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Titcomb TJ, Sherwood M, Ehlinger M, Saxby SM, Shemirani F, Eyck PT, Wahls TL, Snetselaar LG. Evaluation of a web-based program for the adoption of wellness behaviors to self-manage fatigue and improve quality of life among people with multiple sclerosis: A randomized waitlist-control trial. Mult Scler Relat Disord 2023; 77:104858. [PMID: 37399671 PMCID: PMC11071624 DOI: 10.1016/j.msard.2023.104858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/22/2023] [Accepted: 06/24/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Wellness is a promising area of research in multiple sclerosis (MS); however, considerable questions remain regarding the efficacy of behavioral interventions to improve wellness and which delivery methods yield favorable results. OBJECTIVE To evaluate the efficacy of a wellness intervention consisting of diet, stress reduction techniques, sleep hygiene, and exercise, delivered via a 7-week web-based program with no tailored intervention support (e.g., counseling or resources) from the study team, on quality of life (QoL) and fatigue among people with MS. METHODS Individuals (n = 100) with self-reported physician's diagnosis of relapsing-remitting MS or clinically isolated syndrome were recruited to enroll in this randomized waitlist-control trial consisting of three timepoints at 0, 12, and 24 weeks. Participants were randomized to begin the intervention at baseline (INT; n = 51) or to a waitlist to begin the intervention after the 12-week timepoint (WLC; n = 49), and both groups were followed for 24 weeks. RESULTS At 12-weeks, 95 participants (46 INT and 49 WLC) completed the primary endpoint and 86 (42 INT and 44 WLC) completed the 24-week follow-up. Compared to baseline, the INT group had a significant increase in physical QoL (5.43 ± 1.85; P = 0.003) at 12-weeks which was maintained at 24-weeks. Physical QoL values in the WLC group did not significantly increase between weeks 12 and 24 (3.24 ± 2.03; P = 0.11); however, physical QoL values significantly improved compared to week 0 values (4.00 ± 1.87; P = 0.033). Neither group had significant changes in mental QoL. The INT group had a mean baseline to 12-week change of ‑5.06 ± 1.79 (P = 0.005) for MFIS and -0.68 ± 0.21 (P = 0.002) for FSS, both of which were maintained at 24-weeks. The 12- to 24-week changes for the WLC group were -4.50 ± 1.81 (P = 0.013) for MFIS and -0.44 ± 0.17 (P = 0.011) for FSS. At 12-weeks, the INT group had significantly greater reductions in fatigue compared to the WLC (P = 0.009 for both MFIS and FSS). There were no between-group mean differences for physical or mental QoL, but a significantly higher proportion of participants had clinically significant improvement in physical QoL in the INT group (50%) compared to the WLC group (22.5%) at 12-weeks (P = 0.006). The 12-week intervention effect was similar during the active intervention phase (i.e., baseline to 12 weeks for INT and 12 to 24 weeks for WLC) in each group. Course completion rates significantly differed between groups with 47.9% of the INT group and 18.8% of the WLC group completing the course (P = 0.01). CONCLUSION A wellness intervention delivered via a web-based program, without tailored support, resulted in significant improvements in fatigue compared to control. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT05057676.
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Affiliation(s)
- Tyler J Titcomb
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA; Department of Epidemiology, University of Iowa, Iowa City, IA, USA.
| | - Max Sherwood
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Mary Ehlinger
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Solange M Saxby
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | | | - Patrick Ten Eyck
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, USA
| | - Terry L Wahls
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA.
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Spain RI, Piccio L, Langer-Gould AM. The Role of Diet in Multiple Sclerosis: Food for Thought. Neurology 2023; 100:167-168. [PMID: 36257715 DOI: 10.1212/wnl.0000000000201565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 09/28/2022] [Indexed: 01/25/2023] Open
Affiliation(s)
- Rebecca I Spain
- From the Neurology Service (R.I.S.), VA Portland Health Care System, OR; Department of Neurology (R.I.S.), Oregon Health and Science University, Portland; Department of Pathology and Immunology (L.P.), Washington University in St. Louis, MO; Brain and Mind Centre (L.P.), School of Medical Sciences, University of Sydney, NSW, Australia; and Neurology Department (A.M.L.-G.), Southern California Permanente Medical Group/Kaiser Permanente, Los Angeles Medical Center, CA.
