1
|
Komar A, Dickson K, Alavinia M, Bruno T, Bayley M, Feinstein A, Scandiffio J, Simpson R. Effects of mindfulness-based interventions on cognition in people with multiple sclerosis: a systematic review and meta-analysis of randomized controlled trials. Front Psychiatry 2024; 15:1339851. [PMID: 39071226 PMCID: PMC11272459 DOI: 10.3389/fpsyt.2024.1339851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 06/24/2024] [Indexed: 07/30/2024] Open
Abstract
Introduction Cognitive impairment affects up to 65% of people with multiple sclerosis (PwMS), undermining functional independence and quality of life. The objective of this study is to synthesize existing randomized controlled trial (RCT) evidence on the effects of Mindfulness-based interventions (MBIs) on cognitive function in PwMS. Methods A systematic literature search was conducted to identify RCTs assessing MBIs effects on cognitive functioning in PwMS. Using pre-defined criteria, two independent reviewers screened titles, abstracts, and extracted data from included studies. Meta-analysis was performed, where possible, using a random effects model. Narrative synthesis was undertaken. Preferred Reporting Items for Systematic Reviews and Meta-analysis guidance was followed. PROSPERO_ID:(CRD42021286429). Results Twelve eligible RCTs were identified, n=700 PwMS. MBIs included both standardized and tailored interventions, in-person and virtually. A variety of measures of cognitive functioning were reported. Five studies (n=254 PwMS) were included in meta-analysis; pooled results suggested MBIs effectively improved scores on the Paced Auditory Serial Addition Test (PASAT)-2 (SMD=0.38; 95% CI 0.06-0.71; I2 63%; p=0.02), whereas improvements were of borderline significance on the PASAT-3 (SMD=0.32; 95% CI -0.01-0.64; I2 65%; p=0.06), and, although trending to positive, were statistically insignificant on the Perceived Deficits Questionnaire (SMD=0.34; 95 CI -0.05-0.74; I2 0%; p=0.09) and Symbol Digits Modality Test (SMD=0.25; 95% CI -0.15-0.66; I2 0%; p=0.21). Conclusion Preliminary findings in meta-analysis are inconsistent but suggest potential benefits from MBI training on cognitive functioning in PwMS. High quality RCTs are necessary to test more definitively the impact of MBIs on cognitive functioning in PwMS. Systematic review registration PROSPERO, identifier CRD42021286429.
Collapse
Affiliation(s)
- Alyssa Komar
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada
| | | | - Mohammad Alavinia
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada
| | - Tania Bruno
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada
| | - Mark Bayley
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada
| | - Anthony Feinstein
- Department of Medicine, Division of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Robert Simpson
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada
- University of Glasgow, Glasgow, Scotland, United Kingdom
| |
Collapse
|
2
|
Fragkiadaki E, Anagnostopoulos F, Triliva S. The experience of psychological therapies for people with multiple sclerosis: A mixed‐methods study towards a patient‐centred approach to exploring processes of change. COUNSELLING & PSYCHOTHERAPY RESEARCH 2023. [DOI: 10.1002/capr.12615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Evangelia Fragkiadaki
- Department of Psychology Panteion University of Social and Political Sciences Athens Greece
| | - Fotios Anagnostopoulos
- Department of Psychology Panteion University of Social and Political Sciences Athens Greece
| | - Sofia Triliva
- Department of Psychology University of Crete Rethymno Crete Greece
| |
Collapse
|
3
|
Korupolu R, Malik A, Ratcliff C, Robinson-Whelen S, Taylor HB. Feasibility, Acceptability, and Efficacy of Mindfulness Training in People With Upper Motor Neuron Disorders: A Systematic Review. Arch Phys Med Rehabil 2022; 103:2410-2428. [PMID: 35760105 DOI: 10.1016/j.apmr.2022.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 05/03/2022] [Accepted: 05/12/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES This systematic review aims to gain a comprehensive understanding of the feasibility, acceptability, and efficacy of mindfulness-based interventions (MBIs) on depression, anxiety, fatigue, and health-related quality of life among individuals with upper motor neuron disorders (UMNDs). DATA SOURCES PubMed, PsycINFO, Excerpta Medica Database, and Cumulative Index to Nursing and Allied Health Literature were searched for relevant studies published between January 2001 and June 2021. STUDY SELECTION Clinical trials published in English evaluating MBIs in adults with the 4 most common UMNDs (multiple sclerosis, brain injury including stroke, spinal cord injury, amyotrophic