iBet uBet web content aggregator. Adding the entire web to your favor.
iBet uBet web content aggregator. Adding the entire web to your favor.



Link to original content: https://pubmed.ncbi.nlm.nih.gov/30637728
Rehabilitation for people with multiple sclerosis: an overview of Cochrane Reviews - PubMed Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jan 14;1(1):CD012732.
doi: 10.1002/14651858.CD012732.pub2.

Rehabilitation for people with multiple sclerosis: an overview of Cochrane Reviews

Bhasker Amatya  1 , Fary Khan, Mary Galea
Affiliations

Rehabilitation for people with multiple sclerosis: an overview of Cochrane Reviews

Bhasker Amatya et al. Cochrane Database Syst Rev. .

Abstract

Background: Multiple sclerosis (MS) is a major cause of chronic, neurological disability, with a significant long-term disability burden, often requiring comprehensive rehabilitation.

Objectives: To systematically evaluate evidence from published Cochrane Reviews of clinical trials to summarise the evidence regarding the effectiveness and safety of rehabilitation interventions for people with MS (pwMS), to improve patient outcomes, and to highlight current gaps in knowledge.

Methods: We searched the Cochrane Database of Systematic Reviews up to December 2017, to identify Cochrane Reviews that assessed the effectiveness of organised rehabilitation interventions for pwMS. Two reviewers independently assessed the quality of included reviews, using the Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) tool, and the quality of the evidence for reported outcomes, using the GRADE framework.

Main results: Overall, we included 15 reviews published in the Cochrane Library, comprising 164 randomised controlled trials (RCTs) and four controlled clinical trials, with a total of 10,396 participants. The included reviews evaluated a wide range of rehabilitation interventions, including: physical activity and exercise therapy, hyperbaric oxygen therapy (HBOT), whole-body vibration, occupational therapy, cognitive and psychological interventions, nutritional and dietary supplements, vocational rehabilitation, information provision, telerehabilitation, and interventions for the management of spasticity. We assessed all reviews to be of high to moderate methodological quality, based on R-AMSTAR criteria.Moderate-quality evidence suggested that physical therapeutic modalities (exercise and physical activities) improved functional outcomes (mobility, muscular strength), reduced impairment (fatigue), and improved participation (quality of life). Moderate-quality evidence suggested that inpatient or outpatient multidisciplinary rehabilitation programmes led to longer-term gains at the levels of activity and participation, and interventions that provided information improved patient knowledge. Low-qualitty evidence suggested that neuropsychological interventions, symptom-management programmes (spasticity), whole body vibration, and telerehabilitation improved some patient outcomes. Evidence for other rehabilitation modalities was inconclusive, due to lack of robust studies.

Authors' conclusions: The evidence suggests that regular specialist evaluation and follow-up to assess the needs of patients with all types of MS for appropriate rehabilitation interventions may be of benefit, although the certainty of evidence varies across the different types of interventions evaluated by the reviews. Structured, multidisciplinary rehabilitation programmes and physical therapy (exercise or physical activities) can improve functional outcomes (mobility, muscle strength, aerobic capacity), and quality of life. Overall, the evidence for many rehabilitation interventions should be interpreted cautiously, as the majority of included reviews did not include data from current studies. More studies, with appropriate design, which report the type and intensity of modalities and their cost-effectiveness are needed to address the current gaps in knowledge.

PubMed Disclaimer

Conflict of interest statement

The review authors are clinicians in the field of Physical and Medical Rehabilitation who wish to provide the best possible service to their patients.

Bhasker Amatya: none Fary Khan: none Mary Galea: none

The authors acknowledge that four included reviews were conducted by the present authors' team (Amatya 2013; Khan 2007b; Khan 2009; Khan 2015), and one author (FK) was involved in another review (Kopke 2014).

