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'''There was no evidence of subjective or functional improvement associated with the administration of hyperbaric oxygen to patients with chronic progressive multiple sclerosis.''' 

'''Clinical Bottom Line:''' 
1. No evidence of significant functional improvement with the addition of hyperbaric oxygenation to the treatment of multiple sclerosis. 

'''Appraised by:'''Mike Bennett, Dept of Diving and Hyperbaric Medicine, Prince of Wales Hospital 
Sydney; Monday, 8 March 1999 

'''Clinical Scenario:''' A patient with chronic progressive multiple sclerosis presented for treatment. We wondered if the addition of hyperbaric oxygen would improve function or prevent deterioration. 
'''Three-part Question:''' In patients with chronic progressive multiple sclerosis, does the addition of hyperbaric oxygen therapy to the usual on-going measures, result in any addition benefit in terms of functional improvement or subjective awareness of improvement? 
'''Search Terms:''' Hyperbaric oxygenation, multiple sclerosis 

'''The Study:''' 
Double-blinded concealed randomised controlled trial with intention-to-treat. 
Known chronic progressive multiple sclerosis with no acute relapse in the past year and no steroids or immunosuppression in the past six months. 
Control group (N = 44; 44 analysed): Twenty sham hyperbaric oxygen sessions, 5 times per week for 5 weeks, by the administration of air at 1.1ATA. 
Experimental group (N = 44; 44 analysed): Twenty hyperbaric oxygen sessions at 2ATA on 100% oxygen by the same treatment schedule as above. 

'''The Evidence:''' 

{|
| '''Outcome''' '''(Patient assessment of improvement)''' || '''Time to Outcome''' || '''Air group''' || '''HBO group''' || '''Relative risk reduction''' || '''Absolute risk reduction''' || '''NNT''' 
|-
| '''Bladder symptoms''' || 1 month || 0.286 || 0.310 || -8% || -0.024 || -42 
|-
| '''95% CI:''' || || || || -77% to 60% || -0.220 to 0.172 || NNT'''6 to INF NNH'''5 to INF 
|-
| '''Walking''' || 1 month || 0.333 || 0.286 || 14% || 0.047 || 21 
|-
| '''95% CI:''' || || || || -45% to 73% || -0.150 to 0.244 || NNT'''4 to INF NNH'''7 to INF 
|-
|}

'''Non-Event Outcomes Time to outcome Air group HBO group P-value''' 
Patient assessment of 
change compared to pre-trial 1 month +0.7 +10.1 >0.05 

(mm) on a scale 0-100mm 
Neurologist assessment 1 month -1.9 -0.2 >0.05 
(similar to above) 

Timed walk over 50m (sec) 1 month 2.9 -2.0 >0.05 

Change in Kurtzke disability 
score (0-10) 1 month +0.01 +0.05 >0.05 

'''Comments:''' 
1. Good methodological study with 90% power to detect a difference in improvement of disability score of 1.0 points. 
2. The design planned for further assessment at 3 months, 6 months and 1 year but the results do not appear to have been published. 
3. Data was analysed by multiple regression to account for any treatment centre bias and 5 patients who did not tolerate treatment were analysed by intention to do so. 

'''Expiry date:''' January 2015
'''References:''' 
1. Wiles CM, Clarke CR, Irwin HP, Edgar EF, Swan AV. Hyperbaric oxygen in multiple sclerosis: a double blind trial. British Medical Journal 1986; 292:367-371. 

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'''[[Multiple Sclerosis | BACK]]'''

Wiles - Revision history

Gordoben: Imported from Wikispaces