Three studies have attempted to address this question and all were restricted to the evaluation of a single group. The first was a retrospective study based on reviewing inpatient records and making subsequent phone contact with 37 patients 6 to 36 months later. It suggested that gains on the EDSS and FIM documented on discharge were maintained at follow-up. The second study was a prospective evaluation of 47 patients seen 3 months post-discharge and included a measure of handicap (Environmental Status Scale) along with the EDSS and FIM. No change was seen in the EDSS during or following rehabilitation; gains in the FIM were maintained, while the level of handicap actually improved over the 3-month follow-up period.

The most recent study involved the prospective longitudinal evaluation of 50 of the patients with progressive MS involved in the randomized control trial described earlier. This study used a wider range of outcome measures; in addition to the EDSS and FIM, there were measures of handicap (LHS), quality of life (SF-36), and emotional well-being (General Health Questionnaire GHQ). Patients were evaluated for 12 months at 3- month intervals following discharge, and 12-month data were collected on 48 of the 50 patients (92 percent). As might be expected, there was great variation between individual patients as well as considerable differences between the outcome measures. Summary measures were used to calculate the time taken to return to baseline. The EDSS deteriorated from a median of 6.8 on discharge to 8.0 at 12-month follow-up. Despite this, the gains in disability were maintained for 6 months before slowly declining. As in the previous study, handicap improved further following discharge, but the benefit lessened after 6 months. Quality of life and emotional well-being improved considerably during the rehabilitation period, and this improvement was maintained for 10 and 7 months, respectively, before beginning to return to the baseline. A further finding of this study was that those who made the most gains during the rehabilitation period tended to maintain those gains for a longer time.

A final question is whether we can predict those who have the potential to benefit from neurorehabilitation or perhaps, more importantly, those who will not make gains. Two studies have addressed this issue. Both agree that severe cognitive impairment is a particular challenge and one found that severe ataxia was also associated with a poor response.

Conclusion: Although it is difficult to combine the results of all of these studies and there are major methodological differences between them, with few, if any, reaching an adequate scientific level, they all suggest that organized patient-centred multidisciplinary rehabilitation is of benefit in MS management. There is also some evidence to suggest that the gains derived from rehabilitation are maintained in the short term, at least in part, in this progressive condition. They emphasize the need for a range of outcome measures to be used and stress the importance of continuity of care.