Rehabilitation in multiple sclerosis: Commentary on the recent AAN systematic review.

We thank Sutliff et al.1 for their commentary on our systematic review (SR), “Summary of comprehensive systematic review: Rehabilitation in multiple sclerosis.”2 We would like to make several points in response. (A more extensive response is available at Neurology.org/cp.)\n\nFirst, contrary to their comment that our panel2 “lacked specialist diversity,” the panel included multiple sclerosis (MS) experts, rehabilitation experts, non-MS neurologists, and guideline methodologists. Furthermore, the National Multiple Sclerosis Society was part of the process.2 Physical and occupational therapists, speech/language therapists, and exercise physiologists were not included; this reflects the guideline development process at the time. Nevertheless, this was an SR,2 not a clinical practice guideline (CPG). An SR makes conclusions based on available evidence, whereas CPGs make practice recommendations. The CPG process lends itself to expert formal consensus; the SR does not. The conclusions of our SR2 would have been the same even with the inclusion of other experts because they are based on the American Academy of Neurology (AAN) risk of bias assessment of each study and not expert opinion.\n\nSecond, we have highlighted methodologic limitations of the rehabilitation literature in our recommendations for future research.2 We do not deem it appropriate to blame the risk of bias assessment for failure to identify high-level studies in our SR.2 …