Anders Romberg is a physiotherapist at the Masku Neurological Rehabilitation Centre (MNRC), which is a facility of the Finnish Multiple Sclerosis Society, located near the city of Turku. Anders has twenty years of experience in neurological rehabilitation.
Can you describe the MNRC?
The MNRC was founded in 1988 and has grown from 52 to 87 beds and from 32 to 120 staff members. Today 1,400 patients, of whom approximately 1,000 with MS, are treated yearly in the centre. The average length of stay is 21 days.
The services offered by MNRC include in-patient rehabilitation only, with a special emphasis on adaptation training for newly diagnosed patients and rehabilitation for individuals with significant impairments. The MNRC also serves as a resource centre for people with rare neurological diseases.
The work in the MNRC is based on an interdisciplinary team approach. The staff (divided into pink, blue and green teams) includes three neurologists, six psychologists/ neuropsychologists, three social workers, two speech therapists and a number of occupational therapists, physiotherapists and nurses all more or less specialising in neurological rehabilitation.
The vast majority of services provided at the MNRC are reimbursed by the Social Insurance Institution of Finland. The centre has had the ISO-9001 standard (SFS) certification since August 2002. In practice, this means that the quality of the work is continually evaluated, that the centre has a staff person who is responsible for quality control, and that external audits are periodically made in order to assess the level of quality of the services provided. For the individual patient this offers a guarantee of the provision of optimal rehabilitation services.
What are your role and responsibilities?
As a physiotherapist, I plan, perform and evaluate physiotherapy programmes for individual patients. As a team member I also participate in admission, follow-up and discharge meetings together with other rehabilitation professionals.
I am also involved in research and have published a number of scientific articles as well as a book (in Finnish) entitled MS and Exercise – Joy, Quality of Life & Functional Ability (2005). My recent research interests include effects of long-term exercise on MS, and the effects of heat stress on fatigue and functional ability. Dr Juhani Ruutiainen, Director of the MNRC, and Päivi Hämäläinen, Director of Neuropsychology, are my primary research collaborators.
In your experience, has there been an evolution in MS rehabilitation over the years?
Indeed. High-quality studies have shown that rehabilitation can truly benefit people with MS and that the effects can be long-lasting. It is difficult to estimate how much the scientific evidence actually influences clinical practice, but what is certain is that rehabilitation professionals have become more critical in the way they work. There is greater consistency in evaluation tools and the way rehabilitation outcomes are measured in MS centres.
We have seen an evolution in the treatment of bladder problems with improved catheterisation techniques. A better understanding of electrical stimulation and pelvic floor exercises, among other aspects of rehabilitation, has meant that symptom improvement is possible for many people with MS, thus, improving their quality of life.
There has been progress in understanding the neurophysiological basis for neurological rehabilitation in MS. Brain plasticity, the capability of brain structures to adapt to new situations and to build new networks, provides an exciting base on which to build, providing evidence that research in rehabilitation plays an important role.
What aspects does rehabilitation research have in common with other types of research, for example, with clinical trials, and how does it differ?
In rehabilitation research in MS, different types of study approaches and designs are needed to capture the complex interventions, outcomes and human interactions that characterise most aspects of rehabilitation. Descriptive or cross-sectional studies are useful to uncover frequent features in MS symptomatology that might be relevant for, or taken into account when considering new treatments. Qualitative studies are helpful in understanding the individual experiences of rehabilitation (because so much of rehabilitation is based on individual face-to-face or hands-on contact).
Conducting a randomised clinical trial in rehabilitation is complicated. Randomising the participants to different arms of a trial without them knowing which treatment they are getting, an including a placebo treatment, are difficult aspects to overcome. There are also ethical considerations when randomly assigning patients to a less-thanoptimal treatment (or no treatment) condition when we already know (presumably based on clinical experience) that a particular treatment is the best option.
What impact does/can rehabilitation research have on people with MS?
In short, rehabilitation research improves care and treatment for people with MS. For example, based on our study results, physiotherapists at the MNRC have more precise knowledge about what should be taken into account when planning home exercise programmes for people with MS. The results have also provided support for improving adherence to home exercise protocols.
Research also has the potential for demonstrating the value of rehabilitation in MS. Financial resources are always limited and research is among the best tools for showing that rehabilitation is justified in such a complex and unpredictable disease as MS.
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