In Europe, theoretical approaches to physical therapy and rehabilitation in multiple sclerosis often appear significantly different. While there is general agreement that rehabilitation plays an important role in maintaining and improving function in persons with multiple sclerosis, no consensus exists on what may be the most effective approach to achieve the best possible functionality within an individual's limitations.The objective of this paper is to initiate an analysis of currently applied physical interventions for people with multiple sclerosis throughout Europe during inpatient or outpatient rehabilitation programs. A study of the content of rehabilitation may show presently performed treatment methods revealing the basic considerations that nowadays guide clinicians implicitly or explicitly in the treatment of persons with multiple sclerosis. Following this first step, comparative studies can be set up.

Department of Rehabilitation 3rd Medical Faculty Charles University Ruská 87 100 00 Prague 10 Czech Republic

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Thompson AJ. Symptomatic management and rehabilitation in multiple sclerosis. J Neurol Neurosurg Psychiatry. 2001;71(Suppl 2):22–27. PubMed PMC

Henze T, Rieckmann P, Toyka KV. Symptomatic treatment of Multiple Sclerosis. Eur Neurol. 2006;56:78–105. doi: 10.1159/000095699. PubMed DOI

Khan F, Turner-Stokes L, Ng L, Kilpatrick T. Multidisciplinary rehabilitation for adults with multiple sclerosis. Cochrane Database Syst Rev. 2007. p. CD006036. PubMed PMC

Polman CH, O'Connor PW, Havrdova E, Hutchinson M, Kappos L, Miller DH. AFFIRM Investigators. A randomised, placebo-controlled trial of natalizumab for relapsing multiple sclerosis. N Engl J Med. 2006;354(9):899–910. doi: 10.1056/NEJMoa044397. PubMed DOI

Kozak T, Havrdova E, Pitha J. High dose immunosupressive therapy with PBCP support in the treatment of poor risk multiple sclerosis. Bone Marrow Transplant. 2000;25(5):525–531. doi: 10.1038/sj.bmt.1702180. PubMed DOI

Goodkin DE, Rudick RA. Low dose (7,5 mg) oral methotrexate reduces the rate of progression in chronic progressive multiple sclerosis. Ann Neurol. 1995;37:30–40. doi: 10.1002/ana.410370108. PubMed DOI

Barkhof F, Hommes OR, Scheltens P, Valk J. Quantitative MRI changes in gadolinium-DPTA enhancement after high-dose intravenous methylprednisolone in multiple sclerosis. Neurology. 1991;41:1219–1222. PubMed

Wade D. Rehabilitation research-time for a change of focus. The Lancet Neurology. 2002;1(4):209.. doi: 10.1016/S1474-4422(02)00095-9. PubMed DOI

Richardson D. Physical therapy in spasticity. Eur J Neurol. 2002;9(Suppl 1):17–22. doi: 10.1046/j.1468-1331.2002.0090s1017.x. PubMed DOI

Nadeau SE. A paradigm shift in neurorehabilitation. Lancet Neurol. 2002;1(2):126–130. doi: 10.1016/S1474-4422(02)00044-3. PubMed DOI

Pelletier J, Audoin B, Reuter F, Ranjeva JP. Plasticity in MS: from functional imaging to rehabilitation. Int MS J. 2009;16:26–31. PubMed

Khan F, Pallant JF, Brand C, Kilpatrick TJ. Effectiveness of Rehabilitation Intervention in persons with Multiple sclerosis: A Randomized Controlled Trial. J Neurol Neurosurg Psychiatry. 2008;79(11):1230–1235. doi: 10.1136/jnnp.2007.133777. PubMed DOI

Freeman JA, Langgdon DW, Hobart JC. The impact of inpatient rehabilitation on progressive multiple sclerosis. Ann Neurol. 1997;2:236–244. doi: 10.1002/ana.410420216. PubMed DOI

Freeman JA, Langdon DW, Hobart JC, Thompson AJ. Inpatient rehabilitation in multiple sclerosis: do the benefits carry over into the community? Neurology. 1999;52(1):50–56. PubMed

Kidd D, Thompson AJ. Prospective study of neurorehabilitation in multiple sclerosis. J Neurol Neurosurg Psychiatry. 1997;62(4):423–424. doi: 10.1136/jnnp.62.4.423. PubMed DOI PMC

Dalgas U, Stenager E, Ingemann-Hansen T. Multiple sclerosis and physical exercise: recommendations for the application of resistance, endurance and combined training. Mult Scler. 2008;14:35–53. doi: 10.1177/1352458507079445. PubMed DOI

