 19 , 20 , 42 , 43 , 44 ]. However, these results should be interpreted with caution because the samples in most of the studies described were small and there is no evidence regarding their long-term effects on functional performance [ 41 , 42 , 43 ]. In addition, it also should have taken into account that there is a lack of information about the effectiveness of these interventions in the progressive forms of MS [ 61 ], and there is no evidence about therapeutic intervention to enhance cognitive performances in MS patients [ 62 ]. Thus, more studies are needed.

4.3. Physical Interventions

Evidence based on different physical therapeutic modalities suggested that interventions improve different functional outcomes (manual dexterity), reduce fatigue and improve quality of life [ 12 , 23 ]. All the studies focused on upper limb recovery were carried out in MS patients. Lamers et al., evaluated the ideal intensity in an upper limb recovery program, showing a positive result, although no overall intensity was established [ 45 ]. Kamm et al., conducted a program to improve manual dexterity with exercises using fingers, coins, paper and pencil, and clay, showing improvements in fine motor skills in the experimental group [ 46 ]. In the same way Waliño-Paniagua et al., evaluated manual dexterity with virtual reality games in comparison with conventional occupational therapy, showing significant differences. These interventions could also be used as complementary activities in occupational therapy [ 47 ]. Finally, Kalron et al., conducted a sensory re-education with tubes of different textures and thickness, showing an improvement in manual dexterity and, although sensitivity did not improve, this program may help to prevent deterioration in manual dexterity in early stages of rehabilitation [ 48 ]. It should be pointed out that evidence-based rehabilitation for upper limb recovery are essential for improving performance in daily tasks [ 23 ]. Thus, occupational therapists could carry out this evidence-based intervention in MS and ALS patients.

With respect to physical rehabilitation interventions, Bansi et al., evaluated physical rehabilitation with cycle-ergometers or aquatic- bikes in two groups, showing an improvement in quality of life and fatigue [ 49 ]. Another study examined virtual reality rehabilitation with strength and proprioception exercises on unstable surfaces and muscle-tendon stretching, showing significant improvements at the motor level, which suggests that it could be an alternative treatment [ 50 ]. In the same line, Bovend´Eerdt et al., assessed a film and image presentation program with exercise information and guided rehabilitation strategies [ 51 ]. This intervention did not provide valid results because participants did not perform the program in the established time, although there were significant differences after the intervention [ 51 ].

We only identified one study in ALS patients, where Gómez-Fernández et al., examined a multifactorial program in ALS, through postural control exercises, exercises with lips, breathing, walking or psycho-emotional support that showed significant improvements in forced vital capacity [ 54 ]. However, the sample is very small, which could cast doubt on the results [ 54 ].

Regarding the interventions aimed at falls prevention, previous studies carried out programs either by receiving information about falls, strategies and changes in the environment [ 52 ], or by treadmill with caused imbalance [ 53 ]. Both studies showed a decrease in falls in MS patients.

4.4. Other Interventions

Evidence for other interventions was limited. We included four articles in this category because they did not fit into any of the previous categories. In this category, Eyssen et al., explored the effectiveness of client centered practice, comparing it with a control group that received conventional occupational therapy practice [ 55 , 56 ]. The results showed no significant improvements in participants, possibly because more time was spent on evaluation than on intervention, resulting in a less effective recovery. Therefore, this type of practice is not recommended [ 55 , 56 ].

There is currently only limited evidence for the effectiveness of the role of environment in the experience of disability. However, the project Shake-it-up explored the effectiveness of health promotion which works on aspects such as self-efficacy and empowerment among others and found a significant improvement in these aspects [ 57 ]. These results could be useful for occupational therapists in their routine work in order to improve the independence, community access and participation of MS and ALS patients.

Finally, we also found one study which assessed the impact of music therapy in ALS, participants interacted with different instruments to express their emotions and communicate, showing an improvement in their quality of life [ 58 ]. These findings suggest that there is a need for better designed intervention studies which explore the impact of music therapy on other symptoms in ALS and MS patients.

4.5. Study Limitations

This study has a number of limitations. First, regarding inclusion criteria, we only included studies published in English or Spanish and those with full text available. Second, the articles included in this review were experimental studies and might contain biases associated with the experimental study design. Furthermore, the heterogeneity of the included studies meant that they were not comparable in terms of sessions, hours and study objectives. The generally limited study sample size of some included studies means that the results should be interpreted with caution. Third, like other authors in their respective scoping reviews, we did not critically assess the quality of the included studies, because this is not the role of a scoping review [ 63 ]. However, we mentioned the limitations of some of the studies in the discussion section. Finally, it should be pointed out that some studies did not clearly specify which professionals participated in the intervention or what their role in the study was. Thus, more studies are needed that specify the role of the researchers in the interventions, including those which are led by occupational therapists.

However, this review also has several strengths. To the best of our knowledge, it is the first study with the aim of describing the main occupational therapy interventions carried out in MS and ALS. In addition, this scoping review highlights the gaps in our knowledge: (i) there is no evidence regarding occupational therapy interventions carried out in Spain; (ii) most of the studies had small sample sizes and a lack of randomization; (iii) there is little evidence about long-terms interventions; and (iv) there is a need to determine the role of the different professionals in the multidisciplinary teams. These identified gaps of knowledge might be dealt with in future research.

This study provides the professionals with a description of therapies in MS and ALS that can support the use of early therapeutic interventions aimed at optimizing outcomes in this population. The included studies in this review showed that occupational therapists can not only collaborate in the multidisciplinary intervention but can also lead different interventions in MS and ALS. This review suggests that occupational therapy is a relevant discipline for MS and ALS patients’ rehabilitation. The main intervention led by occupational therapists is fatigue management, which showed beneficial effects in MS patients, but occupational therapists could also carry out psychosocial, physical and emotional interventions in this population. In addition, we would like to underline that the updated summary of previous evidence carried out in this scoping review provides knowledge to facilitate occupational therapy evidence-based interventions.

Finally, our findings add new insights about the potentially beneficial role of physical rehabilitation, fatigue and cognitive interventions, and could inform future evidence-based guidelines for ML and ALS patients.

5. Conclusions

In conclusion, most studies were conducted in the MS population, with little representation from the ALS population. The main interventions in occupational therapy were those aimed at fatigue, cognitive interventions and physical rehabilitation. These interventions have shown an improvement in perceived fatigue, manual dexterity, falls prevention and in cognitive aspects such as memory, communication, depression and quality of life in the MS and ALS population. It should be pointed out that some of the interventions included in this review are not exclusive to occupational therapy practice. However, occupational therapy professionals can use these interventions in patients with MS and ALS, and they can help patients to incorporate activities and occupations into their intervention patterns.

Acknowledgments

We would like to acknowledge the English revision made by Jessica Gorlin and María del Mar Freniche Zanari.

Author Contributions

All authors contributed to the conception or design of the review and to the data analysis and interpretation. M.G.-d.-l.-H. coordinated the scoping review. L.T.-C. and L.D.-B.-O. conducted a peer-reviewed search and screening study. L.D.-B.-O. wrote the first draft of the paper and M.G.-d.-l.-H. and L.T.-C. provided critical revision of the article. All authors have read and agreed to the published version of the manuscript.