Figures

1
1
International Classification of Functioning, Disability and Health (ICF) model with case example for multiple sclerosis
2
2
Study flow diagram
3
3
Impact of outcomes of rehabilitation interventions based on the settings of care
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD012732

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to included reviews

Amatya 2013
    1. Amatya B, Mantia L, Demetrios M, Khan F. Non pharmacological interventions for spasticity in multiple sclerosis. Cochrane Database of Systematic Reviews 2013, Issue 2. [DOI: 10.1002/14651858.CD009974.pub2] - DOI - PubMed
Bennett 2004
    1. Bennett MH, Heard R. Hyperbaric oxygen therapy for multiple sclerosis. Cochrane Database of Systematic Reviews 2004, Issue 1. [DOI: 10.1002/14651858.CD003057.pub2] - DOI - PMC - PubMed
das Nair 2016
    1. das Nair R, Ferguson H, Stark DL, Lincoln NB. Memory rehabilitation for people with multiple sclerosis. Cochrane Database of Systematic Reviews 2016, Issue 3. [DOI: 10.1002/14651858.CD008754.pub3] - DOI - PubMed
Farinotti 2012
    1. Farinotti M, Vacchi L, Simi S, Pietrantonj C, Brait L, Filippini G. Dietary interventions for multiple sclerosis. Cochrane Database of Systematic Reviews 2012, Issue 12. [DOI: 10.1002/14651858.CD004192.pub3] - DOI - PubMed
Heine 2015
    1. Heine M, Port I, Rietberg MB, Wegen EE, Kwakkel G. Exercise therapy for fatigue in multiple sclerosis. Cochrane Database of Systematic Reviews 2015, Issue 9. [DOI: 10.1002/14651858.CD009956.pub2] - DOI - PMC - PubMed
Jagannath 2010
    1. Jagannath VA, Fedorowicz Z, Asokan GV, Robak EW, Whamond L. Vitamin D for the management of multiple sclerosis. Cochrane Database of Systematic Reviews 2010, Issue 12. [DOI: 10.1002/14651858.CD008422.pub2] - DOI - PubMed
Khan 2007b
    1. Khan F, Turner‐Stokes L, Ng L, Kilpatrick T, Amatya B. Multidisciplinary rehabilitation for adults with multiple sclerosis. Cochrane Database of Systematic Reviews 2007, Issue 2. [DOI: 10.1002/14651858.CD006036.pub2] - DOI - PMC - PubMed
Khan 2009
    1. Khan F, Ng L, Turner‐Stokes L. Effectiveness of vocational rehabilitation intervention on the return to work and employment of persons with multiple sclerosis. Cochrane Database of Systematic Reviews 2009, Issue 1. [DOI: 10.1002/14651858.CD007256.pub2] - DOI - PMC - PubMed
Khan 2015
    1. Khan F, Amatya B, Kesselring J, Galea M. Telerehabilitation for persons with multiple sclerosis. Cochrane Database of Systematic Reviews 2015, Issue 4. [DOI: 10.1002/14651858.CD010508.pub2] - DOI - PMC - PubMed
Kopke 2014
    1. Kopke S, Solari A, Khan F, Heesen C, Giordano A. Information provision for people with multiple sclerosis. Cochrane Database of Systematic Reviews 2014, Issue 4. [DOI: 10.1002/14651858.CD008757.pub2] - DOI - PubMed
Rietberg 2005
    1. Rietberg MB, Brooks D, Uitdehaag BM, Kwakkel G. Exercise therapy for multiple sclerosis. Cochrane Database of Systematic Reviews 2005, Issue 1. [DOI: 10.1002/14651858.CD003980.pub2] - DOI - PMC - PubMed
Rosti‐Otajärvi 2014
    1. Rosti‐Otajärvi EM, Hämäläinen PI. Neuropsychological rehabilitation for multiple sclerosis. Cochrane Database of Systematic Reviews 2014, Issue 2. [DOI: 10.1002/14651858.CD009131.pub3] - DOI - PMC - PubMed
Sitjà Rabert 2012
    1. Sitjà Rabert M, Rigau Comas D, Fort Vanmeerhaeghe A, Santoyo Medina C, Roqué i Figuls M, Romero‐Rodríguez D, et al. Whole‐body vibration training for patients with neurodegenerative disease. Cochrane Database of Systematic Reviews 2012, Issue 2. [DOI: 10.1002/14651858.CD009097.pub2] - DOI - PubMed
Steultjens 2003
    1. Steultjens EM, Dekker J, Bouter LM, Cardol M, Nes JC, Ende CH. Occupational therapy for multiple sclerosis. Cochrane Database of Systematic Reviews 2003, Issue 3. [DOI: 10.1002/14651858.CD003608] - DOI - PMC - PubMed
Thomas 2006
    1. Thomas PW, Thomas S, Hillier C, Galvin K, Baker R. Psychological interventions for multiple sclerosis. Cochrane Database of Systematic Reviews 2006, Issue 1. [DOI: 10.1002/14651858.CD004431.pub2] - DOI - PMC - PubMed

