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The Influence of Physiotherapy and Climate on Functioning in Multiple Sclerosis

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The Influence of Physiotherapy and Climate on Functioning in Multiple Sclerosis View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by NORA - Norwegian Open Research Archives 1 The Influence of Physiotherapy and Climate on Functioning in Multiple Sclerosis Aspects of physical performance, fatigue and health-related quality of life Tori Smedal Dissertation for the degree of philosophiae doctor (PhD) University of Bergen, Norway 2010 2 Scientific environment This thesis was carried out under supervision at Department of Public Health and Primary Health Care, Physiotherapy research group and Department of Clinical Medicine, University of Bergen. The first study was carried out in cooperation between Department of Public Health and Primary Health Care, University of Bergen; The Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital (HUS); and Department of Physiotherapy, HUS. The main study called Climate Influence on Physiotherapy in Multiple Sclerosis (CIOPIMS) was initiated by Section for Climate Therapy, Oslo University Hospital, who got the assignment to initiate the study from the Ministry of Health and Care Services of the Norwegian Government. The Norwegian Multiple Sclerosis Competence Centre, HUS carried out the study in cooperation with: Department of Public Health and Primary Health Care, University of Bergen; Department of Clinical Medicine, University of Bergen; Section for Climate Therapy, Oslo University Hospital; Department of Physiotherapy, HUS; Department of Neurology, Akershus University Hospital (AHUS); and Department of Neurology, HUS. The patients were treated at Clinica Vintersol Tenerife, Spain and at MS-Senteret Hakadal, Norway. To Olav 3 If the brain were so simple we could understand it, we would be so simple we couldn't. Lyall Watson 4 Contents SCIENTIFIC ENVIRONMENT......................................................................................................... 2 ACKNOWLEDGEMENTS................................................................................................................. 7 ABBREVIATIONS ............................................................................................................................ 11 ABSTRACT........................................................................................................................................ 13 LIST OF PUBLICATIONS............................................................................................................... 16 1. INTRODUCTION ................................................................................................................... 17 1.1 MULTIPLE SCLEROSIS ............................................................................................................ 18 1.1.1 Patophysiology........................................................................................................... 19 1.1.2 Epidemiology.............................................................................................................. 20 1.1.3 Aetiology .................................................................................................................... 21 1.1.3.1.Genetic factors ......................................................................................................................... 22 1.1.3.2 Environmental factors .............................................................................................................. 22 1.1.4 Diagnosis ................................................................................................................... 24 1.1.5 Course of the disease and prognosis.......................................................................... 25 1.1.6 Clinical symptoms ...................................................................................................... 27 1.1.6.1 The International Classification of Functioning, Disability and Health ................................... 27 1.1.6.2 Motor symptoms ...................................................................................................................... 29 1.1.6.3 Other symptoms ....................................................................................................................... 30 1.1.7 Health-related quality of life ...................................................................................... 32 1.1.8 The effect of heat and climate in MS .......................................................................... 33 1.1.9 Medical treatment ...................................................................................................... 34 1.2 REHABILITATION IN MS ........................................................................................................ 35 1.2.1 Neuroplasticity and possible implications for rehabilitation............................................ 37 5 1.2.2 Physiotherapy and physical training in MS...................................................................... 38 1.2.2.1 The Bobath Concept................................................................................................................. 40 2. AIMS OF THE STUDY .......................................................................................................... 42 3. MATERIALS AND METHODS ............................................................................................ 43 3.1 PATIENTS .............................................................................................................................. 44 3.2 MEASUREMENT TOOLS .......................................................................................................... 44 3.3 INTERVENTION ...................................................................................................................... 45 3.4 PAPER = ................................................................................................................................. 47 3.5 PAPER == ................................................................................................................................ 48 3.6 PAPER III............................................................................................................................... 50 3.7 PAPER V............................................................................................................................... 55 4. SUMMARY OF RESULTS .................................................................................................... 56 4.1 PAPER = ................................................................................................................................. 56 4.2 PAPER == ................................................................................................................................ 56 4.3 PAPER ===............................................................................................................................... 57 4.4 PAPER V............................................................................................................................... 60 5. GENERAL DISCUSSION ...................................................................................................... 61 5.1 INTERVENTION STUDIES, PAPER I & III ................................................................................. 61 5.1.1 The climate influence on the effect of physiotherapy ................................................. 61 5.1.2 Physiotherapy based on the Bobath concept.............................................................. 63 5.1.3 Outcome measures, designs and methodological considerations .............................. 68 5.1.3.1 Outcome measures ................................................................................................................... 68 5.1.3.2 Study design............................................................................................................................. 72 5.1.3.3 Other methodological considerations ....................................................................................... 74 5.2 NORWEGIAN VERSION OF MSIS-29, PAPER II ....................................................................... 75 6 5.2.1 The translation process of the MSIS-29 ..................................................................... 77 5.2.2 Psychometric properties of the Norwegian version of MSIS-29................................ 78 5.3 FATIGUE STUDY, PAPER IV ................................................................................................... 81 5.3.1 Associations between fatigue versus HRQoL and physical performance................... 81 5.3.2 Suggestions for a broader startegy in treating fatigue............................................... 83 6. CONCLUSIONS AND FURTHER RESEARCH................................................................. 85 REFERENCES................................................................................................................................... 87 PAPERS -=V.................................................................................................................................... 103 APPENDICES 7 Acknowledgements The present thesis is based upon research carried out from 2002 to 2004 while I was a master student and from 2006 to 2010 a PhD student at Department of Public Health and Primary Health Care and Department of Clinical Medicine, University of Bergen. The work was carried out at The Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, HUS. The studies were financed by: Section for Climate
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