Intervention Review

Occupational therapy for multiple sclerosis

  1. Esther EMJ Steultjens1,*,
  2. Joost J Dekker2,
  3. Lex M Bouter3,
  4. Mieke M Cardol4,
  5. Els CHM Van den Ende5,
  6. Jos van de Nes6

Editorial Group: Cochrane Multiple Sclerosis and Rare Diseases of the CNS Group

Published Online: 21 JUL 2003

Assessed as up-to-date: 21 MAY 2003

DOI: 10.1002/14651858.CD003608

How to Cite

Steultjens EEMJ, Dekker JJ, Bouter LM, Cardol MM, Van den Ende ECHM, van de Nes J. Occupational therapy for multiple sclerosis. Cochrane Database of Systematic Reviews 2003, Issue 3. Art. No.: CD003608. DOI: 10.1002/14651858.CD003608.

Author Information

  1. 1

    Ergologie, Zeist, Netherlands

  2. 2

    VU University Medical Center, Amsterdam, Department of Rehabilitation Medicine, Institute for Research in Extramural Medicine (EMGO), Amsterdam, Netherlands

  3. 3

    Executive Board of VU University Amsterdam, Amsterdam, Netherlands

  4. 4

    Nivel, Utrecht, Netherlands

  5. 5

    Sint Maartenskliniek, Department of Rheumatology, Nijmegen, Netherlands

  6. 6

    University of Professional Education Amsterdam, School of Occupational Therapy, Amsterdam, Netherlands

*Esther EMJ Steultjens, Ergologie, Krakelingweg 73, Zeist, 3707 HS, Netherlands.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JUL 2003




  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要


Multiple sclerosis (MS) patients are referred to occupational therapy with complaints about fatigue, limb weakness, alteration of upper extremity fine motor coordination, loss of sensation and spasticity that causes limitations in performance of activities of daily living and social participation. The primary purpose of occupational therapy is to enable individuals to participate in self-care, work and leisure activities that they want or need to perform.


To determine whether occupational therapy interventions in MS patients improve outcome on functional ability, social participation and/or health related quality of life.

Search methods

We searched the Cochrane MS Group trials register (January 2003), the Cochane Central Register of Controlled Trials (CENTRAL)The Cochrane Library Issue 4, 2002, MEDLINE (January 2003), EMBASE (December 2002), CINAHL (December 2002), AMED (December 2002), SciSearch (December 2002) and reference lists of articles.

Selection criteria

Controlled (randomized and non-randomized) and other than controlled studies addressing occupational therapy for MS patients were eligible for inclusion.

Data collection and analysis

Two reviewers independently assessed the methodological quality of the included trials. Disagreements were resolved by discussion. A list proposed by Van Tulder 1997 was used to assess the methodological quality. For outcome measures, we calculated standardized mean differences. We analysed the results using a best-evidence synthesis based on type of design, methodological quality and the significant findings of outcome and/or process measures.

Main results

One randomized clinical trial was identified and two other included studies were a controlled clinical trial and a study with a pre-post test design. The three studies involved 271 people in total. Two studies evaluated an energy-conservation course for groups of patients and one study evaluated a counseling intervention. The results of the energy conservation studies could be biased because of the designs used, the poor methodological quality and the small number of included patients. The high quality RCT on counseling reported non-significant results.

Authors' conclusions

On basis of this review no conclusions can be stated whether or not occupational therapy improves outcomes in MS patients.
The lack of (randomized controlled) efficacy studies in most intervention categories of occupational therapy demonstrates an urgent need for future research in occupational therapy for multiple sclerosis. Initially, a survey of occupational therapy practice for MS patients, including the characteristics and needs of these patients, is necessary to develop a research agenda for efficacy studies.


Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Occupational therapy as supportive treatment for people with multiple sclerosis

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 participate in the physical and social activities of their daily lives. The review found that there is currently no reliable evidence that OT improves outcomes for people with MS, although there was some suggestion that fatigue might be improved.



  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要







我們檢索了Cochrane MS Group trials register(2003年1月),Cochane Central Register of Controlled Trials (Cochrane Library Issue 4,2002年),MEDLINE(2003年1月),EMBASE(2002年12月),CINAHL(2002年12月),AMED(2002年12月),SciSearch(2002年12月)和文章的參考文獻列表。




兩位審查委員獨立評估所收錄試驗的研究方法品質。如果有分歧的意見則藉由討論來解決。一份1997年由Van Tulder提出的一項列表被使用於評估研究方法的品質。我們計算標準化平均差異值(standardized mean differences)以評估研究成果。根據研究設計的類型、研究方法的品質和研究成果、測量過程的顯著性,我們使用最佳證據綜合法(bestevidence synthesis) 以分析研究結果,


我們找到了一項隨機臨床試驗和一項臨床對照試驗,一項前後測設計(prepost test design)的研究。這三項研究共包含271人。兩項研究評估節能課程(energyconservation course) 的療效及一項研究評估諮商治療(counseling intervention) 的療效。結果發現節能課程的研究因實驗設計、試驗方法品質不良和病人數目太少的關係,可能會有結果的偏差。而品質較高的隨機對照試驗顯示諮商治療無法達到顯著差異的治療效果。





此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。