Randomized Controlled Trials of Rehabilitation in Multiple Sclerosis: Barriers and Unmet Needs.

Randomized controlled trials (RCTs) provide the foundation of evidence-based practice for the application of rehabilitation as complementary of medications for filling in the gaps and enhancing outcomes in people with multiple sclerosis (MS). This paper identifies seven field-wide areas of relevance for RCTs of rehabilitation that are barriers for (a) knowledge translation and implementation, (b) impact among those who most need rehabilitation, and (c) the field and its value in comprehensive MS care. The seven field-wide areas include improving the quality of RCTs; implementing discovery models for informing selection of interventions; focusing on primary end-points in samples screened for presence of symptoms/dysfunction; exploring response heterogeneity as an avenue for precision medicine; quantifying adherence and compliance for guiding future prescriptions; understanding mechanisms of outcomes through experimental medicine; and extending research into under-researched populations. These field-wide areas represent unmet needs for (a) optimizing quality of life and full participation through evidence-based rehabilitation among all people with MS, (b) reducing burdens and strains among caregivers, and (c) minimizing the financial and societal impact of MS.