Physician referral improves adherence to the physical activity guidelines for adults with MS: A randomized controlled trial

Quality of reporting health behaviors for multiple sclerosis (QuoRH-MS): A scoping review to inform intervention planning and improve consistency of reporting

BACKGROUND

Multiple sclerosis (MS) is a neurological condition that necessitates a multidisciplinary approach to aid those living with MS in managing their disease. Health behavior, or lifestyle modification, is an emerging approach to MS self-management. MS researchers utilize measurement tools to ensure that interventions are best suited to the outcomes, thereby potentially influencing practice. The aim of this study was to investigate which tools are being used for health behavior management studies in people living with MS and develop an aid for tool selection.

METHODS

A scoping review guided by the PRISMA-Sc checklist and the JBI manual for evidence synthesis was employed with a systematic search strategy executed across four scientific databases: Medline, PubMed, CINAHL, and Cochrane Libraries. The types of assessment tools used were extracted from the included studies. Each tool was categorized into the health behavior intervention discipline (nutrition, exercise, and psychology) and then subcategorized by the tool's purpose. The frequency of use was determined for each tool. Reporting of validation of the assessment tools were collated to inform a tool selection checklist.

RESULTS

The review identified a total of 248 tools (12 nutrition, 55 exercise, and 119 psychology unique reports) from 166 studies. Seventy-seven multidimensional tools were identified including measures of quality of life, fatigue, and functional scales. Only 88 studies (53%) referred to the validity of the tools. The most commonly reported tools were the dietary habits questionnaire (n = 4, nutrition), 6-minute walk test (n = 17, exercise), Symbol Digits and Modalities Test, and Hospital Anxiety and Depression Scale (n = 15 each, psychology) with the Expanded Disability Status Scale reported 43 times.

CONCLUSION

Evidence from interventions may inform practice for health professionals. This review provides insights into the range of tools reported across health behavior intervention studies for MS and offers a guide toward more consistent reporting of study methods.

Updated Systematic Review and Quantitative Synthesis of Physical Activity Levels in Multiple Sclerosis

OBJECTIVE

This article provided an updated quantitative synthesis of physical activity levels in persons with multiple sclerosis compared with controls and other clinical populations.

DESIGN

A systematic search through PubMed, Scopus, and PsycINFO was conducted for articles published between August 2016 and July 2022. Articles that included a group comparison of at least one measurement of physical activity between adults with multiple sclerosis and controls or other clinical populations were included in the meta-analysis.

RESULTS

Twenty-four studies met the inclusion criteria and yielded a total of 119 comparisons. There was a moderate difference in physical activity levels between persons with multiple sclerosis and controls (effect size = -0.56, P < 0.01), but no significant difference between persons with multiple sclerosis and other clinical populations (effect size = 0.01, P = 0.90). The pooled effect sizes comparing multiple sclerosis with controls ( Q104 = 457.9, P < 0.01) as well as with clinical populations ( Q13 = 108.4, P < 0.01) were heterogeneous. Moderating variables included sex, disability status, measurement method, outcome, intensity, and application of a multiple sclerosis-specific cut-point.

CONCLUSIONS

Physical activity levels remain significantly lower in persons with multiple sclerosis compared with controls, but the magnitude of difference has become smaller over the past decade. There is a need for continued development of effective physical activity programs that can reach the greater community with multiple sclerosis.

Approach to Symptom Management in Multiple Sclerosis With a Focus on Wellness

PURPOSE OF REVIEW

This article describes an approach to symptom management in people with multiple sclerosis (MS), emphasizing healthy lifestyles and evidence-based treatments.

RECENT FINDINGS

Growing evidence supports healthy nutrition, exercise, and emotional well-being (wellness) as foundational for MS symptom management. A stepped approach starts with healthy lifestyle practices and adds nonpharmacologic, pharmacologic, and procedural-based therapies balancing levels of evidence, risks, and potential benefits. The growing availability of cannabis and widespread use of dietary supplements in self-management of MS symptoms raise both therapeutic promises and challenges.

SUMMARY

Wellness approaches for MS symptom management foster self-reliance and should be reinforced early and often. Recognition of symptom clusters and medical comorbidities helps limit polypharmacy.

Predictors of positive outcomes following resistive inspiratory muscle training in non-ambulatory persons with advanced multiple sclerosis

Background

Inspiratory muscle training (IMT) using a threshold device improves inspiratory muscle strength. What factors influence the IMT outcome has not been examined.

Objective

To identify predictors of the positive outcome following IMT in persons with advanced multiple sclerosis (PwAMS).