| | - Laura Piccio
- From the Neurology Service (R.I.S.), VA Portland Health Care System, OR; Department of Neurology (R.I.S.), Oregon Health and Science University, Portland; Department of Pathology and Immunology (L.P.), Washington University in St. Louis, MO; Brain and Mind Centre (L.P.), School of Medical Sciences, University of Sydney, NSW, Australia; and Neurology Department (A.M.L.-G.), Southern California Permanente Medical Group/Kaiser Permanente, Los Angeles Medical Center, CA
| | - Annette M Langer-Gould
- From the Neurology Service (R.I.S.), VA Portland Health Care System, OR; Department of Neurology (R.I.S.), Oregon Health and Science University, Portland; Department of Pathology and Immunology (L.P.), Washington University in St. Louis, MO; Brain and Mind Centre (L.P.), School of Medical Sciences, University of Sydney, NSW, Australia; and Neurology Department (A.M.L.-G.), Southern California Permanente Medical Group/Kaiser Permanente, Los Angeles Medical Center, CA
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Brenton JN, Lehner-Gulotta D, Woolbright E, Banwell B, Bergqvist AGC, Chen S, Coleman R, Conaway M, Goldman MD. Phase II study of ketogenic diets in relapsing multiple sclerosis: safety, tolerability and potential clinical benefits. J Neurol Neurosurg Psychiatry 2022; 93:637-644. [PMID: 35418509 PMCID: PMC9350909 DOI: 10.1136/jnnp-2022-329074] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/16/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Dietary changes impact human physiology and immune function and have potential as therapeutic strategies. OBJECTIVE Assess the tolerability of a ketogenic diet (KD) in patients with relapsing multiple sclerosis (MS) and define the impact on laboratory and clinical outcome metrics. METHODS Sixty-five subjects with relapsing MS enrolled into a 6-month prospective, intention-to-treat KD intervention. Adherence was monitored with daily urine ketone testing. At baseline, fatigue, depression and quality of life (QoL) scores were obtained in addition to fasting adipokines and MS-related clinical outcome metrics. Baseline metrics were repeated at 3 and/or 6 months on-diet. RESULTS Eighty-three percent of participants adhered to the KD for the study duration. Subjects exhibited significant reductions in fat mass and showed a nearly 50% decline in self-reported fatigue and depression scores. MS QoL physical health (67±16 vs 79±12, p<0.001) and mental health (71±17 vs 82±11, p<0.001) composite scores increased on-diet. Significant improvements were noted in Expanded Disability Status Scale scores (2.3±0.9 vs 1.9±1.1, p<0.001), 6-minute walk (1631±302 vs 1733±330 ft, p<0.001) and Nine-Hole Peg Test (21.5±3.6 vs 20.3±3.7 s, p<0.001). Serum leptin was lower (25.5±15.7 vs 14.0±11.7 ng/mL, p<0.001) and adiponectin was higher (11.4±7.8 vs 13.5±8.4 µg/mL, p=0.002) on the KD. CONCLUSION KDs are safe and tolerable over a 6-month study period and yield improvements in body composition, fatigue, depression, QoL, neurological disability and adipose-related inflammation in persons living with relapsing MS. TRIAL REGISTRATION INFORMATION Registered on ClinicalTrials.gov under registration number NCT03718247, posted on 24 October 2018. First patient enrolment date: 1 November 2018. Link: https://clinicaltrials.gov/ct2/show/NCT03718247?term=NCT03718247&draw=2&rank=1.