Rietberg MB, Brooks D, Uitdehaag BM, Kwakkel G. Exercise therapy for multiple sclerosis. Cochrane Database Syst Rev. 2005. p. CD003980. PubMed PMC

Romberg A, Virtanen A, Ruutiainen J. Long-term exercise improves functional impairment but not quality of life in multiple sclerosis. J Neurol. 2005;252(7):839–845. doi: 10.1007/s00415-005-0759-2. PubMed DOI

Romberg A, Virtanen A, Ruutiainen J, Aunola S, Karppi SL, Vaara M. Effects of a 6-month exercise program on patients with multiple sclerosis: a randomized study. Neurology. 2004;63(11):2034–2038. PubMed

Mostert S, Kesselring J. Effects of a short-term exercise training program on aerobic fitness, fatigue, health perception and activity level of subjects with multiple sclerosis. Mult Scler. 2002;8:161–168. doi: 10.1191/1352458502ms779oa. PubMed DOI

World Health Organization. International Classification of Functioning, Disability and Health (ICF) Pocket-sized Book. 2001. ISBN-13 9789241545440.

Kesselring J, Coenen M, Cieza A, Thompson A, Kostanjsek N, Stucki G. Developing the ICF Core Sets for multiple sclerosis to specify functioning. Mult Scler. 2008;14(2):252–254. doi: 10.1177/1352458507082615. PubMed DOI

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. Disabil Rehabil. 2007;29(3):205–213. doi: 10.1080/09638280600756141. PubMed DOI

Motl RW, McAuley E. Pathways between physical activity and quality of life in adults with multiple sclerosis. Health Psychol. 2009;28(6):682–689. doi: 10.1037/a0015985. PubMed DOI

Petajan JH, Gappmaier E, White AT. Impact of aerobic training on fitness and quality of life in multiple sclerosis. Ann Neurology. 1996;39:432–441. doi: 10.1002/ana.410390405. PubMed DOI

EMSP. Code of Good Practice in MS, May 2007 - revised in March 2008

Haigh R, Tennant A, Biering-Sørensen F, Grimby G, Marincek C, Phillips S, Ring H, Tesio L, Thonnard JL. The use of outcome measures in physical medicine and rehabilitation within Europe. J Rehabil Med. 2001;33(6):273–8. doi: 10.1080/165019701753236464. PubMed DOI

Moret-Hartman M, Reuzel R, Grin J, van der Wilt GJ. Participatory Workshops are Not Enough to Prevent Policy Implementation Failures: An Example of a Policy Development Process Concerning the Drug Interferon-beta for Multiple Sclerosis. Health Care Anal. 2008;16(2):161–175. doi: 10.1007/s10728-007-0069-1. PubMed DOI PMC

Flachenecker P, Khil L, Bergmann S, Kowalewski M, Pascu I, Pérez-Miralles F, Sastre-Garriga J, Zwingers T. Development and pilot phase of a European MS register. J Neurol. 2010. in press . PubMed

Prodinger B, Weise AP, Shaw L, Stamm TA. A Delphi study on environmental factors that impact work and social life participation of individuals with multiple sclerosis in Austria and Switzerland. Disabil Rehabil. 2010;32(3):183–95. doi: 10.3109/09638280903071883. PubMed DOI

Kwakkel G. Towards integrative neurorehabilitation science. Physiother Res Int. 2009;14(3):137–146. doi: 10.1002/pri.446. PubMed DOI

Hutchinson B, Forwell SJ, Bennett S, Brown T, Karpatkin H, Miller D. Toward a Consensus on Rehabilitation Outcomes in MS: Gait and Fatigue. Report of a CMSC Consensus Conference, November 28-29, 2007. Int J MS Care. 2009;11:67–78.

Gijbels D, Alders G, Van Hoof E, Charlier C, Roelants M, Broekmans T, Thijs H, Eijnde BO, Feys P. Predicting habitual walking performance in MS: relevance of capacity and self-report measures. Multiple Sclerosis. 2010;16(5):618–26. doi: 10.1177/1352458510361357. PubMed DOI

Wiles CM, Newcombe RG, Fuller KJ, Shaw S, Furnival-Doran J, Pickersgill TP. Controlled randomised crossover trial of the effects of physiotherapy on mobility in chronic multiple sclerosis. J Neurol Neurosurg Psychiatry. 2001;70(2):174–179. doi: 10.1136/jnnp.70.2.174. PubMed DOI PMC