Methods

Inclusion criteria were non-ambulatory PwAMS, Expanded Disability Status Scale (EDSS) ≥6.5, age >18 years, no acute medical conditions, current non-smokers, and ability to consent. Participants (n = 38) performed daily inspiratory exercises using a resistive threshold device for 10 weeks. Baseline measurements included age, sex, body mass index, year post multiple sclerosis diagnosis, comorbidities, EDSS, Modified Fatigue Impact Scale-5, and oral Symbol Digit Modality Test. The percentage of completed prescribed exercise trials (Trials%) during the 10-week intervention was calculated. Age- and sex-adjusted predicted values of maximum inspiratory pressure (MIP%pred) and maximum expiratory pressure (MEP%pred) were obtained before and after the 10-week intervention. Backward multivariable regression analyses for the primary outcome (MIP%pred) were conducted.

Results

After controlling for the initial MIP%pred, perceived fatigue at the baseline and Trial% were significant and independent predictors of MIP%pred after IMT.

Conclusion

Less fatigue at the baseline and higher adherence to the prescribed exercise repetitions were positive predictors of the positive outcome following IMT in PwAMS.

Experiences and perceived outcomes of persons with multiple sclerosis from participating in a randomized controlled trial testing implementation of the Canadian Physical Activity Guidelines for Adults with MS: an embedded qualitative study

PURPOSE

To describe the experiences and outcomes of participants who enrolled in a randomized controlled trial testing implementation of the Canadian Physical Activity Guidelines for Adults with Multiple Sclerosis.

MATERIALS AND METHODS

Fifty-six persons with MS who enrolled in the trial participated in the current study which involved a semi-structured interview at 16-week follow-up. Interview data were analyzed using thematic analysis.

RESULTS

Of the 56 participants, 26 ended up enrolling in a community-based exercise program specialized for persons with multiple sclerosis (MS), 7 joined another gym, 4 trained at home, and 17 took part in no specific program. Across all study participants, positive outcomes were reported across a number of domains including mental function, knowledge about the physical activity (PA) and MS, physical function, advocacy of PA to peers, daily participation, and body awareness. For those who enrolled in the community-based program, having a supportive and inclusive environment was critical to their PA experiences. Furthermore, environmental supports, particularly knowledgeable and supportive trainers and similar peers, contributed largely to the positive mental changes and increased knowledge gained.

CONCLUSIONS

Our study provides support for the promotion of PA in persons with MS and the development of community-based programs adapted for people with MS.IMPLICATIONS FOR REHABILITATIONEngaging in regular physical activity is associated with many positive benefits and outcomes for people with MS.Supportive elements such as a community of peers who also have MS, adaptive equipment, and trainers who are knowledgeable about MS are especially important for creating positive experiences including enjoyment from and desire to engage in regular physical activity.This study provides support for further advocacy (e.g., by persons with MS directly) and referral to community-based exercise programs adapted for people with MS.

Behavior Change Techniques in Physical Activity Interventions for Multiple Sclerosis

OBJECTIVE

To identify and summarize the behavior change techniques (BCTs) included in behavior change interventions for promoting physical activity in persons with multiple sclerosis (MS).

DATA SOURCES

PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health Complete, Scopus, and Embase were initially searched in November 2019, and data extraction began in June 2020.

STUDY SELECTION

The inclusion criteria for studies were: adults older than 18 years with diagnosed MS, English language, clinical trial designs (ie, pre-post or randomized controlled trials), group or individual interventions, and home or community-based settings wherein physical activity was defined as a primary or secondary outcome. Exclusion criteria for studies included protocol manuscripts pending results, case studies, studies focused on populations with multiple chronic diseases, and interventions targeting multiple behaviors. Two researchers completed screening for study selection, and a third researcher served as a referee. Of the initially identified 8681 studies, 54 studies met selection criteria.

DATA EXTRACTION

Data extraction was completed by 3 researchers. Each article was coded by 2 of the 3 researchers, and a fourth researcher resolved discrepancies. Data extracted from each paper included study title, authors, country, year, sample size, study design, intervention details, physical activity outcomes, and BCTs.

DATA SYNTHESIS

Thirty-eight unique behavior change interventions were identified, and 53 of the 93 possible BCTs were included across the studies. The mean number of BCTs per study was 15, and studies and effect sizes across studies ranged from 0.04-1.49.

CONCLUSIONS

This review provides a comprehensive overview of BCTs as the active ingredients in behavior change interventions targeting physical activity in MS. Results from this study provide a compendium for future intervention development for increasing physical activity and improving overall health in MS.