Efficacy and safety of rehabilitation exercise in neuromyelitis optica spectrum disorder during the acute phase: A prospective cohort study

Rehabilitation treatment may alleviate the disease severity of patients with NMOSD. The reports of rehabilitation exercise for NMOSD during acute phase are rare.To explore the efficacy and safety of rehabilitation exercise in patients with NMOSD during acute phase.This is a prospective cohort study of 36 patients (rehabilitation exercise group, RG) and 37 patients (control group, CG) in whom acute attack of NMOSD involved the spinal cord with EDSS≥4.5 were included. EDSS, American Spinal Injury Association Impairment Scale (AIS) grade, total motor score (TMS), light touch score (LTS), pin prick score (PPS), Berg balance scale (BBS), and Barthel index (BI) were used as outcome measures.During hospitalization, EDSS scores of both groups decreased significantly (P<0.05). After treatment, the decline in EDSS was more significant in RG than in CG (P<0.05). The change reaching minimal clinically important difference (MCID) was observed in 90% (9/10) of patients in RG and in 27.78% (5/18) of patients in CG in the subgroup with EDSS 4.5-6.0 (MCID, 1.0), which was statistically significant between the groups (P<0.05). In the subgroup with EDSS 6.5-10.0 (MCID, 0.5), the proportion of patients with the change that reached MCID was significantly different between CG and RG (P<0.05). BBS, TMS, and BI score significantly improved after treatment (P<0.001). The improvement ranges of BBS, TMS, and BI scores were more significant in RG than CG (P<0.05). AIS grade improvement in RG was significantly higher than in CG. There were no significant changes in LTS and PPS after treatment in either of the groups. In RG, two mild adverse events were recorded.Rehabilitation exercise may improve nervous system function, balance function, and activities of daily living in patients with acute NMOSD, with few adverse reactions.