Multidisciplinary care for Guillain-Barré syndrome

Abstract

Background. Guillain-Barré syndrome (GBS) can be a significant cause of new long-term disability, which is thought to be amenable to multidisciplinary care. However, the evidence base of its effectiveness is unclear. Aim. The aim of this systematic review is to assess the effectiveness of multidisciplinary care in adults with GBS, the types of approaches that are effective (setting, type, intensity) and the outcomes that are affected. Methods. The search strategy comprised: The Cochrane Neuromuscular Disease Group Specialized Register and the Cochrane Central Register of Controlled Trials; MEDLINE, EMBASE, AMED, PEDro, LILACS and CINAHL (up to May 2010). Selected studies included randomized and controlled clinical trials that compared multidisciplinary care in GBS with a control (routine local service, lower level of intervention); or studies that compared multidisciplinary care in different settings or at different levels of intensity of therapy. Best evidence synthesis was based on methodological quality. Three observational studies were also reported but they make limited contribution to evidence base synthesis. Results. No randomized or controlled clinical trials were identified. Evidence from three low-quality observational studies provide some support for improved disability in the short term (6 months) with high intensity rehabilitation; and for improved participation and quality of life. Conclusion. The gaps in existing research should not be interpreted as ineffectiveness of multidisciplinary care in GBS. Appropriate and methodologically robust study designs, responsive outcome measures; and more research in the setting, type and intensity of rehabilitation are needed.