الفهرس 
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Abstract
Multiple sclerosis is a chronic autoimmune disease that affects the nervous system (brain and spinal cord), in which the immune system in the human body secretes antibodies that attack the myelin membrane, which leads to its destruction and thus affects the neurotransmitter so leads to long term impairment of movement and physical functions.
The chronic course of multiple sclerosis can result in significant mental and physical symptoms and irreversible neurologic deficits, including muscle weakness, ataxia, tremor, spasticity, paralysis, balance disorder, cognitive impairment, loss of vision, double vision, vertigo, impaired swallowing and speech, sensory deficits, bladder and bowel dysfunction, pain, fatigue, and depression
Despite a number of immunomodulatory agents and various symptomatic therapies, there is still a significant level of disability and reduction of quality of life in this population. Therefore, rehabilitation exercise program seems to be a very important therapeutical approach. As physicians now believe that regular exercise training is a potential solution for limiting the reconditioning process and achieving an optimal level of patient activities, functions and many physical and mental health benefits.
The aim of the study:
Evaluate the effect of rehabilitation exercise program on health status outcome of patients with multiple sclerosis
Materials and Method:
The study was conducted at the Neuropsychiatric Inpatient and outpatient clinics of Al Hadara Alexandria University Hospital. A convenience sample of 60 adult’s patients diagnosed with multiple sclerosis will be recruited in this study. The study sample will be randomly assigned and divided attentively into equal groups
• The first was the study group and comprised 30 patients and they receive the rehabilitation exercise program.
• The second was the control group which comprised 30 patients and exposed to routine hospital care only.
Two tools were used by the resecher to collect the necessary data
Tool I: Kurtzke Expanded Disability Status Scale:
It used to measure the disability status of people with multiple sclerosis (MS) and monitoring changes in the level of disability over time. It consists of 10 scales that created an objective approach to quantify the functional abilities level for diagnostic assessment of MS. It consists of two additional parts as follows: Part I: Socio demographic data, Part II: Patients Clinical Data.
Tool II: Functional Assessment of Multiple Sclerosis (version4)
This tool used to obtain self-report health-related quality-of-life instrument for people with multiple sclerosis it consists of 59 items (44 of which are scored) in six quality of life domain.
Method:
The study was carried out on four phases
a. Phase I: Assessment phase:
- An initial assessment to all patients (study and control groups) was carried out before implementing the rehabilitation program. It was aimed to collect baseline patients’ data, clinical data, and assess the functional abilities level and health related quality of life using tool I & II.
b. Phase II: Planning phase:
- Based on the data collected from the assessment phase and review of related literature, the program goals, priorities contents, expected outcomes were developed by the researcher according to the individual needs and problems. In addition illustrated colored booklet was developed by the researcher and distributed to each patient in the implementation phase.
c. Phase III: implementation phase:
The developed rehabilitation exercise program was conducted and applied to each patient in the outpatient clinics of Al Hadara Alexandria University Hospital using demonstration and redemonstration and colored booklet.
d. Phase IV: evaluation phase:
The study patients were re-evaluated through three phases by the researcher using tools II, and III to determine the effectiveness of rehabilitation program on their health status outcome.
The main findings of this study showed that:
A around (46.7%) of the control group and the studied group were in aged group (>30 - 40 years)
The highest percentage of both control and studied group ( 8o%, 73.3% respectively) were females
More than half (60%, 56.7% respectively) in both control and studied group patients were at university level.
More than half (53.3%) in the control group patients were housewives and less than half (46.7%) in the studied group was worker.
The highest percentage ( 66.7%) of both control and studied group were married
Vast majority (93.3, 86.7% respectively) of both control and studied group were living in urban area.
The highest percentage of the control group had reported worse mobility either pre or post exercise rehabilitation program (66.7%, 76.7% consecutively). On the other hand, 60% the studied group had reported moderate mobility pre exercise rehabilitation program, which had been changed to moderate 63.3% post exercise rehabilitation program with highly significant difference.
Half (50%) of the control group had reported that their symptoms were worse. Otherwise, near half (46.7%) of the studied group had reported worse symptoms pre exercise rehabilitation program, which had been changed to better 66.7% post exercise rehabilitation program.
More than two third (70%) of the control group had reported that their emotional wellbeing was worse pre and post exercise rehabilitation program. On the other side, more than half of the patients (53.3%) of the studied group had reported that their emotional wellbeing was worse pre exercise rehabilitation program, which had been changed to moderate 80% post exercise rehabilitation program.
More than two third (66.7%, 76.7% consecutively)of the control and the studied group had reported better family and social well-being pre and post exercise rehabilitation program with no statistically significant difference.
The patients within the control group had reported that their overall functional status was worse (60%). Whereas, less than half (40%) of the studied group had reported that their overall functional status was moderate pre exercise rehabilitation program, which had been increased to 83.3% post exercise rehabilitation program.
There was statistical significant relation between level of education, occupation of the patients within the study and overall functional assessment domains.
from the findings of the present the study, it can be concluded that:
There were a statistically significant differences was observed in the study group than in control group after application of exercise rehabilitation program, indicating a significant improvement in overall functional status including (mobility, symptoms, emotional wellbeing and patient’s satisfaction). Therefore, the application of exercise rehabilitation program is more effective in improving patients with MS QOL and outcome in the study groups than the control group.
Based on the findings of the present study, the following recommendations had been suggested:
1. A colored illustrated educational booklet should be available and distributed to all patients with MS.
2. In service training program should be carried out for nurses working in MS unit about the different types of exercises that perform especially to patients with MS.
3. Periodic multidisciplinary scientific meeting should be carried out for physicians, nurses, physiotherapists about MS and its causes, advanced treatment, and rehabilitation program needed.