Neurorehabilitation in multiple sclerosis--what is the evidence-base?

Multiple sclerosis is associated with a variety of symptoms and functional deficits that result in a range of progressive impairments and handicap. The symptoms, which contribute to loss of independence and restrictions in the participation in social activities, are often responsible for a continuing decline in quality of life. The main objective of rehabilitation is, therefore, to ease the burden of symptoms by improving self-performance and independence. Compensation of functional deficits, adaptation and reconditioning, together with management of symptoms, impairment, emotional coping and self-estimation, are all important long-term objectives. Although rehabilitation has no direct influence on disease progression, recent studies indicate that this form of intervention improves personal activities and participation in social activities, thereby improving quality of life. The improvements often outlast the treatment period by several months. These findings suggest that quality of life is determined by disability and handicap more than by functional deficit and disease progression.