Evaluating rehabilitation: An ongoing challenge.

Research on the effectiveness of rehabilitation interventions is crucial for people with multiple sclerosis (MS), their caregivers, treatment providers and policy makers. Whilst there has been a steady increase in rehabilitation research activity over the past decade, studies have tended to focus on the evaluation of single interventions, such as supervised exercise programmes, and even here there are challenges. In comparison few studies have evaluated the more complex packages, such as multi-disciplinary inpatient rehabilitation. Further, as is typical across the rehabilitation arena, many of the studies undertaken have been pilot or feasibility studies which have not moved onto a definitive trial. As a consequence, practice guidelines have been unable to make specific recommendations about the effectiveness of multi-disciplinary rehabilitation, with regard, for example, to MS subtypes, stages of disability or model of service delivery. The recurring conclusion of systematic reviews, guidelines and commentaries is that there is a need for well-designed trials of rehabilitation therapies with adequate sample sizes and appropriate outcome measures, powered to measure change, over both the short and longer term. The randomised controlled trial of multi-disciplinary inpatient rehabilitation, reported by Boesen et al. in this issue, addresses this call; it is large (n = 427), covers an important domain (quality of life) and follows up the outcomes at six months. The authors describe this article as being the first in a series on the study, reporting results of a broad range of secondary measures (including costs) in future publications. In doing so, this study provides an important contribution to the rehabilitation evidence base.