Fischer
Improvement in objective functional measurements in chronic multiple sclerosis with the addition of hyperbaric oxygen therapy.
Clinical Bottom Line: 1. Significant improvement in objective measures of ability in multiple sclerosis with the application of hyperbaric oxygenation. 2. Treatment effect persisted at 1 year follow-up, although some patients experienced transient benefit only.
Appraised by: Mike Bennett, Dept. of Diving and Hyperbaric Medicine, Prince of Wales Hospital Sydney; Monday, 15 March 1999
Clinical Scenario: A patient with multiple sclerosis presented for consideration of hyperbaric oxygen therapy. We wondered whether HBO was efficacious in chronic multiple sclerosis. Three-part Question: For patients with advanced chronic multiple sclerosis, does the addition of hyperbaric oxygen therapy to the standard regime of treatments result in any functional improvement? Search Terms: Multiple sclerosis
The Study: Double-blinded concealed randomised controlled trial without intention-to-treat. Established multiple sclerosis for 5 years with a neurological deficit for at least 2 years. Each patient continued on the care established at entry to the trial. No patients having acute exacerbations were admitted. Control group (N = 20; 20 analysed): 10% oxygen at 2ATA for 90 minutes daily, 5 times each week to a total of 20 sham treatments. Experimental group (N = 20; 20 analysed): 100% oxygen at 2ATA on the same schedule as control.
The Evidence:
| Outcome | Time to Outcome | Sham group | HBO group | Relative benefit increase | Absolute benefit increase | NNT |
| Improvement in at least one objective measure | 4 weeks | 0.05 | 0.600 | 1100% | 0.55 | 2 |
| 95% CI: | 100% to 630% | 0.79 to 0.32 | 1 to 3 | |||
| Sustained improvement | 1 year | 0.05 | 0.25 | 400% | 0.2 | 5 |
| 95% CI: | 100% to 25% | -0.01 to 0.41 | NNT2 to INF NNH80 to INF | |||
| Deterioration | 1 year | 0.55 | 0.150 | 82% | 0.45 | 2 |
| 95% CI: | 36% to 100% | 0.20 to 0.71 | 1 to 5 |
Non-Event Outcomes Time to outcome Placebo group HBO group P-value Change from initial disability score 1 year +0.35 -0.59 <0.006 Comments: 1. Suggestion of more benefit for patients who were both more recent in onset and had less functional disability. 2. Three patients in the oxygen group did not tolerate treatment beyond 5 sessions. They have been included here, but excluded in the paper. 3. Well-conducted study with good randomisation and blinding. Expiry date: January 2005 References: 1. Fischer BH, Marks M, Reich T. Hyperbaric-oxygen treatment of multiple sclerosis. A randomized, placebo-controlled, double-blind study. New England Journal of Medicine 1983; 308:181-186.
File:Http://www.hboevidence.com/ themes/copy-of-sumi-painting/sumhorsa.gif