References to excluded reviews

Mills 2007
    1. Mills RJ, Yap L, Young CA. Treatment for ataxia in multiple sclerosis. Cochrane Database of Systematic Reviews 2007, Issue 1. [DOI: 10.1002/14651858.CD005029.pub2] - DOI - PubMed
Regan 2014
    1. Regan J, Murphy A, Chiang M, McMahon BP, Coughlan T, Walshe M. Botulinum toxin for upper oesophageal sphincter dysfunction in neurological swallowing disorders. Cochrane Database of Systematic Reviews 2014, Issue 5. [DOI: 10.1002/14651858.CD009968.pub2] - DOI - PMC - PubMed

Additional references

Amatya 2017
    1. Amatya B, Young J, Khan F. Non‐pharmacological interventions for chronic pain in multiple sclerosis. Cochrane Database of Systematic Reviews 2017, Issue 3. [DOI: 10.1002/14651858.CD012622] - DOI - PMC - PubMed
Amatya 2017a
    1. Amatya B, Khan F, Ng L, Galea M. Rehabilitation for people with multiple sclerosis: an overview of Cochrane systematic reviews. Cochrane Database of Systematic Reviews 2017, Issue 7. [DOI: 10.1002/14651858.CD012732] - DOI - PMC - PubMed
Andreasen 2011
    1. Andreasen AK, Stenager E, Dalgas U. The effect of exercise therapy on fatigue in multiple sclerosis. Multiple Sclerosis 2011;17(9):1041‐54. - PubMed
Ansari 2008
    1. Ansari NN, Naghdi S, Hasson S, Azarsa MH, Azarnia S. The Modified Tardieu Scale for the measurement of elbow flexor spasticity in adult patients with hemiplegia. Brain Injury 2008;22(13‐14):1007‐12. - PubMed
Ansari 2009
    1. Ansari NN, Naghdi S, Hasson S, Fakhari Z, Mashayekhi M, Herasi M. Assessing the reliability of the Modified Ashworth Scale between two physiotherapists in adult patients with hemiplegia. NeuroRehabilitation 2009;25(4):235‐40. - PubMed
Asano 2014
    1. Asano M, Finlayson M. Meta‐analysis of three different types of fatigue management interventions for people with multiple sclerosis: exercise, education, and medication. Multiple Sclerosis International 2014;2014:1‐12. - PMC - PubMed
Balshem 2011
    1. Balshem H, Helfand M, Schünemann HJ, Oxman AD, Kunz R, Brozek J, et al. GRADE guidelines: 3. Rating the quality of evidence. Journal of Clinical Epidemiology 2011;64:401‐6. - PubMed
Barten 2010
    1. Barten LJ, Allington DR, Procacci KA, Rivey MP. New approaches in the management of multiple sclerosis. Drug Design, Development and Therapy 2010;24(4):343‐66. - PMC - PubMed
Becker 2011
    1. Becker LA, Oxman AD. Chapter 22: Overview of reviews. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Beer 2012
    1. Beer S, Khan F, Kesselring J. Rehabilitation interventions in multiple sclerosis: an overview. Journal of Neurology 2012;259:1994‐2008. - PubMed
Bennett 2010
    1. Bennett SE. Effective rehabilitation methods in patients with multiple sclerosis. US Neurology 2010;5(2):67‐70.
Bilkman 2013
    1. Blikman LJ, Huisstede BM, Kooijmans H, Stam HJ, Bussmann JB, Meeteren J. Effectiveness of energy conservation treatment in reducing fatigue in multiple sclerosis: a systematic review and meta‐analysis. Archives of Physical Medicine and Rehabilitation 2013;94(7):1360‐76. - PubMed
Bohannon 1987
    1. Bohannon RW, Smith MB. Interrater reliability of a Modified Ashworth Scale of muscle spasticity. Physical Therapy 1987;67(2):206‐7. - PubMed
Bronson 2010
    1. Bronson C, Brewerton K, Ong J, Palanca C, Sullivan SJ. Does hippotherapy improve balance in persons with multiple sclerosis: a systematic review. European Journal of Physical and Rehabilitation Medicine 2010;46(3):347‐53. - PubMed