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Affiliation(s)
- J Nicholas Brenton
- Department of Neurology, Division of Child Neurology, University of Virginia, Charlottesville, Virginia, USA
| | - Diana Lehner-Gulotta
- Department of Neurology, Division of Child Neurology, University of Virginia, Charlottesville, Virginia, USA
| | - Emma Woolbright
- Division of Child Neurology, Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brenda Banwell
- Department of Neurology, Universitygi of Virginia, Charlottesville, Virginia, USA
| | | | - Shanshan Chen
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Rachael Coleman
- Division of Child Neurology, Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark Conaway
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Myla D Goldman
- Department of Neurology, Virginia Commonwealth University, Richmond, Virginia, USA
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Dean C, Parks S, Titcomb TJ, Arthofer A, Meirick P, Grogan N, Ehlinger MA, Bisht B, Fox SS, Daack-Hirsch S, Snetselaar LG, Wahls TL. Facilitators of and Barriers to Adherence to Dietary Interventions Perceived by Women With Multiple Sclerosis and Their Support Persons. Int J MS Care 2022; 24:235-241. [DOI: 10.7224/1537-2073.2021-051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Abstract
Background:
People with multiple sclerosis (MS) frequently report implementing dietary strategies as part of their personal wellness programs; however, little is known about the perceived themes of healthy behavior change in people with MS.
Methods:
Semistructured one-on-one interviews were conducted with 20 women with MS enrolled in 2 different restrictive dietary intervention studies and their 18 self-identified support persons consisting of partners and adult children. Interviews were transcribed, coded, categorized, and then grouped into summative themes. The frequency of issues being mentioned as facilitators of or barriers to diet adherence was evaluated to identify possible differences in perceived experiences between women with MS and their support persons during the studies.
Results:
Five qualitative themes were identified: (1) personal motivation, (2) diet components, (3) time, (4) support, and (5) resource access. Major facilitators of dietary adherence were positive support from support persons and study staff, access to resources, symptom improvement, and personal motivation. Major barriers included the novelty of the study diet, lack of cooking skills, no change in or worsening of symptoms, lack of diet knowledge, and food preferences and temptations. Symptom severity was more frequently reported as a barrier to study diet adherence among participants with secondary progressive MS.
Conclusions:
Methods to enhance personal motivation and ensure positive support from support persons and study staff may improve study diet adherence. Due to the unique challenges faced by people with MS, future studies should tailor interventions to their unique MS cohort to increase diet adherence.
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Affiliation(s)
- Cassidy Dean
- From the Department of Internal Medicine, Carver College of Medicine (CD, SP, TJT, AA, PM, NG, MAE, BB, TLW), University of Iowa, Iowa City, IA, USA
| | - Samantha Parks
- From the Department of Internal Medicine, Carver College of Medicine (CD, SP, TJT, AA, PM, NG, MAE, BB, TLW), University of Iowa, Iowa City, IA, USA
| | - Tyler J. Titcomb
- From the Department of Internal Medicine, Carver College of Medicine (CD, SP, TJT, AA, PM, NG, MAE, BB, TLW), University of Iowa, Iowa City, IA, USA
- From the Department of Epidemiology, College of Public Health (TJT, LGS), University of Iowa, Iowa City, IA, USA
| | - Andrea Arthofer
- From the Department of Internal Medicine, Carver College of Medicine (CD, SP, TJT, AA, PM, NG, MAE, BB, TLW), University of Iowa, Iowa City, IA, USA
| | - Paul Meirick
- From the Department of Internal Medicine, Carver College of Medicine (CD, SP, TJT, AA, PM, NG, MAE, BB, TLW), University of Iowa, Iowa City, IA, USA
| | - Nicole Grogan
- From the Department of Internal Medicine, Carver College of Medicine (CD, SP, TJT, AA, PM, NG, MAE, BB, TLW), University of Iowa, Iowa City, IA, USA
| | - Mary A. Ehlinger
- From the Department of Internal Medicine, Carver College of Medicine (CD, SP, TJT, AA, PM, NG, MAE, BB, TLW), University of Iowa, Iowa City, IA, USA
| | - Babita Bisht
- From the Department of Internal Medicine, Carver College of Medicine (CD, SP, TJT, AA, PM, NG, MAE, BB, TLW), University of Iowa, Iowa City, IA, USA
| | - Sara Shuger Fox
- From the Department of Exercise Science (SSF), Central College, Pella, IA, USA
| | | | - Linda G. Snetselaar
- From the Department of Epidemiology, College of Public Health (TJT, LGS), University of Iowa, Iowa City, IA, USA
| | - Terry L. Wahls
- From the Department of Internal Medicine, Carver College of Medicine (CD, SP, TJT, AA, PM, NG, MAE, BB, TLW), University of Iowa, Iowa City, IA, USA
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