A cohort study of functional electrical stimulation in people with multiple sclerosis demonstrating improvements in quality of life and cost-effectiveness

Abstract

Objective: The objective of this study was to determine the impact on health-related quality of life of functional electrical stimulation used to improve walking in people with multiple sclerosis and to explore cost-effectiveness. Design: A retrospective analysis of patient records was conducted. Setting: This study used outpatient therapy service as the study setting. Subjects: Data from 82 consecutive patients with multiple sclerosis attending for set up with functional electrical stimulation were analysed. Interventions: Patients were seen at baseline, three and six months for support in use of functional electrical stimulation, and data were collected at baseline and six months. Main measures: The EQ-5D-5L and walking speed were collected at baseline and six months after using functional electrical stimulation. The Psychosocial Impact of Assistive Device Scale was collected at six months. EQ-5D-3L utilities were derived and cost-effectiveness analysis was completed utilizing a five-year time horizon and methodology published by National Institute for Health and Care Excellence. Results: Significant differences (P < 0.001) were seen in walking speed (baseline 0.670 m/s; with stimulation 0.768 m/s) and maintained over six months (0.772 m/s with stimulation). EQ-5D data significantly improved over six months (baseline 0.486, six months 0.596, P < 0.001) and meaningful mean scores were seen in all aspects of the Psychosocial Impact of Assistive Device Scale. However, there were no correlations between measures. In the cost utility analysis, compared to standard care, functional electrical stimulation was more expensive and more effective with an incremental cost-effectiveness ratio of £6137. Conclusion: Functional electrical stimulation is a cost-effective treatment to improve walking speed and health-related quality of life in people with multiple sclerosis.

Functional electrical stimulation to aid walking in patients with adrenomyeloneuropathy: A case study and observational series

“…FES has been shown to be a cost effective treatment of foot drop, which improves quality of life in patients with upper motor neuron lesions. 19 However, walking speed alone does not correlate with improvements in patient reported quality of life, 10 and should not be the sole determining factor on decisions about treatment; walking speed is simply one element of walking. The VAS scale, 20 which considers walking satisfaction, encompasses the patient's subjective experience of their walking which may include speed, smoothness of gait and confidence for example.…”

“…FES has been shown to have positive effects on walking speed and stability as well as reducing the effort of walking and number of falls in patients 7,8 . Additional benefits from the use of FES include improvements in overactive bladder symptoms, 9 as well as demonstrated improvement in quality of life in people with multiple sclerosis 10 . Most research involving FES has focussed on patients with multiple sclerosis 11 or stroke 12 reflecting the increased prevalence of these conditions in adults with walking difficulties secondary to upper motor neuron lesions.…”

“… 7 , 8 Additional benefits from the use of FES include improvements in overactive bladder symptoms, 9 as well as demonstrated improvement in quality of life in people with multiple sclerosis. 10 Most research involving FES has focussed on patients with multiple sclerosis 11 or stroke 12 reflecting the increased prevalence of these conditions in adults with walking difficulties secondary to upper motor neuron lesions. However, FES has also been used successfully in a range of other neurological disorders, including hereditary spastic paraplegia, 13 spinal cord injuries 14 and more recently Parkinson's disease.…”

Cost-efficiency of specialist inpatient rehabilitation for adults with multiple sclerosis: A multicentre prospective cohort analysis of the UK Rehabilitation Outcomes Collaborative national clinical dataset for rehabilitation centres in England

“…Such evidence is required not only in the context of clinical trials but also in real-life clinical practice. 16,17 Economic analysis of individual interventions such as home-exercise programmes, functional electrical stimulation, and schemes to keep people in work have been reported, [18][19][20][21][22][23][24] but there is no published evaluation of the cost-efficiency of holistic multidisciplinary specialist rehabilitation.…”