lateral sclerosis) were included. DATA EXTRACTION Two reviewers independently performed the risk of bias assessment using standardized tools and extracted desired data electronically. DATA SYNTHESIS A total of 44 studies were included: 26 randomized controlled trials, 10 nonrandomized controlled trials, and 8 pre-post intervention studies. The average ± SD duration of MBIs was 8±2 weeks. On average, 85%±14% of participants completed the MBI, and the retention rate at follow-up was 80%±16%. Only 14% of the studies delivered MBIs virtually, and feasibility metrics were similar to in-person studies. Among studies reporting acceptability data, most participants reported satisfaction with the MBI. Randomized controlled trials that evaluated the effects of MBI on depression, anxiety, fatigue, and quality of life revealed greater relative improvement in these outcomes among MBI participants compared with controls, with differences greater when compared with passive control than active control participants. None of the studies included in this review studied dose response. CONCLUSIONS Based on current data, MBIs are feasible and offer a promising approach to address the biopsychosocial needs of individuals with UMNDs. MBIs are associated with a high acceptance rate among participants, with notable improvements in depression, anxiety, fatigue, and quality of life post intervention. Future studies are needed to evaluate alternate models of delivery of MBIs and the dose-response relationship.
Collapse
Affiliation(s)
- Radha Korupolu
- Department of Physical Medicine and Rehabilitation, University of Texas Health Sciences Center at Houston, Houston, Texas; TIRR Memorial Hermann, Houston, Texas.
| | - Aila Malik
- Department of Physical Medicine and Rehabilitation, University of Texas Health Sciences Center at Houston, Houston, Texas
| | - Chelsea Ratcliff
- Department of Psychology, Sam Houston State University, Huntsville, Texas
| | - Susan Robinson-Whelen
- TIRR Memorial Hermann, Houston, Texas; Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Heather B Taylor
- Department of Physical Medicine and Rehabilitation, University of Texas Health Sciences Center at Houston, Houston, Texas; TIRR Memorial Hermann, Houston, Texas
| |
Collapse
|
4
|
Fahy A, Maguire R. Potentially modifiable associates of anxiety in people with multiple sclerosis: a systematic review. Disabil Rehabil 2022; 44:8201-8212. [PMID: 35040719 DOI: 10.1080/09638288.2021.2022776] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE A high percentage of people with multiple sclerosis (PwMS) experience anxiety, which can negatively impact quality of life. Despite this, anxiety in PwMS remains under researched. This review aims to identify associates with anxiety in PwMS that are amenable to change, with a view to informing the development of interventions in the area. MATERIALS AND METHODS The following databases were searched for studies investigating anxiety in PwMS from 2015 to 2021: PsycINFO, PubMed, EMBASE, Web of Science. The search consisted of keywords relating to MS and fear, anxiety or worry. Once screening was completed by two reviewers, a narrative synthesis was used to analyze the data, with the MMAT used for quality appraisal. RESULTS Of the 3117 unique abstracts screened, 39 studies met the criteria for inclusion. Evidence was found linking anxiety in PwMS to several modifiable factors broadly categorized as either psychological, social or lifestyle factors. Perceptions of self and one's ability to cope/adjust to MS emerged as important psychological factors. Physical activity and social support from friends were also linked with improved anxiety outcomes. CONCLUSIONS Anxiety in PwMS is linked to a number of modifiable factors. Findings may help inform the development of rehabilitation interventions to decrease anxiety in MS.Implications for rehabilitationThis review highlights interventions which have successfully lowered anxiety in people with MS (PwMS); however, there is a clear need for the development of further interventions which target the pathologically specific concerns surrounding anxiety in this population.We show how a number of factors amenable to change associate with anxiety, suggesting that these factors may be appropriate targets for anxiety interventions in PwMS.Enhancing physical activity and self-efficacy are important means in which healthcare professionals can reduce anxiety in MS.Identifying ways of encouraging positive coping and increasing social support are further targets for improving comorbid anxiety in PwMS.Focusing on the modifiable factors highlighted here offers considerable potential for enhancing psychological wellbeing in this group.