This research was funded by grants from Alicante Institute for Health and Biomedical Research, ISABIAL (UGT_18_453, UGP-19-490, and UGT_19_252).

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Data availability statement, conflicts of interest.

The authors declare no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Chih-Huang Yu , Virgil Mathiowetz; Systematic Review of Occupational Therapy–Related Interventions for People With Multiple Sclerosis: Part 1. Activity and Participation. Am J Occup Ther January/February 2014, Vol. 68(1), 27–32. doi: https://doi.org/10.5014/ajot.2014.008672

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This article is the first part of a systematic review of studies on occupational therapy–related intervention for people with multiple sclerosis (MS). The objective of this systematic review was to critically appraise and synthesize the applicable findings to address the following focused question: What is the evidence for the effectiveness of interventions within the scope of occupational therapy practice for people with multiple sclerosis? This article focuses on occupational therapy interventions aimed at activity and participation, including programs (e.g., inpatient and outpatient rehabilitation) in which an occupational therapy practitioner was one member of the team. Part 2 (Yu & Mathiowetz, 2014) focuses on interventions within the scope of occupational therapy to remediate impairment (e.g., exercise, cognition, emotional regulation).

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Occupational therapy in multiple sclerosis

This is a protocol for a Cochrane Review (intervention). The objectives are as follows:

To assess the benefits and harms of occupational therapy interventions for improving daily functioning, participation, and quality of life in people with multiple sclerosis.

To assess whether the effects of occupational therapy interventions differ according to the format of intervention delivery (individually versus group) and to the location of service delivery (outpatient, inpatient, or home-based therapy).

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  • http://orcid.org/0000-0002-2821-9042 Bruno Kusznir Vitturi 1 ,
  • Alborz Rahmani 1 ,
  • http://orcid.org/0000-0002-0497-4879 Guglielmo Dini 1 , 2 ,
  • Alfredo Montecucco 1 , 2 ,
  • Nicoletta Debarbieri 2 ,
  • Elvira Sbragia 2 , 3 ,
  • Paolo Bandiera 4 ,
  • Michela Ponzio 5 ,
  • Mario Alberto Battaglia 5 , 6 , 7 ,
  • Tommaso Manacorda 4 ,
  • Benedetta Persechino 8 ,
  • Giuliana Buresti 8 ,
  • Matilde Inglese 2 , 3 ,
  • http://orcid.org/0000-0001-5047-5176 Paolo Durando 1 , 2
  • 1 Department of Health Sciences , University of Genoa , Genoa , Italy
  • 2 Occupational Medicine Unit , IRCCS Ospedale Policlinico San Martino , Genoa , Italy
  • 3 Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) and Center of Excellence for Biomedical Research (CEBR) , University of Genoa , Genoa , Italy
  • 4 Italian Multiple Sclerosis Association (AISM) , Genoa , Italy
  • 5 Research Area , Italian Multiple Sclerosis Association , Genoa , Italy
  • 6 Italian Multiple Sclerosis Foundation (FISM) , Genova , Italy
  • 7 Department of Life Science , University of Siena , Siena , Italy
  • 8 Italian Workers' Compensation Authority (INAIL) , Rome , Italy
  • Correspondence to Bruno Kusznir Vitturi; z_azul{at}hotmail.com

Objectives To update the knowledge on the occupational outcomes associated with multiple sclerosis (MS), systematically examine the extent, scope and nature of the pre-existing literature and identify research gaps in the existing literature.

Design Scoping review.

Data sources A comprehensive database search of PubMed/MEDLINE, Scopus, SciVerse ScienceDirect and Web of Science was performed. There were no time limits.

Eligibility criteria We included any peer-reviewed original article reporting the occupational outcomes of people with MS between the ages of 18 and 65 years. We excluded those off-topic and with insufficient information.

Methods This review was conducted following the Joanna Briggs Institute recommendations and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for scoping review checklist. Screening, reading of full-texts and data extraction was performed in a standardised way by expert reviewers from 14 July 2021 to 31 October 2021. We provided a narrative synthesis and an overview of findings.

Results The initial systematic search yielded 104 228 results. After removing duplicates and applying the exclusion criteria, 403 articles were included in the review. In total, the studies evaluated 492 062 subjects with MS. One hundred fifty-four (38.2%) articles were published in the last 5 years, mostly from Europe and North America (50.9% and 33.0%, respectively). Concerning the occupational outcomes, studies mostly addressed unemployment (311, 77.2%), early retirement (120, 29.8%), disability pension (117, 29.0%), sick leave (77, 19.1%), the indirect cost of MS (74, 18.4%) and work characteristics (57, 14.1%). The results were categorised into seven subtopics: ‘Changes in work and occupational status due to MS’, ‘work-related socio-economic consequences of MS’, ‘risk factors for unfavourable occupational outcomes’, ‘reported barriers to employment’, ‘reported job accommodations and vocational rehabilitation strategies’, ‘job satisfaction, stigma, and disclosing the diagnosis in the workplace’ and ‘rating clinical scales’.

Conclusions There are several issues that deserve further in-depth study by the scientific community in order to improve the occupational outcomes of people with MS.

  • Multiple sclerosis
  • PUBLIC HEALTH
  • OCCUPATIONAL & INDUSTRIAL MEDICINE
  • Health economics
  • EPIDEMIOLOGY

Data availability statement

Data are available upon reasonable request.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/ .

https://doi.org/10.1136/bmjopen-2021-058948

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Strengths and limitations of this study

The scoping design allowed a summary of the diverse/heterogeneous range of terms and conceptualisations or even the multidimensional relationship of work and multiple sclerosis.

All original peer-reviewed articles included were reviewed by our research group.

As we respected the scoping review approach, we did not formally assess the quality of included studies.

We could have missed some data for not including results from the grey literature.

Introduction

Multiple sclerosis (MS) is a chronic autoimmune disease that causes demyelination and neurodegeneration in the central nervous system. It mainly affects young people between 20 and 40 years of age and it is the main cause of non-traumatic disability among young adults in the Western world. 1 MS is a global disease, affects 2.5 million people worldwide, the incidence and prevalence are known to be increasing in both developed and developing countries. 2 The symptoms are extremely varied and the clinical course is within a spectrum that extends from relapsing-remitting to progressive. 1–3

In addition to the inherent clinical complexity of MS, the age of onset of the disease brings inevitable repercussions to work activity, as it often coincides with the moment in which patients find themselves managing the already expected difficulties of the job market and the beginning of the professional career. 4 As long as MS symptoms remain ‘invisible’, people with MS (PwMS) are reluctant to inform their employer about their disease out of fear of losing their job. 4 Concerns about disclosing the diagnosis in the workplace stem from a range of issues involving the fear of appearing vulnerable, suffering discrimination and losing their jobs. 5 PwMS often require essential accommodations in the work environment to continue providing satisfactory work. Often limiting and disabling, symptoms such as fatigue, neuropsychiatric impairment and motor disturbances constantly threaten the full performance at work and the search for new professional skills. PwMS are more vulnerable to unemployment and early retirement and the influence of MS on professional life is known to be directly associated with quality of life (QoL). 6

The impact of MS on work activities has already been evaluated in many studies carried out in different parts of the world. 7–10 Calabrese et al demonstrated that workforce participation can decline from 82% to 8% and employment rates vary between 31% and 65%, 7 being influenced by factors such as the degree of disability, the duration of disease, the level of education and the type of work activity. Another study outlined the complexity of the association between employment and MS and revealed that 56.2% of PwMS are unemployed and face great difficulty in returning to the workforce. 8

Besides the potential consequences of MS for people’s working life, it is also important to recognise the impact of the disease at the community level. Long-term absence, invalidity and early retirement may demand an annual expense of 17 945€ per patient in the late stages of MS. 11 Loss of productivity at work and occupation change due to MS account for an annual cost of $2691 and $2982 for each patient, respectively. 12 Indeed, the impact of MS on occupational outcomes is responsible for a significant economic burden and represents a matter of public health all around the world.

