‘Applying Evidence with Confidence in MS Rehabilitation’
Lead: Martin Heine, Heleen Beckerman, Vincent de Groot
The RIMS project ‘Applying Evidence with Confidence in MS Rehabilitation’, or so-called APPECO project, is a living documentation system aiming to translate scientific evidence about MS rehabilitation treatments to clinical practice, and can be found at www.appeco.net. The most important goal of this open access application is to make evidence in MS rehabilitation real-time accessible, and to support health professionals worldwide in treating patients with MS. It bridges the gap between systematic reviews and clinical practice, and offers a solution for MS therapists who do not have the ability to assess systematic reviews on their merits and could generalize the findings to their clinical practice.
Progress since inception
In 2015-2018, we were able to develop an online platform for the identification, inclusion, data-extraction, analysis and reporting of randomized clinical trials on MS rehabilitation for fatigue and cognitive impairments. Thus far, more than 140 clinical trials have been added to APPECO, already providing insight into the effectiveness of a range of interventions on these important patient symptoms. The financial support of Sanofi Genzyme is highly appreciated. The great amount of scientific literature continuously being published makes it difficult for any health professional to keep his/her knowledge up to date. A possible aid would be a “living documentation system”, to which relevant data from new publications is continuously added. This would make it possible for a broad medical user group to always have the latest evidence on various interventions available. The target users of APPECO are all physiotherapists, occupational therapists, psychologists, clinical neuropsychologists, social workers, speech therapists, MS nurses, rehabilitation physicians, neurologists, residents and students, further summarized as MS therapists, working with patients with MS in various community-based and institutional health care settings in- and outside Europe. Health care professionals can make a synthesis of the information on their turn, to inform persons with MS on evidence-based rehabilitation treatments.
In 2018, the APPECO website was upgraded to a user-friendly and professional web-environment.
Per type of rehabilitation treatment APPECO displays the total number of studies, quality of evidence, and short and long-term effects of the treatment. In a simple and elegant way, for each intervention it is shown whether the intervention has a significant positive effect or not. Effect sizes and their 95% confidence intervals are graphically presented relative to the duration of the intervention. Three quality stars are assigned to each study in order to help the user determine the best evidence through clinical and academic reasoning. Studies can be filtered by using these quality stars, for example by only viewing studies of sufficiently high quality or only studies with a specific domain as primary outcome. The 53 outcome domains (fatigue, cognition, and 51 others) are logically grouped according to the International Classification of Functioning, a common model in rehabilitation medicine. More importantly, for each study intervention, a structured summary according to the Template for Intervention Description and Replication (TiDIER checklist) is available, which can be saved/printed in pdf format for clinical use.
Current developments and future points of action
To fully utilize the potential of what APPECO may provide to the MS clinical community the platform needs to be extended beyond fatigue and cognition. To facilitate this process, the project team has already extracted information from 51 other relevant outcomes for MS rehabilitation derived from the studies that reported on fatigue and cognition; for example, depression, mobility, and quality of life. RIMS is a not-for-profit European Network for best practice and research in MS Rehabilitation for Rehabilitation in MS (www.eurims.org), that cannot carry out its work without the generous support of its sponsors. With the financial support of multiple sponsors other MS symptoms as focus areas will be added to APPECO.
A further key step for the near future is approaching study authors of clinical trials on the APPECO website to consider uploading relevant “tools” to facilitate evidence-based MS rehabilitation. Study authors can already intuitively upload relevant information (e.g. pdf, ppt, doc) when requested and have the opportunity to add information that could not be extracted from the publication.
Finally, the project team anticipates the development of interactive content and e-learning materials that will guide the clinician using the platform, and to facilitate evidence-based clinical decision making (with confidence), and guide organisations of health care professionals in using the platform in guideline development and care pathways.
A complete and up-to-date living documentation system of randomized clinical trials on MS rehabilitation will help RIMS to building a research agenda to prioritize future research in the field of MS rehabilitation.