[Therapy of day time fatigue in patients with multiple sclerosis]

Effect of Rehabilitation on Fatigue Level in Patients with Multiple Sclerosis

BACKGROUND The objective of this study was to evaluate the effect of a rehabilitation program in changing the perception of fatigue in patients with multiple sclerosis. MATERIAL AND METHODS The study involved 65 respondents/patients with clinically confirmed multiple sclerosis (54 women, 11 men, average age 46.49 years). The evaluation of the effects of fatigue on the physical, psychological, and psychosocial aspects of life was assessed using the Modified Fatigue Impact Scale (MFIS). To test the effectiveness of the neurorehabilitation program, we enrolled 2 groups: the experimental group (EG, n=32, 29 women, 3 men, Expanded Disability Status Scale (EDSS) 4.8 average, SD±1.77, min. 1.5 max 8.0) participated in the intervention and rehabilitation program over a period of 12 weeks and the control group (CG, n=33, 25 women, 8 men. EDSS average 5.12±1.74 SD, min. 2.0 max. 8.0). Each group of patients was divided into 3 sub-groups according to the severity of EDSS: a) 1-3.5, b) 4-6, and c) 6.5-8. For the statistical evaluation of the significance of the observed changes, the MANOVA/ANOVA model was used. RESULTS Between the input and output assessment of the MFIS individual areas questionnaire between the EG and the CG, there existed a statistically significant in the physical area (p<0.000), psychological area (p<0.000), and psychosocial area (p=0.002). CONCLUSIONS Our results support the importance of an active approach in patients with multiple sclerosis using individualized rehabilitation intervention programs.

Effect of pulsed magnetic field therapy on the level of fatigue in patients with multiple sclerosis - a randomized controlled trial

Twenty-five multiple sclerosis patients, taking part in a rehabilitation program, were randomly assigned to treatment with pulsed magnetic field therapy (PMFT) or to sham therapy in order to study the additional effect of PMFTas part of a multimodal neurological rehabilitation program on fatigue. Patients demographic and disease specific characteristics were recorded. Level of fatigue was measured by fatigue sverity scale (FSS) at entrance and discharge and with a visual analog scale (VAS) immediate before and after a single treatment session. The ‘Magnetic Cell Regeneration’ system by Santerra was used for PMFT. A single treatment lasted 16 minutes twice daily over 3-4 weeks and consisted of relaxed lying on a PMF mattress. Sham intervention was conducted in an identical manner with the PMF-device off. Patients and statistics were blinded.

Level of fatigue measured by FSS was high at entrance in both treatment group (TG) and control group (CG) (5.6 versus 5.5). Over time of rehabilitation fatigue was reduced by 18% in TG and 7% in CG which was statistically not significant. There was a statistically significant immediate effect of the single treatment session witch 18% reduction of fatigue measured by VAS in TG versus 11% in CG.

Because of a high ‘placebo effect’ of simple bed rest, a only small and short lasting additional effect of PMFT and high costs of a PMF-device, we cannot recommend PMFTas an additional feature of a multimodal neurological rehabilitation program in order to reduce fatigue level of MS-patients.

The Effect of Orem's Self-Care Model on Fatigue in Patients With Multiple Sclerosis: A Single Blind Randomized Clinical Trial Study

Background

Orem’s self-care model is a nursing model that was introduced with the purpose of improving the self-care of individuals, especially patients suffering from chronic diseases.

Objectives

To determining the effect of Orem’s self-care model on fatigue in multiple sclerosis patients.

Patients and Methods

This research involved a clinical trial. Sixty-three multiple sclerosis patients at the vice-chancellor in treatment affairs of Yasuj University of Medical Sciences were selected based on nonrandom sampling, but they were allocated to the two groups based on random allocation. In the intervention group, Orem’s model was applied during six sessions of 45 - 60 minutes in length, and the process continued for 1 month. The data were collected 1 week before and 7 weeks after the end of the intervention using the Orem’s self-care model-based assessment form and fatigue severity scale, the validity and reliability of which have been

Results

Before the intervention, 11.11% of the participants had a good knowledge of self-care. In addition, self-care willingness and skills were observed in 76.19% and 4.76% of participants, respectively. The mean difference in fatigue reduced significantly in the intervention group after the intervention (P < 0.05). After the intervention, a statistically significant difference was observed in the mean difference of fatigue between the two groups (P < 0.05).

Conclusions

Orem’s self-care model is significantly effective in reducing the fatigue of multiple sclerosis patients.

Yoga effects on physical activity and sexual satisfaction among the Iranian women with multiple sclerosis: a randomized controlled trial

BACKGROUND

Multiple Sclerosis (MS) is a chronic and disabling disease resulting in disabilities in young and middle-aged persons. In this study, researchers explored the effect of yoga techniques on physical activities and sexual function among some Iranian women with MS.

MATERIALS AND METHODS

In this study, 60 Iranian women with multiple sclerosis (MS) were placed in two equally divided control and case groups through random selection to assess pre-and post-effects of yoga exercises on their physical activities and sexual satisfaction levels. Women in case group were offered a series of yoga training and exercises for 3 months, which consisted of 8 sessions per month for 60 to 90 minutes at each session. Yoga training program included the 3 principles of slow motions (Hatayoga), respiratory exercises (Pranayama) and centralization to control mind via meditation, expansion and stasis (Rajayoga). After 3 months both groups were surveyed using the initial questionnaire to evaluate and compare findings with the base-line data.

RESULTS

Researchers found significant statistical difference in physical activity and sexual satisfaction levels among the women in case group (P=0.001). Women in case group showed improvement in physical ability while women in control group manifested exacerbated symptoms.

CONCLUSION

Yoga techniques may improve physical activities and sexual satisfaction function of women with MS.

Management of fatigue in patients with multiple sclerosis

As long as no causal treatment is available for multiple sclerosis (MS), and as long as only some patients with MS respond to immunomodulators, symptomatic treatment is of paramount importance. Fatigue is the most common symptom of MS and is associated with a reduced quality of life. It is described as the worst symptom of their disease by 50-60% of patients. The first step in managing MS-related fatigue is identifying and eliminating any secondary causes. Primary fatigue syndrome can be alleviated with drug treatment in many cases. Modafinil has been shown to be effective in some studies, and amantadine is an alternative for patients who do not respond to or cannot tolerate modafinil. The nonpharmacological management of fatigue in MS includes inpatient rehabilitation and aerobic endurance exercise. This article describes the pathophysiology, diagnosis and treatment of MS-related fatigue--the most common symptom of MS.