There is an eminent need for further scientific research on the occupational outcomes of PwMS. Furthermore, research in this area is highly encouraged as it contributes to address the eighth Sustainable Development Goal set up by the United Nations. Although it is relatively easy to find information on MS and work in the literature, being diagnosed with MS still increases the risk of unemployment, early retirement, loss of working capacity, reduced monthly income, job dissatisfaction and impaired QoL. Recent advances in the treatment of MS and the emergence of new types and modalities of work also call for new studies investigating the role of MS on work. Moreover, previous reviews were focused on specific occupational outcomes that do not reflect the totality of possible outcomes, contributing only partially to the holistic understanding of the relationship between MS and work. 13–17 Due to the large number and heterogeneity of articles already published, there is a significant difficulty in detecting gaps in the pre-existing literature and consolidating evidence on the subject. This scenario favours unnecessary investments in redundant studies that could be reallocated to research with potential to truly influence patients’ lives. In this context, we decided to conduct the first scoping review related to the occupational outcomes of PwMS, as it can provide a broad map of the existing evidence and identify gaps for potential future studies.

The objectives of the present scoping review are related to occupational outcomes associated with MS: the primary objective is to update the knowledge on the occupational outcomes of PwMS compared with people without MS, and among PwMS by clinical characteristics. Our secondary objectives were to systematically examine the extent, scope and nature of the pre-existent literature, to summarise and disseminate the research results deriving from the already published articles, to identify research gaps in the existing literature and to provide an accurate rationale to develop further relevant research in the area.

We performed this scoping review following the guidelines outlined by Arksey and O’Malley, the Joanna Briggs Institute recommendations and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for scoping review (PRISMA-ScR) guidelines. 18–20 As this was a literature review, it analysed data from already published original articles and did not involve the recruitment of subjects and, therefore, the ethical approval was not necessary.

Study selection/search strategy

From 14 July 2021 to 31 July 2021, we systematically searched on PubMed/MEDLINE, Scopus, SciVerse ScienceDirect and Web of Science the following keywords (employ* OR unemploy* OR occupation* OR ‘work’ OR vocation* OR ‘work resumption’ OR workplace* OR ‘return to work’ OR ‘work force’ OR ‘workforce’ OR ‘labour force’ OR ‘labour force’ OR career* OR job* OR ‘job retention’ OR retire* OR ‘disability pension’ OR ‘worker’ OR ‘fitness for work’) AND (‘multiple sclerosis’ OR ‘disseminated sclerosis’ OR ‘demyelinating autoimmune diseases’ OR ‘demyelinating autoimmune disorders’ OR ‘clinically isolated syndrome’ OR ‘demyelinating’). The details of the search strategy used are reported in table 1 . We decided not to include specific terms due to the expected diversity in concepts and terms related to the central argument of the study. Furthermore, this choice is supported by the traditional scoping review methodology. After the preliminary identification, the articles were exported and managed in Mendeley 1.19.8 (Elsevier, New York, USA).

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Detailed search strategy in PubMed, Scopus, SciVerse science direct and web of science

Inclusion and exclusion criteria

A priori, we chose a broad search methodology to be able to form an accurate and comprehensive picture of the relationship between the occupational outcomes and MS. The PCC (Population/Concept/Context) framework was used to define inclusion criteria. We included any peer-reviewed original article reporting the occupational outcomes of PwMS between the ages of 18 and 65 years (population). MS must have been diagnosed according to accepted international criteria at the time of the study. No time limits were set for the search. The context was broad and we accepted articles published in English, Italian, Spanish, French and Portuguese, as these are the languages spoken in our research group (context). The term ‘occupational outcomes’ was defined as direct and indirect work-related characteristics/consequences potentially associated with MS (concept).

After removing duplicate entries, we performed an initial screening of titles and abstracts to assess potential relevance and excluded those not directly or indirectly focused on the topic of interest. Screening of titles, abstracts and full texts for each article was conducted by two experienced and trained investigators (BKV and AR), each blinded to the other’s ratings. In case of discrepancy, a final decision was made by a consensus after a debate with a senior researcher (GD). Afterwards, we obtained relevant full-text articles, read all of them, evaluated their eligibility and determined their final inclusion or exclusion.

Studies written in languages other than the five prespecified above and studies designed as reviews, letters to the editor, conference abstracts, expert opinions, commentaries, case reports, case series and editorials were excluded. Studies that did not address any aspect of an occupational outcome or that eventually only mentioned it as part of the arguments presented in the introduction or discussion (off-topic articles) were excluded. In case of lack of essential information or full-text not being available, we tried to contact the corresponding author twice to obtain the information by email. Whenever our contact attempt failed, the study was excluded. We did not accept studies where MS was not the primary condition or the subjects had other chronic diseases that could potentially influence the occupational outcomes (eg, a study that included patients with MS and migraine). Some authors published more than one article with the same study population and reporting the same occupational outcomes. In these cases, we included the most recent one and excluded the others. Figure 1 provides the PRISMA flowchart overview of the search and screening strategy performed.

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PRISMA flowchart. PRISMA, Preferred Reporting Items for Systematic reviews and Meta-Analyses.

Data extraction

Data were extracted in a standardised way by an expert reviewer (BKV) and they were double-checked after 2 months in order to minimise the intrapersonal variability. We determined the information to extract a priori. Among the basic characteristics, we gathered information about the authors’ names, the title of the study, the year of publication, the country of origin of the study, the study design, the number of subjects with and without MS, the subtype of the disease, the prevalence of each clinical symptom, the duration of the disease, the distribution by age and sex, the level of education, the marital status, the description of any neuroradiological finding, treatment data, assessment of the QoL and disability, prevalence of fatigue, psychiatric symptoms and cognitive symptoms. Regarding the occupational outcomes, the following data were collected: the description of the profession, the prevalence of unemployment and early retirement, the influence of the disease on monthly income, the need for disability pension, the indirect cost of MS, the stigma and prejudice faced in the workplace, job characteristics, strategies of vocational rehabilitation and job accommodations, patient opinion on work and working life in general, barriers to employment, degree of job satisfaction, need for a change of employment due to MS, the prevalence of work handicap and information on the disclosure of the diagnosis in the workplace. Job accommodations were defined as any reasonable adjustment to a job or work environment that enables PwMS to perform their job duties. Barriers to employment were defined as any challenge or difficulty that may prevent PwMS from getting or keeping a job or advancing in their career. The definitions of sick leave and absenteeism vary in the literature. We considered sick leave when the absence is granted because of illness. Usually, it takes many days and are due to a specific necessity provoked by the illness. In contrast, we considered absenteeism the habitual non-presence of an employee at their job that is not formally justified to the employer or linked to the illness. Usually, it takes just a couple of days but may be more frequent. 21 22

