Papeix Caroline, Gambotti Laetitia, Assouad Rana, Ewenczyck Claire, Tanguy Marie-Laure, Pineau Fanny, Houis Marie-Claire, Mazevet Dominique, Maillart Elisabeth, Lubetzki Catherine
AP-HP, Pitié-Salpêtrière Hospital, Neurology Department, France.
AP-HP, Pitié-Salpêtrière Hospital, Clinical Research Unit, France.
Mult Scler J Exp Transl Clin. 2015 Sep 28;1:2055217315608864. doi: 10.1177/2055217315608864. eCollection 2015 Jan-Dec.
Disabled multiple sclerosis (MS) patients often need intervention of multiple specialists, resulting in a complex organization of care. How this multidisciplinary care should be organized and structured has not been studied.
The objective of this article is to address the effectiveness of an integrated multidisciplinary approach versus usual care in MS patients.
This is a prospective, randomized, controlled, monocentric clinical trial in MS patients. Two treatment strategies were compared: (i) an integrated multidisciplinary (IMD) approach, consisting of a half-day individually tailored comprehensive assessment in the MS clinic; and (ii) a standard care. The primary outcome was the impact of the strategy on quality of life (QoL) measured using the MSIS-29 scale at inclusion and after six months.
Fifty MS patients were included. Median MSIS 29 score decreased over six months in the control group (-4.89) and increased in the IMD group (+2.00), with a significant difference between the two groups ( = 0.03). However, in the multivariate analysis, after adjustment of HAD-D and INTERMED score, this difference was no longer significant.
This prospective, randomized study is the first attempt to evaluate the multidisciplinary approach in MS patients. The results show that, contrary to our expectations, an integrated multidisciplinary approach is not superior to usual care on QoL.
残疾多发性硬化症（MS）患者通常需要多位专科医生的干预，这导致了护理组织的复杂性。目前尚未对这种多学科护理应如何组织和构建进行研究。
本文的目的是探讨综合多学科方法与常规护理对MS患者的有效性。
这是一项针对MS患者的前瞻性、随机、对照、单中心临床试验。比较了两种治疗策略：（i）综合多学科（IMD）方法，包括在MS诊所进行为期半天的个性化全面评估；（ii）标准护理。主要结局是该策略对入组时和六个月后使用MSIS - 29量表测量的生活质量（QoL）的影响。
纳入了50例MS患者。对照组的MSIS 29评分中位数在六个月内下降（-4.89），而IMD组上升（+2.00），两组之间存在显著差异（= 0.03）。然而，在多变量分析中，调整HAD - D和INTERMED评分后，这种差异不再显著。
这项前瞻性随机研究是首次尝试评估MS患者的多学科方法。结果表明，与我们的预期相反，综合多学科方法在生活质量方面并不优于常规护理。