Campbell 2016
    1. Campbell E, Coulter EH, Mattison PG, Miller L, McFadyen A, Paul L. Physiotherapy rehabilitation for people with progressive multiple sclerosis: a systematic review. Archives of Physical Medicine and Rehabilitation 2016;97(1):141‐51. - PubMed
Cruickshank 2015
    1. Cruickshank TM, Reyes AR, Ziman MR. A systematic review and meta‐analysis of strength training in individuals with multiple sclerosis or Parkinson disease. Medicine 2015;94(4):e411. - PMC - PubMed
Cui 2010
    1. Cui Y, Zhishun L, Marchese M, Lee MS, Wang J, Niu J. Acupuncture for multiple sclerosis. Cochrane Database of Systematic Reviews 2010, Issue 1. [DOI: 10.1002/14651858.CD008210] - DOI
Dalgas 2015
    1. Dalgas U, Stenager E, Sloth M, Stenager E. The effect of exercise on depressive symptoms in multiple sclerosis based on a meta‐analysis and critical review of the literature. European Journal of Neurology 2015;22(3):443‐e34. - PubMed
FDA 2016
    1. US Food, Drug Adminstration. What is a serious adverse event? 2016. www.fda.gov/safety/medwatch/howtoreport/ucm053087.htm (accessed 29 June 2017).
Glinsky 2007
    1. Glinsky J, Harvey L, Es P. Efficacy of electrical stimulation to increase muscle strength in people with neurological conditions: a systematic review. Physiotherapy Research International 2007;12(3):175‐94. - PubMed
GRADEpro GDT 2015 [Computer program]
    1. McMaster University (developed by Evidence Prime). GRADEpro GDT. Version accessed 15 February 2016. Hamilton (ON): McMaster University (developed by Evidence Prime), 2015.
Granger 1990
    1. Granger CV, Cotter AC, Hamilton BB, Fiedler RC, Hens MM. Functional assessment scales: a study of persons with multiple sclerosis. Archives of Physical Medicine and Rehabilitation 1990;71(11):870‐5. - PubMed
Green 2002
    1. Green J, Forster A. Reliability of gait speed measured by a timed walking test in patients one year after stroke. Clinical Rehabilitation 2002;16:306‐14. - PubMed
Hammond 2000
    1. Hammond SR, McLeod JG, Macaskill P, English DR. Multiple sclerosis in Australia: prognostic factors. Journal of Clinical Neuroscience 2000;7:16‐9. - PubMed
Haselkorn 2015
    1. Haselkorn JK, Hughes C, Rae‐Grant A, Henson LJ, Bever CT, Lo AC, et al. Summary of comprehensive systematic review: rehabilitation in multiple sclerosis: report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology 2015;85(21):1896‐903. - PMC - PubMed
Hayes 2017
    1. Hayes S, Kennedy C, Galvin R, Finlayson M, McGuigan C, Walsh CD, et al. Interventions for preventing falls in people with multiple sclerosis. Cochrane Database of Systematic Reviews 2017, Issue 1. [DOI: 10.1002/14651858.CD012475] - DOI - PMC - PubMed
Higgins 2011
    1. Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Hoffman 2014
    1. Hoffman T, Glasziou P, Boutron I, Milne R, Perera R, Moher D, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ 2014;348:1‐12. - PubMed
Kalron 2015
    1. Kalron A, Zeilig G. Efficacy of exercise intervention programs on cognition in people suffering from multiple sclerosis, stroke and Parkinson's disease: A systematic review and meta‐analysis of current evidence. NeuroRehabilitation 2015;37(2):273‐89. - PubMed
Kantele 2015
    1. Kantele S, Karinkanta S, Sievanen H. Effects of long‐term whole‐body vibration training on mobility in patients with multiple sclerosis: a meta‐analysis of randomized controlled trials. Journal of the Neurological Sciences 2015;358(1‐2):31‐7. - PubMed