Data synthesis

Following data extraction, due to the range of outcomes assessed and different study designs included in the review, we used a narrative synthesis to report data. This process was carried out after reading the full-text of all the articles included in the review in order to summarise the results as clearly and accurately as possible and cover all the outcomes found. One expert reviewer (BKV) performed a thematic categorisation of the findings, which was verified by two other reviewers (AR and AM). The results were categorised into seven subtopics: ‘changes in work and occupational status due to MS’, ‘work-related socio-economic consequences of MS’, ‘risk factors for unfavourable occupational outcomes’, ‘reported barriers to employment’, ‘reported job accommodations and vocational rehabilitation strategies’, ‘job satisfaction, stigma, and disclosing the diagnosis in the workplace’ and ‘rating clinical scales’. These subgroups were created to guide the synthesis of the main results reported in the pre-existing literature. We generated a set of statements to adequately represent each subtopic, based on their relevance and degree of evidence.

Patient and public involvement

No patients or public were involved in the study.

Overview of the literature search

The initial systematic search yielded 104 228 results, of which 7486 were from PubMed, 8346 were from Scopus, 63 731 were from SciVerse Science Direct 24 665 were from Web of Science. Removing duplicates and applying the eligibility criteria resulted in a total of 1136 articles. At the end of the study selection, 403 articles were included in the review, and information about the baseline clinical–epidemiological characteristics and the occupational outcomes was properly extracted ( online supplemental table S1 ). Figure 1 describes the entire PRISMA-ScR flowchart.

Supplemental material

Characteristics of the included literature.

The number of studies published on the topic has increased over time, as 154 (38.2%) of the included studies were published in the last 5 years. Most of the studies were conducted in Europe and North America (50.9% and 33.0%, respectively). Asia and Oceania produced 32 (7.9%) and 24 (6.0%) of the studies on the subject, respectively. There were no published data on the association between MS and work from the African continent. Italy, with less than 1% of the world population, promoted the publication of 29 (7.2%) articles on the subject of our study. Regarding the study design, 314 (77.9%) were cross-sectional, 12 (3.0%) were interventional and 77 (19.1%) were longitudinal. Only 63 (15.6%) studies included a control group in their analysis. In total, the 403 studies evaluated 492 062 subjects with MS. Among the explored characteristics of MS, the assessment of disability and QoL, the type of MS and the prevalence of fatigue, psychiatric and cognitive symptoms were the most mentioned variables ( table 2 ). Neuroimaging data and the use of disease-modifying drugs (DMDs) were explored in 10 (2.5%) and 117 (29.0%) studies, respectively.

Clinical, epidemiological and occupational variables reported in the 403 studies

Work was considered as a dependent variable in 285 (70.7%) articles. Eighty-two (28.8%) studies dealt with the description of employment outcomes, 85 (29.8%) aimed to assess the economic impact of MS, 14 (4.9%) described any strategy of vocational rehabilitation, 17 (6.0%) evaluated the QoL in MS in general, 81 (28.4%) determined possible risk factors associated with occupational outcomes and 6 (2.1%) aimed to develop a possible assessment scale of occupational outcomes. The prevalence of unemployment was the most explored variable (311, 77.2%). Other addressed issues were early retirement (120, 29.8%), disability pension (117, 29.0%), sick leave (77, 19.1%), the influence of MS on monthly income (52, 12.9%), the indirect cost of MS (74, 18.4%) and work characteristics (57, 14.1%). Barriers to employment were reported in 65 (16.1%) studies and job accommodations in 45 (11.2%) studies. Perceived stigma in the workplace, job satisfaction and knowledge of colleagues about MS were less commonly explored aspects in the studies (5.7%, 4.7% and 4.2%, respectively). Finally, 59 (14.6%) articles examined occupational absenteeism, 85 (21.1%) aimed to understand the patient’s opinion on aspects of his professional life, and 19 (4.7%) evaluated strategies of occupational rehabilitation. The definition of each outcome is extremely diverse across studies in order to suit the particularities of the study design and the research context.

Changes in work and occupational status due to MS

MS is a disease that directly influences the patient’s professional life. 23–26 PwMS are vulnerable to a spectrum of several negative consequences at work, ranging from reduction of working hours to unemployment. In a Swedish cohort, only 28% and 23% of PwMS were working full-time and part-time after a follow-up of 10 years, respectively. 27 A Norwegian study demonstrated that after 19 years of disease, only 45% of patients were still employed. 10 Even for those who remain employed, more than a quarter show some deterioration in employment status and 56% observe a work performance loss in the short term after the diagnosis. 28 29 Moreover, once unemployed, it is difficult for workers with MS to return to the workforce. 8 Pfleger et al found that the probability of remaining without early pension at 20 years was 22% for patients and 86% for controls. 30

Work-related socioeconomic consequences of MS

MS is a debilitating disease that poses a substantial burden in terms of absenteeism, presenteeism, disability pension and sick leave costs. 31–34 Both employees and employers bear the socioeconomic consequences of MS. Employees with MS are significantly more likely to have disability days compared with employees without MS (21.4% vs 5.2%). 35 Overall, employees with MS had lost over four times more workdays compared with their controls (37.7 vs 8.8 days). 36 In a cohort of 8350 PwMS, two-thirds received a form of benefit. 37 Increased disability as measured on the Expanded Disability Status Scale (EDSS) is strongly associated with reduced earnings and increased benefits, 23 37 38 but it is noteworthy that even mild disability can pose a significant economic burden at the expense of premature retirement, premature work disability and time lost from work. 23 31 38 39 Interestingly, Jennun et al demonstrated that negative effects on employment and health costs have been shown up to 8 years prior to MS diagnosis. 40 Neusser et al reported an estimated total expenditure of 4.3 billion euros annually when considering all interventions enabling work-life integration. 41 Studies on the economic impact of MS come from different countries and continents, 7 9 42–44 so the interpretation of their findings must necessarily take into account the specific social security systems of different countries.

Risk factors for unfavourable occupational outcomes

Multiple studies have addressed the risk factors associated with worse professional outcomes. The progressive phenotype of the disease is certainly a negative predictor of occupational outcomes in PwMS compared with the relapsing–remitting form. 10 39 45 Older age, longer disease duration and high EDSS are also associated with a higher risk of unemployment. 46–49 Recently, the link between neuroimaging findings and occupational status has been demonstrated. Tauhid et al showed that the T1 lesion load, the ratio between the T1 and T2 burden, and the overall brain volume are significantly different between employed and non-employed PwMS. 50 In a cohort of 145 patients followed up to 12 years, severe brain atrophy, T1 and T2 injury load were the best predictors of deterioration of the occupational status. 51 Cognitive impairment, neuropsychiatric symptoms and fatigue are also well-described risk factors for labour force withdrawal and work productivity loss. 28 52 53 The main reasons reported by PwMS for their loss of employment involved the ineffective management of symptoms of MS in the workplace, rather than workplace-related factors including insufficient flexibility of employment conditions or being dismissed.

