Classification of Neurorehabilitation treatments: Preliminary results of a Multicentre Italian Study

Objective: To taxonomize the contents of neurorehabilitation programs and categorize goals and treatments provided to people with Parkinson Disease(PD) and Multiple Sclerosis(MS) to understand their impact on the outcomes. Background: Few researches investigated the importance of the com- ponents of a neurorehabilitation program on clinical outcome in everyday clinical practice[1,2]. Moreover, there is no standard method to categorize rehabilitative interventions, making difficult to explain why subjects improve and which of the various treatments is more effective. A multi- centre network was formed to collect data using a taxonomy tool devel- oped to provide information on the goals of rehabilitation and to categorize rehabilitation interventions. Methods: Subjects with PD and MS were evaluated pre and post inter- vention and a taxonomy tool was completed by physiotherapists at the end of the rehabilitation program. To provide a broad overview, treatments were categorized as “Task oriented” or “Impairment oriented”. In addition, subjects who improved 20% or more on the Modified Barthel Index (MBI) were defined as responders. Frequency analysis was performed to understand prevalence of goals and treatments and logistic models were used to provide Odd Ratio(OR) with 95% CI to provide degree of associa- tion between treatment and outcome. Results: We report preliminary data of 54 subjects (18 PD, 36 MS) from 1 of the 11 centres involved in this project. 1060 hours of physio- therapy were analysed. Gait was the main goal for both PD(54%) and MS(40.5%) followed by body transfers for PD(12%) and upper limb func- tion for MS(23.5%). Most frequent treatments were gait(27.6%) and bal- ance(17.7%) training for PD, while robotic therapy(25.6%) and gait training (13.3%) were mostly used for MS. MBI results showed 28% of PD were responders compared with 10% of MS subjects OR=3.8 (0.7-23.6;p=0.1). “Task oriented” treatment provided to 36% of PD and 19% of MS showed better results on the MBI, OR=17(12-355;p = 0.002) compared with the “Impairment oriented” treatment. Conclusions: Gait was the main goal of rehabilitation for PD and MS and the most frequently provided treatments were gait training and robot therapy. Preliminary results showed that improvements in functional out- come were more likely in PD subjects and in those who received Task ori- ented treatment. References: 1)Dijkers MP, Hart T, Tsaousides T, Whyte J, Zanca JM. Treatment taxonomy for rehabilitation: past, present, and prospects. Arch Phys Med Rehabil. 2014 Jan; 95: S6-16. 2)Rasova K, Freeman J, Martinkova P, Pavlikova M, Cattaneo D, Jonsdottir J, Henze T, Baert I, Van Asch P, Santoyo C, Smedal T, Beiske AG, Stachowiak M, Kovalewski M, Nedeljkovic U, Bakalidou D, Guerreiro JM, Nilsagård Y, Dimitrova EN, Habek M, Armutlu K, Donzé C, Ross E, Ilie AM, Marti c A, Romberg A, Feys P. The organisation of physiotherapy for peo- ple with multiple sclerosis across Europe: a multicentre questionnaire sur- vey. BMC Health Serv Res. 2016;16:552.