One systematic review of 12 RCTs assessed the efficacy of a variety of complementary and alternative therapies used by people with MS447 (1b). The specific therapies addressed in the review were nutritional therapy (n = 4), Feldenkrais bodywork (n = 1), reflexology (n = 1), magnetic field therapy (n = 2), neural therapy (n = 1) and psychological counselling (n = 2). It reported some evidence to suggest some benefit of nutrition therapy, linoleic acid (n = 3) and fish oils (n = 1) for the physical symptoms of MS. Likewise, magnetic field therapy and neural therapy also appeared to have a short-term beneficial effect on physical symptoms. The results also showed that massage/bodywork and psychological counselling appear to improve depression, anxiety and self-esteem. However, the strength of evidence for any of the therapies was limited as many of the trials suffered from significant methodological flaws. One further CCT that also examined reflexology reported no effect on a range of symptoms, and although symptoms scores improved slightly during treatment this was not maintained at follow-up448 (IIa).
Two small randomised crossover trials examined the effectiveness of body cooling for heat sensitive patients449,450 (Ib). The first placebo-controlled trial reported beneficial effects on three out of four of the indices tested, namely visual acuity, timed walk test and muscle strength, but no effect on coordination.450 However, the length of follow-up was not reported and so it is impossible to determine whether these effects were transitory. The second trial reported no significant effects on either tympanic temperature decreases or on any of twelve performance tests.449
Three RCTs assessed the effectiveness of different exercise programmes for increasing the fitness and well-being of individuals with MS451,452,453 (Ib). The first that examined the effectiveness of a water exercise training program found positive effects upon pain, energy, social and sexual function as assessed by the MSQOL-54, and tension, fatigue and vigour, assessed by the POMS-SF.452 However, the second RCT that examined an exercise programme using a leg cycle ergometer found no improvement in either the physical fitness indices assessed or grades of fatigue, as assessed by the Fatigue Severity Scale.453 The last RCT examined the utility of lectures on exercise philosophy combined with nutrition, stress management and an individualised exercise programmes.451 The results showed no effect on either graded exercise time or on EDSS scores.
Two RCTs (Ib) and one CCT (IIa) investigated the effects of antidepressants.454,456 The antidepressants assessed included imipramine, lofepramine combined with phenylalanine, and tranylcypromine. None of these trials reported an overall beneficial effect of the intervention, although one of the RCTs reported some beneficial effect. This good quality RCT found a greater improvement on the Chalder fatigue scale score in those receiving lofepramine combined with phenylalanine compared to those receiving placebo, however, it found no effect of treatment for any of the other five outcomes investigated.454 Side effects were relatively minor but occurred more frequently in the intervention group.
Two further RCTs (Ib) and two CCTs (IIa) examined the interventions of t'ai chi, Chinese medicine, relaxation training and a multimodal intervention program. The results of the CCT assessing t'ai chi reported significant changes in patients' assessment of their symptoms at three month follow-up.457 One CCT of a multimodal intervention program reported significant effects on five of the eight areas assessed. These included two measures of list learning and memory, improved BDI scores, one measure of grip strength and one of tactile sensitivity458 (IIb). One of the RCTs looked at relaxation training and biologically orientated imagery treatment.459 The results showed a significant improvement on state anxiety, but not on trait anxiety or the other three tests examining mood or health states. The last RCT compared the efficacy of traditional Chinese medicine combined with Western medicine to treatment with Western medicine alone. The results indicated beneficial effects upon remittance of symptoms.460
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