Reported barriers to employment

Some studies described the main barriers to employment for PwMS, which may result from the disease itself or circumstances related to the workplace. Cognitive symptoms, pain, fatigue, psychiatric disorders, disease severity and mobility/gait impairment are illness-related factors considered as major barriers to employment. 54–57 In addition, jobs requiring long-distance travel, overly stressful work, limited feedback on performance, hostile supervisors, high-temperature level and inflexible work schedules are some working conditions considered difficult for PwMS. 57–59 Moreover, negative work events have been reported as an important barrier. Workers with MS may be particularly vulnerable to verbal reprimands, decrease in scheduled work hours, reduction of job responsibilities and mandatory additional retraining. 29 60–62 Kordovski et al and Frindak et al both demonstrated that negative work events may act as an indicator of an increased risk of unemployment in the short and medium term. 61 63

Reported job accommodations and vocational rehabilitation strategies

Job accommodations are associated with greater chances of retaining occupation. The studies considered work accommodations as reasonable adjustments in the workplace or strategies related to professional retraining and vocational rehabilitation. In a study with 746 workers with MS, participants with a progressive course of the disease, cognitive impairment, a higher number of MS symptoms and greater symptom severity were more likely to use job accommodations. 64 More than 60% of PwMS who kept their jobs described any type of accommodation and adopting flexible hours as the most frequently reported accommodation. 29 65 66 Other common accommodations are the possibility of working from home and availability of memory aids, additional time to complete tasks, preferential parking, written job instructions and air conditioning. 29 60 Rumrill et al listed the use of equipment/assistive technological resources as being of great importance. 66

Dorstyn et al verified that sending a standardised, mail-delivered, resource-based package to job seekers with MS improved their vocational self-efficacy, optimism and identity. 67 Chiu et al examined the effect of rehabilitation technology interventions on job retention and concluded that this kind of technological tool may ensure better occupational outcomes. 68 Vocational rehabilitation is a topic that interests PwMS, a group of people receptive to this type of initiative. 69 According to these subjects, a programme of vocational rehabilitation must address two main points: managing work performance and expectations. 70

Job satisfaction, stigma and disclosing the diagnosis in the workplace

Almost one-third of patients who remain employed are dissatisfied at work 54 and 20%–30% of workers do not feel comfortable disclosing their diagnosis in the work environment. 29 59 63 71 Approximately 40% of these patients did not inform the occupational physician about their diagnosis. 72 More often, patients with increased disease severity and longer work experience disclosed their diagnosis. 63 In parallel, PwMS with ‘invisible’ symptoms tend not to disclose. A quarter of PwMS report feelings of stigmatisation at work. Stigma is directly associated with poorer QoL, work handicap and depression. 45 55 73

Rating clinical scales

The EDSS and the Multiple Sclerosis Functional Composite (MSFC) scale have both been associated with employability. 74 Andries et al designed the Work and Handicap Questionnaire (WHQ) aiming to estimate the degree of work handicap in PwMS, neuromuscular diseases and asthma based on the association of daily life disabilities and job demands. 75 Although it was not specifically created for PwMS, it showed good reliability. Honan et al developed a shortened version of the Multiple Sclerosis Work Difficulties Questionnaire (MSWDQ) that consists of a 23-item measure of self-reported perceived workplace difficulties in PwMS. 76 Schiavolin et al designed and validated the Multiple Sclerosis Questionnaire for Job Difficulties (MSQ-Job), which demonstrated to be a useful tool for measuring the work-related difficulties in PwMS. 77 Both MSWDQ and MSQ-Job proved to be comprehensive tools for tracking subjective work-related problems, but they could not be compared with objective occupational outcomes in a longitudinal perspective and were not validated as a predictive tool of unemployment. McFadden et al created a 22-item, self-administered scale that indicates if PwMS are at low, medium or high risk of work instability. 78 It was further used in a 3-year longitudinal study aimed at assessing the psychological determinants of job retention. 79 Table 3 summarises all scales associated with occupational outcomes.

Identified scales described in the literature associated with occupational outcomes

The scientific literature on occupational outcomes and MS is vast. Nevertheless, it is possible to identify some important gaps on this subject. The quality of the scientific evidence in this field is still limited due to a significant lack of longitudinal and interventional studies. Few studies have analysed the evolution of occupational outcomes of PwMS over time, much less the factors that led to an eventual change: there is no scientific evidence that any improvement has occurred in the prevalence of unfavourable occupational outcomes. Indeed, there is no study supporting the hypothesis that a worker with MS in 2022 is not susceptible to the same occupational consequences caused by the disease as 40 years ago. In contrast, over the past 20 years, there have been notable advances in the treatment of MS due to a significant increase in the availability and effectiveness of DMDs that, in theory, may have influenced various occupational outcomes. 80 In this scenario, a study that assesses the specific role of DMDs on occupational outcomes is highly encouraged. Likewise, there is a lack of studies that compare the variables related to work based on a geographical perspective (eg, countries and continents). Furthermore, there is little evidence on the biopsychosocial context related to work disability, as most articles focus only on the relationship between work trajectories and morbidity.

Data about occupational outcomes come from different contexts and study designs. In most cases, occupational outcomes are part of the primary objectives of the studies. The geographical distribution of the origin of the studies is uneven and creates a bias in the interpretation of the results. No article defined the term ‘occupational outcomes’ and the definitions of each variable differed substantially. Our scoping review brings an evidence-based description about the several possibilities of occupational outcomes and shows that it comprises of several possible variables, most of them easily evaluated objectively—such as unemployment or salary reduction. The variables described in the literature comprise potentially reversible outcomes present at the beginning of the illness and outcomes that are generally irreversible and are associated with the end of the professional career.

The literature is unanimous regarding the MS burden on the economy and public health; indeed, the economic impact of the influence of MS on work has driven several research projects. However, the cost-effectiveness of the new DMDs has not been thoroughly studied, considering both the occupational items and the feasible strategies of professional integration concerning their potential benefit in promoting better occupational outcomes with consequent decrease of the economic impact of MS.

Moreover, despite the literature provides a wide description of possible risk factors and work accommodations for PwMS, little evidence exists concerning the possible protective factors associated with occupational outcomes. Most studies are focused on the aspects related to the disease, and few are dedicated to work-related risk factors. Furthermore, the real role of each type of accommodation in promoting favourable occupational outcomes is still unclear due to a lack of studies providing strong evidence (longitudinal and interventional studies).

Our scoping review identified gaps between the patient’s interest in receiving technical guidance on how to improve the occupational outcomes and the degree of evidence on this topic. Few studies were dedicated to identifying strategies capable of promoting job retention, work performance and even return to work. Moreover, most of the strategies of vocational rehabilitation were studied in small samples of subjects and did not consider the particular characteristics of PwMS. Given the still unsatisfactory unemployment rates among PwMS, vocational rehabilitation may be a valuable complementary resource that deserves further research.

There is also extremely limited evidence related to job satisfaction, stigma and prejudice in the workplace; in this view, it is important to study these outcomes to gauge an individual’s overall level of work adjustment. More studies are needed to understand the reasons for not communicating the diagnosis of MS, including to the occupational physician, since the disclosure may be the first step to promote the worker’s full integration.