Khan 2006
    1. Khan F, McPhail T, Brand C, Turner‐Stokes L, Kilpatrick T. Multiple sclerosis: disability profile and quality of life in an Australian community cohort. Internationale Zeitschrift fur Rehabilitationsforschung. Revue Internationale de Recherches de Readaptation [International Journal of Rehabilitation Research] 2006;29(2):87‐96. - PubMed
Khan 2007a
    1. Khan F, Pallant JF. Use of the International Classification of Functioning, Disability and Health (ICF) to identify preliminary comprehensive and brief core sets for multiple sclerosis. Disability and Rehabilitation 2007;29:205‐13. - PubMed
Khan 2010
    1. Khan F, Pallant JF, Zhang N, Turner‐Stokes L. Clinical practice improvement approach in multiple sclerosis rehabilitation: a pilot study. Internationale Zeitschrift fur Rehabilitationsforschung. Revue Internationale de Recherches de Readaptation ]International Journal of Rehabilitation Research] 2010;33(3):238‐47. - PubMed
Khan 2011
    1. Khan F, Amatya B, Turner‐Stokes L. Symptomatic therapy and rehabilitation in primary progressive multiple sclerosis. Neurology Research International 2011;2011:1‐22. - PMC - PubMed
Khan 2017
    1. Khan F, Amatya B. Rehabilitation in multiple sclerosis: a systematic review of systematic reviews. Archives of Physical Medicine and Rehabilitation 2017;98(2):356‐67. - PubMed
Kjolhede 2012
    1. Kjolhede T, Vissing K, Dalgas U. Multiple sclerosis and progressive resistance training: a systematic review. Multiple Sclerosis (Houndmills, Basingstoke, England) 2012;18(9):1215‐28. - PubMed
Kung 2010
    1. Kung J, Chiappelli F, Cajulis OO, Avezova R, KossanG, Chew L, et al. From systematic reviews to clinical recommendations for evidence‐based health care: validation of Revised Assessment of Multiple Systematic Reviews (R‐AMSTAR) for grading of clinical relevance. Open Dentistry Journal 2010;4:84‐91. - PMC - PubMed
Latimer‐Cheung 2013
    1. Pearson M, Dieberg G, Smart N. Exercise as a therapy for improvement of walking ability in adults with multiple sclerosis: a meta‐analysis. Archives of Physical Medicine and Rehabilitation 2015;96(7):1339‐48. - PubMed
Mahoney 1965
    1. Mahoney FI, Barthel D. Functional evaluation: the Barthel Index. Maryland State Medical Journal 1965;14:56‐61. - PubMed
Mehrholz 2005
    1. Mehrholz J, Wagner K, Meissner D, Grundmann K, Zange C, Koch R, et al. Reliability of the Modified Tardieu Scale and the Modified Ashworth Scale in adult patients with severe brain injury: a comparison study. Clinical Rehabilitation 2005;19:751‐9. - PubMed
Mitolo 2015
    1. Mitolo M, Venneri A, Wilkinson ID, Sharrack B. Cognitive rehabilitation in multiple sclerosis: a systematic review. Journal of Neurological Sciences 2015;354(1‐2):1‐9. - PubMed
Moher 2001
    1. Moher D, Schultz KF, Altman D, CONSORT Group (Consolidated Standards of Reporting Trials). The CONSORT statement: revised recommendations for improving the quality of reports of parallel‐group randomized trials. JAMA 2001;285:1987‐91. - PubMed
Paltamaa 2012
    1. Paltamaa J, Sjögren T, Peurala SH, Heinonen A. Effects of physiotherapy interventions on balance in multiple sclerosis: a systematic review and meta‐analysis of randomized controlled trials. Journal of Rehabilitation Medicine 2012;44(10):811‐23. - PubMed
Podsiadlo 1991