Solari A, Filippini G, Gasco P, Colla L, Salmaggi A, La Mantia L. Physical rehabilitation has a positive effect on disability in multiple sclerosis patients. Neurology. 1999;52(1):57–62. PubMed

Rasova K, Brandejsky P, Havrdova E, Zalisova M, Foubikova B. Comparison of the influence of different rehabilitation programs on clinical spirometric and spiroergometric parameters in patients with multiple sclerosis. Multiple Sclerosis. 2006;12:227–234. doi: 10.1191/135248506ms1248oa. PubMed DOI

Di Fabio RP, Soderberg J, Choi T, Hansen CR, Schapiro RT. Extended outpatient rehabilitation: its influence on symptom frequency, fatigue, and functional status for persons with progressive multiple sclerosis. Arch Phys Med Rehabil. 1998;79(2):141–146. doi: 10.1016/S0003-9993(98)90290-8. PubMed DOI

Lord SE, Wade DT, Halligan PW. A comparison of two physiotherapy treatment approaches to improve walking in multiple sclerosis: a pilot randomized controlled study. Clin Rehabil. 1998;12(6):477–486. doi: 10.1191/026921598675863454. PubMed DOI

Freeman D, Harris M. In: Case management for mentally ill patients. Harris M, Bergman H, editor. Harwood Accademic Publishers; 1993. The philosophy of science and theories of case management; pp. 1–5.

Elola J, Daponte A, Navarro V. Health indicators and the organization of health care systems in western Europe. Am J Public Health. 1995;85(10):1397–401. doi: 10.2105/AJPH.85.10.1397. PubMed DOI PMC

van Doorslaer E, Wagstaff A, van der Burg H, Christiansen T, De Graeve D, Duchesne I, Gerdtham UG, Gerfin M, Geurts J, Gross L, Häkkinen U, John J, Klavus J, Leu RE, Nolan B, O'Donnell O, Propper C, Puffer F, Schellhorn M, Sundberg G, Winkelhake O. Equity in the delivery of health care in Europe and the US. J Health Econ. 2000;19(5):553–83. doi: 10.1016/S0167-6296(00)00050-3. PubMed DOI

Perkins MB, Jensen PS, Jaccard J, Gollwitzer P, Oettingen G, Pappadopulos E, Hoagwood KE. Applying theory-driven approaches to understanding and modifying clinicians' behavior: what do we know? Psychiatr Serv. 2007;58(3):342–8. doi: 10.1176/appi.ps.58.3.342. PubMed DOI

Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, Rubin HR. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999;282(15):1458–65. doi: 10.1001/jama.282.15.1458. PubMed DOI

Mauksch LB, Dugdale DC, Dodson S, Epstein R. Relationship, communication, and efficiency in the medical encounter: creating a clinical model from a literature review. Arch Intern Med. 2008;168(13):1387–95. doi: 10.1001/archinte.168.13.1387. PubMed DOI

Faissner A, Kettenmann H, Trotter J. In: Comprehensive Human Physiology. Greger R, Windhorst U, editor. Springer-Verlag, Berlin; 1996. A critical review of contemporary therapies; pp. 96–108.

Umphred DA, El-din D. In: Theoretical Foundations for Clinical Practice Neurological Rehabilitation. Fourth. Umphred DA, editor. Mosby, Inc., St. Luis Missouri; 2001. Introduction; pp. 3–31.

Kolar P. In: Rehabilitation of the Spine. Craig Liebenson, editor. Lippincott Williams & Wilkins; 2007. Facilitation of Agonist-Antagonist Co-activation by Reflex Stimulation methods.

Wolf SL, Winstein CJ, Miller JP, Taub E, Uswatte G, Morris D, Giuliani C, Light KE, Nichols-Larsen D. Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. JAMA. 2006;296:2095–2104. doi: 10.1001/jama.296.17.2095. PubMed DOI

Wolf SL, Blanton S, Baer H, Breshears J, Butler AJ. Repetitive task practice: a critical review of constraint-induced movement therapy in stroke. Neurologist. 2002;8(6):325–338. doi: 10.1097/00127893-200211000-00001. PubMed DOI PMC

Levin MF, Kleim JA, Wolf SL. What do motor "recovery" and "compensation" mean in patients following stroke? Neurorehabil Neural Repair. 2009;23(4):313–319. PubMed

Shumway-Cook A, Woollacott MH. Translating research into clinical praktice. Third. Lippincott Wiliams and Wilkins; 2006. Motor control.

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