Rehabilitation interventions in patients with acute demyelinating inflammatory polyneuropathy: a systematic review

Acute inflammatory demyelinating polyneuropathy (Guillain-Barre syndrome, GBS) can be a significant cause of new long-term disability, which is thought to be amenable to rehabilitation. Rehabilitation is an expensive resource and the evidence to support its justification is urgently needed. This systematic review presents an evidence-based overview of the effectiveness of various rehabilitation interventions in adults with GBS and the outcomes that are affected. Medline, EMBASE, CINAHL, AMED, PEDro, LILACS and the Cochrane Library were searched up to March 2012 for studies reporting outcomes of GBS patients following rehabilitation interventions that addressed functional restoration and participation. Two reviewers applied the inclusion criteria to select potential studies and independently extracted data and assessed the methodological quality. Included studies were critically appraised using GRADE methodological quality approach. Formal levels of evidence of each intervention were assigned using a standard format defined by National Health and Medical Research Council. Fourteen papers (one systematic review, one randomized controlled trial, one case-control study, five cohort studies and six case series/reports) that described a range of rehabilitation interventions for persons with GBS were evaluated for the "best" evidence to date. One high quality randomised controlled trial demonstrated effectiveness of higher intensity multidisciplinary ambulatory rehabilitation in reducing disability in persons with GBS in the later stages of recovery, compared with lesser intensity rehabilitation intervention for up to 12 months. Four observational studies, further demonstrated some support for improved disability and quality of life following inpatient multidisciplinary rehabilitation up to 12 months. Evidence for uni-disciplinary rehabilitation interventions is limited, with 'satisfactory' evidence for physical therapy in reducing fatigue, improving function and quality of life in persons with GBS. This review provides "good" evidence to support multidisciplinary rehabilitative intervention in adults with GBS; and "satisfactory" evidence for physical therapy in these patients. Evidence for other uni-disciplinary interventions is limited or inconclusive. The gaps in existing research should not be interpreted as ineffectiveness of rehabilitation intervention in GBS. Further research is needed with appropriate study designs, outcome measurement, type of modalities and cost-effectiveness of these interventions.