Only few studies tried to develop a scale associated with the occupational outcomes of PwMS. All the proposed scales described the work handicap or job difficulties in restricted samples and mostly in a cross-sectional design. Most of them revealed to be excessively extensive and complex, which represents a limitation for their wide use in clinical practice. The EDSS is the only scale that has already been associated with occupational outcomes as it generally reflects the severity and progression of the disease. However, this evidence comes from secondary analysis of studies and, despite being simple, the EDSS does not include several other factors already proven to specifically influence the professional outcomes, which can also raise concerns about its sensitivity. The development of a simple and validated scale should be the subject of future studies, as it may represent an easy-to-use tool capable of supporting a more objective and uniform assessment of PwMS by physicians with different backgrounds.

Finally, no study addressed how the new ways of working in the 21st century interfered with the occupational outcomes of PwMS. The nature and the pattern of work have undoubtedly changed in the last 20 years 81 and it is reasonable to imagine that PwMS may find more alternatives and resources to ensure a fruitful professional life. Possibly, technological advances in the workplace may even relativise the concept of work disability. PwMS with the same clinical characteristics can be classified with different degrees of work disability depending on the technological adjustments that help them perform their work. It is reasonable to imagine that a few decades ago, a worker with MS could easily be considered unfit for work, while today’s modernisation of types of work and the provision of various technological resources may contribute to delay the definitive endpoint of inability to work.

This is the first scoping review dedicated to the occupational outcomes of PwMS. We highlight that a broad and rigorous search strategy was used to properly include all relevant studies describing the occupational outcomes of MS and promote reliable and accurate results. We applied a range of outcome possibilities that allowed us to accurately understand the evidence related to the impact of MS in the occupational setting. The wide variability of aspects, outcomes and measures identified motivated the breadth of our methods. This review highlighted several opportunities for new research on the topic. Among the limitations of the study, we did not formally assess the quality of included studies, as we respected the scoping review approach. We could also have missed some data for not including results from the grey literature. Notwithstanding, we intended to disclose the current reality regarding the highest scientific evidence in the field of MS and work and, therefore, the selection of peer-reviewed articles seemed more appropriate. We decided not to use specific terms in our search strategy which may have excluded some articles from our review. Nevertheless, there is an infinite number of possible specific words and synonyms that could be characterised as occupational outcomes so that it would be impossible to cover all the possibilities. Finally, the definitions of each variable changed significantly according to the study, so that, as usually happens with systematic reviews, it was not possible to standardise a definition for each one of them.

Conclusions

This is the first scoping review dedicated to the occupational outcomes of PwMS. MS is a chronic neurological disorder that is often associated with disabilities and significant impairment of professional life. Many studies have already been published on the subject and several outcomes have been described. Nevertheless, there are still several issues that deserve further in-depth study by the scientific community in order to match the quality of scientific evidence to the undeniable complexity inherent in this topic.

Ethics statements

Patient consent for publication.

Not required.

Ethics approval

Not applicable.

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Supplementary materials

Supplementary data.

This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

  • Data supplement 1

Contributors All authors approved the final version. BKV designed the study, performed database search, data extraction and wrote the manuscript. AR designed, integrated the research group and reviewed the manuscript. GD, AM and ND integrated the research group and reviewed the manuscript. PB, TM, MP, MAB, BP, GB, MI and ES globally supported the research and reviewed the manuscript. PD coordinated, supervised and reviewed the manuscript. BKV is the guarantor of the work.

Funding This work was supported by the Italian Multiple Sclerosis Association (AISM) and Italian Workers' Compensation Authority (INAIL), in the framework of BRIC 2019: “PRISMA” project (Bando BRIC 2019_ID 24). This work was developed within the frameworks of the Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) of the University of Genoa—Department of Excellence of MIUR 2018-2022 (legge 232 del 2016), of the Department of Health Sciences (DISSAL) of the University of Genoa and of the Occupational Medicine Unit of the IRCCS Ospedale Policlinico San Martino of Genoa, Italy.

Competing interests None declared.

Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

Provenance and peer review Not commissioned; externally peer reviewed.

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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Evidence-Based Management

There is no cure to multiple sclerosis. There are medications to help with easing the symptoms associated with the different stages of the disease, their severity, and progression. Alternative therapies like physical and occupational therapy have proven to improve quality of life and prevent disability (Kesselring & Beer, 2005). Research by Munger and Ascherio (2011) states vitamin D supplementation may reduce the risk of MS and promote a more favorable progression.

Main goals of medical management for multiple sclerosis are to return function after attacks, prevent new attacks, and prevent disability. Most common medical management includes injectable, oral, and infusion therapies (Kesselring & Beer, 2005).

  • The use of high dose intravenous corticosteroids, like methylprednisolone, is aimed at decreasing the inflammation caused by T- Cells during an acute attack. IV steroids are only used for short term to relieve symptoms and cannot be continued for longer than a few weeks to months (Derwenskus, 2011).
  • For severe attacks where high dose corticosteroids are not working, the use of plasmapheresis is recommended and highly successful in decreasing the severity of symptoms. Plasmapheresis removes the circulating antibodies that are active in this autoimmune disease and ultimately helps patients increase muscle strength and improve fatigue within a day or two after treatment, and it lasts for a few months (National Multiple Sclerosis Society, 2015).

When treating relapsing- remitting multiple sclerosis or clinically isolated syndromes of MS the first line of treatment is the use of interferons (drugs similar to proteins produced by your body) and glatiramer acetate, which are proven to decrease attacks by 30% (Derwenskus, 2011). Second choice of treatment is the use of natalizumab, which is an infusion therapy given every 4 weeks and is shown to decrease relapse by 50-60% (Derwenskus, 2011), but not preferred due to severe side effects. Another treatment used for progressive MS is the use of mitoxantrone, also an infusion therapy, which has the worst side effects and is used when nothing else has shown signs of improvement (Derwenskus, 2011).

Other common treatments to help with symptoms include Deep Brain Stimulation to help control tremors, and Baclofen Pumps or Botox to help with spasticity and to relax the muscles (National Multiple Sclerosis Society, 2015).

Rehabilitation programs that increase activity and include exercises that focus on increasing muscle strength can help with improving fatigue and prevent disability (National Multiple Sclerosis Society, 2015). 50% of patients use alternative therapies like cognitive behavioral approaches, yoga, herbal medicine, hyperbaric oxygen therapy, reflexology, acupuncture, and dietary supplementation and regiments (Martinez-Assucena et al., 2010).

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Occupational Therapy Treatment for Patients with Multiple Sclerosis

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This course will offer occupational therapists a background on Multiple Sclerosis (pathophysiology, diagnosis, and signs/symptoms), functional and cognitive impairments associated with the disease, as well as information on interventions for addressing occupational performance with this patient population.

