On my desk at the office (the one I have seldom graced with my presence in the past year) stand two framed quotations: “No heart has ever suffered when it goes in search of its dreams” (Paulo Coelho) and “The art of medicine consists in amusing the patient while nature cures the disease” (Voltaire). I see them as guiding principles (or guideposts) in my professional endeavors: let’s dream big in our mission to stop MS and all of its consequences, while remaining humble and well aware of our shortcomings. Even if medicine has progressed by quantum leaps since Voltaire’s times, our understanding of what triggers MS and causes it to “act up” remains limited. As a rehabilitation professional, I often feel like I intervene once damage has been dealt, yet I dream that, by combining increasingly potent pharmacologic agents, carefully crafted exercise regimens, mindfulness techniques, and yet-to-be-discovered therapeutic avenues, the slope of the inexorable upward line of MS burden can be further reduced. As much as the vagaries of daily life strive to convince us of the opposite, the alchemist reassures us that “when you want something, all the universe conspires in helping you to achieve it” (Paulo Coelho).
There may come a time when our patients need physical support to walk more safely and efficiently, yet they may not be ready to accept it (isn’t this “giving in to the disease”?). Furthermore, what we consider the most stable of these supports may also be the least acceptable, as exemplified in this issue’s continuing education article by Cohen and colleagues: a four-point cane was perceived less positively than a single-point cane or a trekking pole in their randomized crossover trial. Interestingly, these more acceptable devices also led to better outcomes on measures of gait and walking capacity. Isn’t evidence all the more educational when it challenges our intuition?
As if to show us what could represent a next step in this line of questioning, Comber and colleagues illustrate how evidence can be integrated into the development of a multimodal intervention, with input from all stakeholders, to help prevent falls in the context of MS. I cannot wait to read more on the results of an evaluation of the Better Balance program, as another stepping stone towards building a strong foundation for evidence-based comprehensive MS care.
Increasingly, care is sought from the comfort of one’s home, laying the foundation for a more continuous model of care, as opposed to an episodic facility-based delivery. In the same way, randomized controlled trials, such as the ones by Freedman and colleagues (at-home positive psychology intervention) and Siengsukon and colleagues (Web-based cognitive behavioral therapy for insomnia), are moving interventions to nontraditional settings. Broadening the focus to include family caregivers, Halstead and colleagues conducted telephone interviews to assess the impact of cognitive impairment on patient/caregiver dyads, paving the way for future support and intervention programs in the home setting.
As essential and onerous as it can be, generating high-quality evidence on pharmacologic treatments and multidisciplinary programs is only a first step. Then health care delivery science steps in, to ascertain whether all treatment options are made available to everyone (Ghasemi and colleagues), patient preferences are considered (Rath and colleagues), and patterns of use that are driven by both external and personal factors are assessed (Greenberg and colleagues).
Along with scholarly journals, international conferences are essential to the sharing of knowledge and practices. Make sure you visit our website (ijmsc.org) for links to the 2021 Consortium of Multiple Sclerosis Centers (CMSC) and Rehabilitation in Multiple Sclerosis (RIMS) annual meetings, and plan to attend—online or in person!