There was talk of therapies, research on the early stages of the disease to identify signs and markers that can improve and anticipate access to treatments, but in Amsterdam, at the Ectrims European Congress on multiple sclerosis, there was also a lot of discussion about rehabilitation. Because, cognitive and motor, rehabilitation is a therapy for people with multiple sclerosis. This was said above all during the Rims (Rehabilitation in multiple sclerosis) conference, a European network dedicated to research and sharing of practices in the field of rehabilitation in multiple sclerosis, at the head of which the Italian has just been elected as president Giampaolo Brichettomedical director of the Aism Liguria rehabilitation service.
One of the first actions that Brichetto, as president, will face is the revision of the guidelines on rehabilitation in 2024. The latest, in fact, date back to 2012, but the world of rehabilitation for people with multiple sclerosis has changed since then. thanks to the pandemic and above all the arrival of new digital technologies, which make the thinking of rehabilitation performed only in clinics obsolete.
Research on digital therapies
If, in fact, one of Rims’s objectives is to continue research on digital therapies in the rehabilitation field, the time is already ripe to integrate them into clinical practice, trying to move, explains Brichetto on the sidelines of the congress, towards a holistic approach. “The goal – explains Brichetto – is to rehabilitate not only the motor aspects, but also the cognitive ones, and those linked to the employment of people, with the possibility of improving all those actions that lead to maintaining the working activity”. And all this, adds the expert, requires integration with technological innovations, such as digital ones, thanks to the possibility of providing some of these treatments directly at the person’s home.
New technologies, difficult diffusion
In 2012, the year in which the latest guides on the subject date back, there was no talk of apps, digital technologies or remote monitoring. And, moreover, there was no pandemic, which forced a rethink of care models, especially for the chronically ill, highlighting at the same time all the difficulties that still exist when it comes to digitalising healthcare. In the last two years there has been a lot of talk about telemedicine, remote monitoring, but from here to say that, with the arrival of the pandemic, we are now ready to take up the challenge of digital technologies.
Reimbursement of health systems
“We have just published, like Rims, a study on Multiple Sclerosis and Related Disorders in which it emerges that the use of these technologies is sometimes seen as a barrier for healthcare workers – underlines Brichetto -. This is because they are very heterogeneous, there is no standard and it is not clear at European level whether they are reimbursed by national health systems. “The expert underlines the fact that during the pandemic we have adapted to using the technologies in question, rather than actually implementing them. in organizational processes. “The hope – he says – is that these recommendations will now help, also taking into account what patients report, namely the fact that if on the one hand they recognize its usefulness, on the other they are afraid that they will lead to isolation, precluding the possibility of being followed by a home health worker “.
The new guidelines on rehabilitation
Starting from this, and therefore taking into account the patients’ point of view – in line with the multistakeholder nature of the Rims network – the new guidelines on rehabilitation will focus on new digital technologies, but not only. “We will aim at the integration of these technologies in all health professions that deal with rehabilitation, from physiotherapy, to occupational therapy, to cognitive rehabilitation”, explains Brichetto. This will essentially mean improving remote access to rehabilitation programs, both with apps and, for example, with videos and direct links with the physiotherapist, taking into account the disability levels of each patient.
Wearable devices
“At the same time, when we talk about digital technologies, we also refer to the possibility of monitoring the patient’s health with wearable devices, to also anticipate rehabilitation choices”, says Brichetto, referring to technologies already available, but which struggle to be incorporated into practice. : systemized, in the future, they could be integrated with more innovative rehabilitation programs still under study, such as those involving exergames, which was discussed during the congress at Ectrims.
The revision of rehabilitation settings
“In the new guidelines, ample space will then be dedicated to the revision of rehabilitation settings, with indications on which of the outpatient, home and hospital settings are most effective based on the type of pathology and the level of disability”, underlines Brichetto, and finally to create a European standard on the preparation of the individual rehabilitation plan: “This is to ensure that there is uniformity for the operators who deal with rehabilitation – he concludes -. Taking into account that the different health systems travel at different speeds, not only from nation from country to country, but also from region to region, as the case of Italy shows, where access to rehabilitation is extremely heterogeneous, with regions that are virtuous and others that are less “.