The effectiveness of neurological rehabilitation in multiple sclerosis.

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