    1. Podsiadlo D, Richardson S. The timed 'up and go': a test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society 1991;39:142‐8. - PubMed
Rietberg 2011
    1. Rietberg MB, Veerbeek J, Wegen EEH, Gosselink R, Kwakkel G. Respiratory muscle training for multiple sclerosis. Cochrane Database of Systematic Reviews 2011, Issue 11. [DOI: 10.1002/14651858.CD009424] - DOI - PMC - PubMed
Robinson 1983
    1. Robinson BC. Validation of a Caregiver Strain Index (CSI). Journal of Gerontology 1983;38(3):344‐8. - PubMed
Shea 2007a
    1. Shea BJ, Grimshaw JM, Wells GA, Boers M, Andersson N, Hamel C, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Medical Research Methodology 2007;7:1‐10. - PMC - PubMed
Shea 2007b
    1. Shea BJ, Bouter LM, Peterson J, Andersson N, Ortiz Z, Ramsay T, et al. External validation of a measurement tool to assess systematic reviews (AMSTAR). PLoS One 2007;2:e1350. - PMC - PubMed
Shepherd 2016
    1. Shepherd E, Middleton P, Makrides M, McIntyre S, Badawi N, Crowther CA. Neonatal interventions for preventing cerebral palsy: an overview of Cochrane systematic reviews. Cochrane Database of Systematic Reviews 2016, Issue 10. [DOI: 10.1002/14651858.CD012409] - DOI - PMC - PubMed
Smith 2011
    1. Smith V, Devane D, Begley CM, Clarke M. Methodology in conducting a systematic review of systematic reviews of healthcare interventions. BMC Medical Research Methodology 2011;11(1):15. - PMC - PubMed
Snook 2009
    1. Snook EM, Motl RW. Effect of exercise training on walking mobility in multiple sclerosis: a meta‐analysis. Neurorehabilitation and Neural Repair 2009;23(2):108‐16. - PubMed
Trisolini 2010
    1. Trisolini M, Honeycutt A, Wiener J, Lesesne S. Global economic impact of multiple sclerosis. www.msif.org/wp‐content/uploads/2014/09/Global_economic_impact_of_MS.pdf (accessed 03 March 2017).
Vickrey 1997
    1. Vickrey BG, Hays RD, Genovese BJ, Myers LW, Ellison GW. Comparison of a generic to disease‐targeted health related quality‐of‐life measures for multiple sclerosis. Journal of Clinical Epidemiology 1997;50(5):557‐69. - PubMed
White 2008a
    1. White LJ, Castellano V. Exercise and brain health ‐ implications for multiple sclerosis: part 1 ‐ neuronal growth factors. Sports Medicine 2008;38(2):91‐100. - PubMed
White 2008b
    1. White LJ, Castellano V. Exercise and brain health ‐ implications for multiple sclerosis: part II ‐ immune factors and stress hormones. Sports Medicine 2008;38(3):179‐86. - PubMed
WHO 2001
    1. World Health Organization (WHO). International Classification of Functioning, Disability and Health (ICF). www.who.int/classifications/icf/en/ (accessed 27 September 2016).
WHO 2008
    1. World Health Organization (WHO). Atlas: multiple sclerosis resources in the world. www.who.int/mental_health/neurology/Atlas_MS_WEB.pdf (accessed 27 September 2016).
WHO 2011
    1. World Health Organization (WHO). World Report on Disability. www.who.int/disabilities/world_report/2011/report/en/ (accessed 27 September 2016).
Yu 2014
    1. Yu CH, Mathiowetz V. Systematic review of occupational therapy‐related interventions for people with multiple sclerosis: part 1. Activity and participation. American Journal of Occupational Therapy 2014;68(1):27‐32. - PubMed
Yu 2014a
    1. Yu CH, Mathiowetz V. Systematic review of occupational therapy‐related interventions for people with multiple sclerosis: part 2. Impairment. American Journal of Occupational Therapy 2014;68(1):33‐8. - PubMed

Publication types

MeSH terms