Course created on October 16, 2020

Course Type : Video, Text

CEUs/Hours Offered: AOTA/0.1 Intermediate, OT Service Delivery, 00747; CE Broker/1.0 Home Study, General (FL), Patient Related (AL), General Continuing Education (GA), Direct Client/patient Services In Occupational Therapy (SC), Related To OT (AZ), Related To OT (LA), Directly Related To OT (MS), Directly Related To OT (TN), CE Broker #20-795366; IACET/0.1; NBCOT PDUs/1.25 Intermediate, Rehabilitation

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Scott Rushanan, MS, OTR/L, MBA

Scott Rushanan MS, OTR/L, MBA

Scott is the current Director of Rehabilitation Services and Co-Director of Penn Medicine’s Home Health Agency. Scott previously spent 8 years as the Lead Occupational Therapist at Penn Medicine’s ALS Clinic. Scott is currently pursuing his Doctorate in Occupational Therapy at Columbia University focusing on cognitive impairments for patients with neuro-motor disease.

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Which Autoimmune Diseases Could CAR-T Therapy Treat?

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Key Takeaways

  • CAR-T therapy is a cancer treatment that engineers the body’s own cells to kill cancer tumors.
  • This treatment is being tested against some autoimmune diseases.
  • In a recent study, CAR-T therapy had the most success with lupus patients.

Autoimmune diseases are notoriously difficult to manage, with patients often facing periods of remission and relapses. While there are treatments to help manage symptoms of autoimmune diseases, there is no cure—but that may be coming.

New research suggests that a form of specialized treatment used for some cancer patients shows promise as a potential cure for autoimmune disease. It’s called chimeric antigen receptor T-cell treatment (CAR-T), and it uses T cells, which are white blood cells that are an important part of the immune system.

Experts say the findings show promise for CAR-T therapy beyond cancer treatment.

3 Autoimmune Diseases Showed Improvement

 The study, which was published in the New England Journal of Medicine , followed 15 patients with autoimmune diseases as they underwent CAR-T therapy. Eight of the patients had lupus, four had scleroderma, and three had a rare muscle disease called idiopathic inflammatory myositis.

The study participants received a single infusion of CAR-T cells after “preconditioning” with chemotherapy drugs fludarabine and cyclophosphamide. The researchers found that all of the patients responded to the treatment, but some had better results than others.

The researchers found that autoimmune diseases were either eliminated or had reduced symptoms or disease biomarkers after that one CAR-T therapy. Patients with lupus did not relapse after having the treatment during the two-year follow-up period. Patients with scleroderma and those with myositis had a reduction in symptoms during the follow-up period.

“CAR T-cell transfer appeared to be feasible, safe, and efficacious in three different autoimmune diseases, providing [a] rationale for further controlled clinical trials,” the researchers wrote.

How CAR-T Therapy Works

CAR-T  therapy revolves around T cells, which are a type of white blood cell that develops from stem cells in the bone marrow. T cells help protect the body from infection and may help fight cancer.

“T cells are sort of the quarterback of your immune system,” Michael Jain, MD, PhD , ICE-T medical director in the Moffitt Cancer Center Department of Blood and Marrow Transplant and Cellular Immunotherapy, told Verywell.

CAR-T therapy takes a sample of a patient’s T cells and changes some genes in the cells to help them be better at finding proteins called antigens in cancer cells. The process uses a chimeric antigen receptor for the form of cancer a person has and adds it to the T cells. After the cells are ready, they’re put back into the patient’s body through an IV.

“CAR-T redirects our own T cells to recognize and kill tumor cells and is several-fold more potent than our native T cells,” Rashmi Khanal, MD , assistant professor in the Department of Bone Marrow Transplant and Cellular Therapies at Fox Chase Cancer Center, told Verywell.

But CAR-T therapy can cause side effects. One is cytokine release syndrome (CRS), which is a condition that happens when your immune system responds to infection or immunotherapy drugs more aggressively than it should.

CAR-T therapy can also cause neurologic effects like severe confusion, seizure-like activity, and impaired speech. Other less severe side effects can include fever, chills, vomiting, dizziness, and agitation.

Why CAR-T Therapy May Help With Autoimmune Disease

“Under typical circumstances, our immune cells have the ability to differentiate and recognize what is your own cells and what is foreign cells,” Wael Harb, MD , a board-certified hematologist and medical oncologist at MemorialCare Cancer Institute at Orange Coast and Saddleback Medical Centers, told Verywell. “When you get a virus or bacteria, the body recognizes that this is not my own cells and attacks it.”

With autoimmune disease, your immune cells mistakenly attack your own body.

“The idea is that we can use CAR-T cells to attack the immune cells that are confused and eliminate them,” Harb said.

With that, the treatment may help “reset” immunity, Khanal said.

In this particular study, CAR-T therapy had the most success with lupus patients. However, it’s also being studied for use against graft versus host disease, cardiac fibrosis, and fungal pulmonary aspiration.

CAR-T May Be Difficult to Implement for Autoimmune Diseases

Harb called the use of CAR-T therapy for autoimmune diseases “fascinating, because you’re able to take your own cells and reengineer them.” But he also said that the process is complex and expensive. “You have to give patients some sort of chemotherapy before you infuse it, and this can cost about $500,000 for a treatment,” he said.

Jain said that there are important logistical elements—in addition to more research—that need to be overcome before CAR-T therapy can become a widespread treatment for people with autoimmune disease.

“This is a very cumbersome treatment to give, he said. “Patients have to stay in the hospital for a period of time and it’s hard to scale.”

Autoimmune diseases are also more common than the types of cancer that CAR-T therapy is currently used to treat.

“You have to figure out how to take this process—which is very boutique—and expand it out to a large population,” Jain said. “It may be that only those who have more severe autoimmune diseases could get this.”

What This Means For You

CAR-T therapy is a form of cancer treatment that is being explored to treat some autoimmune diseases. While CAR-T therapy is not currently FDA-approved to treat people with autoimmune diseases, there are clinical trials happening now.

American Cancer Society.  CAR T-cell therapy and its side effects .

Müller F, Taubmann J, Bucci L, et al. CD19 CAR T-cell therapy in autoimmune disease—a case series with follow-up . N Engl J Med . 2024;390(8):687-700. doi:10.1056/NEJMoa2308917

National Cancer Institute. Definition of T cell .

National Cancer Institute. CAR T cells: engineering patients’ immune cells to treat their cancers .

By Korin Miller Korin Miller is a health and lifestyle journalist who has been published in The Washington Post, Prevention, SELF, Women's Health, The Bump, and Yahoo, among other outlets.

IMAGES

  1. Occupational Therapy Practice and Research with Persons with Multiple

    multiple sclerosis case study occupational therapy

  2. Occupational Therapy Helps Patient Living With Multiple Sclerosis

    multiple sclerosis case study occupational therapy

  3. (PDF) Systematic Review of Occupational Therapy Related Interventions

    multiple sclerosis case study occupational therapy

  4. (PDF) A cognitive occupation-based programme for people with multiple

    multiple sclerosis case study occupational therapy

  5. (PDF) Strengthening the occupational and social participation of

    multiple sclerosis case study occupational therapy

  6. Multiple Sclerosis case study 44

    multiple sclerosis case study occupational therapy

VIDEO

  1. 🌟 Review 👉 Systemic sclerosis by Dr Rehab

  2. Patient Forum: What You Need to Know About Systemic Sclerosis & Research (2022)

  3. Part 6, Multiple Sclerosis Symposium UMHS 2011

  4. What you need to to know about Multiple Sclerosis

  5. Ask A Doctor: Identifying and living with multiple sclerosis

COMMENTS

  1. Occupational Therapy Interventions in Adults with Multiple Sclerosis or Amyotrophic Lateral Sclerosis: A Scoping Review

    The inclusion criteria were as follows: (1) articles evaluating the intervention of occupational therapy in MS or ALS including experimental, randomized, nonrandomized and exploratory studies; (2) written in English or Spanish; (3) adult population (over 18 years old).

  2. Occupational Therapy Interventions for Adults With Multiple Sclerosis

    Occupational Therapy Interventions for Adults With Multiple Sclerosis Katharine Preissner; Marian Arbesman; Deborah Lieberman Author & Article Information The American Journal of Occupational Therapy, 2016, Vol. 70 (3), 7003395010p1-7003395010p4. https://doi.org/10.5014/ajot.2016.703001 Standard View PDF Share Tools Abstract Listen

  3. PDF Occupational Therapy in Multiple Sclerosis Rehabilitation

    Multiple sclerosis (MS) is a chronic, frequently progressive disease of the central nervous system that is usually diagnosed between the ages of 20 and 50. While MS can result in considerable disability, it does not significantly reduce life expectancy.

  4. PDF AOTA ECHO Series on Occupational Therapy Interventions forAdults with

    AOTA ECHO Series on Occupational Therapy Interventions forAdults with Multiple Sclerosis January 19, 2023 © 2022 by the American Occupational Therapy Association Preparing for the session To ensure sessions run smoothly, please follow the AOTA Event Code of Conduct. Use the Q&A feature to submit questions.

  5. Occupational Therapy Practice Guidelines for Adults With Multiple Sclerosis

    Abstract Importance: Occupational therapy practitioners play an important role in addressing the occupational performance and participation needs of adults with multiple sclerosis (MS) and their caregivers.

  6. Occupational therapy interventions for multiple sclerosis: A scoping

    Background Evidence for the effectiveness of occupational therapy for people with multiple sclerosis (MS) is yet to be established. Aims/objectives To review the evidence regarding the effectiveness of occupational therapy interventions in improving outcomes for adults with MS. Material and methods

  7. Occupational therapy as supportive treatment for people with multiple

    Multiple sclerosis (MS) is a chronic disease of the nervous system which affects young and middle-aged adults. MS causes disruption of the ability of nerves to conduct electrical impulses, leading to symptoms such as muscle weakness, fatigue and loss of control over the limbs. Occupational therapy (OT) is used to try to help people with MS ...

  8. Multiple sclerosis and occupational therapy: Everything to know

    Occupational therapy for people with MS focuses on helping them accomplish daily tasks, such as folding clothes, driving to work, and walking. Occupational therapy is different than...

  9. Systematic Review of Occupational Therapy-Related Interventions for

    This article is the first part of a systematic review of studies on occupational therapy-related intervention for people with multiple sclerosis (MS). The objective of this systematic review was to critically appraise and synthesize the applicable findings to address the following focused question: What is the evidence for the effectiveness ...

  10. Occupational therapy in multiple sclerosis

    Occupational therapy in multiple sclerosis. This is a protocol for a Cochrane Review (intervention). The objectives are as follows: Main objective. To assess the benefits and harms of occupational therapy interventions for improving daily functioning, participation, and quality of life in people with multiple sclerosis. Secondary objectives.

  11. Occupational Therapy Practice Guidelines for Adults With Multiple Sclerosis

    Abstract Importance: Occupational therapy practitioners play an important role in addressing the occupational performance and participation needs of adults with multiple sclerosis (MS)...

  12. AOTA ECHO Series on Occupational Therapy Interventions for Adults with

    AOTA ECHO Series on Occupational Therapy Interventions for Adults with Multiple Sclerosis the American Occupational Therapy Association. About Project ECHO ® Project ECHO (Extension for Community Healthcare Outcomes) began as an initiative from the University of New

  13. Multiple Sclerosis (MS) Case Study

    Abstract The purpose of this case study is to illustrate important clinical findings in an active patient recently diagnosed with relapse-remitting multiple sclerosis (RRMS) and suggest an evidence-based management plan to address the patient's participation restriction.

  14. Occupational Therapy for the Management of Fatigue in Multiple Sclerosis

    A fatigue management programme for clients with multiple sclerosis has been developed as part of the occupational therapy service at the National Hospital for Neurology and Neurosurgery.* A single case study approach was used to evaluate the effectiveness of the fatigue management programme during a 3-week period of inpatient rehabilitation.

  15. PDF Occupational Therapy Interventions in Adults with Multiple Sclerosis or

    multiple sclerosis (MS) and amyotrophic lateral sclerosis (ALS) patients in occupational therapy. ... in the case of MS, the incidence is 2.5 per 100,000 inhabitants, while in ALS it is between 0.6 and 3.8 per 100,000 inhabitants, although the age of onset is later than in MS [3,6]. ... Some previous occupational therapy studies have proposed ...

  16. Occupational outcomes of people with multiple sclerosis: a scoping

    Objectives To update the knowledge on the occupational outcomes associated with multiple sclerosis (MS), systematically examine the extent, scope and nature of the pre-existing literature and identify research gaps in the existing literature. Design Scoping review. Data sources A comprehensive database search of PubMed/MEDLINE, Scopus, SciVerse ScienceDirect and Web of Science was performed.

  17. Evidence-Based Management

    Evidence-Based Management. There is no cure to multiple sclerosis. There are medications to help with easing the symptoms associated with the different stages of the disease, their severity, and progression. Alternative therapies like physical and occupational therapy have proven to improve quality of life and prevent disability (Kesselring ...

  18. Occupational therapy and Multiple Sclerosis -- Gary's story

    Occupational therapy and Multiple Sclerosis -- Gary's story Royal College of Occupational Therapists 4K subscribers Subscribe Subscribed 61 21K views 13 years ago Occupational therapy can...

  19. Occupational Therapy Interventions in Adults with Multiple Sclerosis or

    This scoping review aims to describe occupational therapy interventions carried out with multiple sclerosis (MS) and amyotrophic lateral sclerosis (ALS) patients in occupational therapy. A peer review of the literature was conducted in different databases: Pubmed, Scopus, Web of Science and Embase, and in some occupational therapy journals. A search of the literature published was carried out ...

  20. Occupational Therapy Treatment for Patients with Multiple Sclerosis

    This course will offer occupational therapists a background on Multiple Sclerosis (pathophysiology, diagnosis, and signs/symptoms), functional and cognitive impairments associated with the disease, as well as information on interventions for addressing occupational performance with this patient population. Course created on October 16, 2020.

  21. CD19 CAR T-Cell Therapy in Autoimmune Disease

    Preliminary short-term effects of CAR T-cell therapy on Patients 1 through 5 with SLE, 10,14 Patients 1 and 2 with idiopathic inflammatory myositis, 11,26 and Patient 1 with systemic sclerosis 12 ...

  22. Which Autoimmune Diseases Could CAR-T Therapy Treat?

    CAR-T therapy is a cancer treatment that engineers the body's own cells to kill cancer tumors. This treatment is being tested against some autoimmune diseases. In a recent study, CAR-T therapy had the most success with lupus patients. Autoimmune diseases are notoriously difficult to manage, with ...