Collapse
Affiliation(s)
- Austin Fahy
- Department of Psychology, Maynooth University, Maynooth, Ireland
| | - Rebecca Maguire
- Department of Psychology, Maynooth University, Maynooth, Ireland
| |
Collapse
|
5
|
Simpson R, Simpson S, Wasilewski M, Mercer S, Lawrence M. Mindfulness-based interventions for people with multiple sclerosis: a systematic review and meta-aggregation of qualitative research studies. Disabil Rehabil 2021; 44:6179-6193. [PMID: 34498997 DOI: 10.1080/09638288.2021.1964622] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Mindfulness-based interventions (MBIs) are effective treatments for stress, anxiety, and depression in PwMS. However, low adherence and high attrition may limit effectiveness. Qualitative research can provide important insights into MBI acceptability, accessibility, and implementation. This systematic review and meta-aggregation evaluated qualitative research findings on the use of MBIs for PwMS. METHODS Systematic searches were undertaken in six major electronic databases. Studies using qualitative or mixed methods were included. Two reviewers screened, data extracted, and critically appraised studies. Meta-aggregation was performed following the Joanna Briggs Institute approach, extracting findings, developing categories, and synthesizing findings. RESULTS Six eligible papers, including 136 PwMS were included in meta-aggregation. 136 findings were extracted, grouped into 17 categories, with four synthesized findings: (1) "accessing mindfulness," (2) "a sense of belonging," (3) "experiencing mindfulness," and (4) "making mindfulness more relevant and sustainable for PwMS." CONCLUSIONS MBIs for PwMS need to take into consideration disability which can limit accessibility. Online MBIs (synchronous and asynchronous) appear acceptable alternatives to traditional face-to-face courses. However, PwMS benefit from shared (mindful) experiencing and highlight MBI instructors as crucial in helping them understand and practice mindfulness. Involving PwMS in design, delivery, and iterative refinement would make MBIs more relevant to those taking part.IMPLICATIONS FOR REHABILITATIONBoth face-to-face and online Mindfulness-based interventions (MBIs) appear acceptable to PwMS and, ideally, people should be offered a choice in training modality.PwMS derive benefit from undertaking MBIs with their peers, where a sense of camaraderie and belonging develop through shared (mindful) experiences.Instructors delivering MBIs for PwMS should be knowledgeable about the condition; participants describe how the instructor has a key role in helping them practice mindfulness effectively in the context of unpleasant experiences associated with MS.MBIs tailored for PwMS should include a pre-course orientation session, clearly articulate how mindfulness practices can help with MS, provide well-organized course materials in large font size, and deliver individual mindfulness practices flexibly depending on participant need.
Collapse
Affiliation(s)
- Robert Simpson
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Toronto, Canada.,Institute of Health and Wellbeing, University of Glasgow, Scotland, UK
| | - Sharon Simpson
- Institute of Health and Wellbeing, University of Glasgow, Scotland, UK
| | - Marina Wasilewski
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Toronto, Canada
| | | | - Maggie Lawrence
- School of Health and Life Sciences, Glasgow Caledonian University, Scotland, UK
| |
Collapse
|
6
|
Han A. Mindfulness- and Acceptance-Based Interventions for Symptom Reduction in Individuals With Multiple Sclerosis: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2021; 102:2022-2031.e4. [PMID: 33812883 DOI: 10.1016/j.apmr.2021.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/12/2021] [Accepted: 03/19/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To examine the effects of mindfulness- and acceptance-based interventions (MABIs) on reducing symptoms in individuals with multiple sclerosis (MS). DATA SOURCES A comprehensive search was conducted within the PubMed, CINAHL, PsycINFO, and SCOPUS databases for articles published from inception to July 3, 2020. STUDY SELECTION Randomized controlled trials (RCTs) were included if MABIs were provided to individuals with MS exclusively, with reported pre-and posttest results in symptoms of depression, anxiety, stress, fatigue, or pain. DATA EXTRACTION Characteristics of the included RCTs and data for meta-analysis were extracted. The quality of the included RCTs was assessed using the Cochrane Collaboration risk of bias tool. DATA SYNTHESIS A random effects model with the inverse variance method was used with effect size reported as standardized mean difference. Heterogeneity was assessed using the I2 statistic. RESULTS Twenty-three RCTs met the eligibility criteria. Meta-analyses found large effects of MABIs on reducing depressive symptoms, anxiety, stress, and pain, as well as a moderate effect of MABIs on reducing fatigue at the immediate posttest. Large effects of MABIs on reducing depressive symptoms, anxiety, and stress at follow-up were also found, whereas a moderate effect on reducing fatigue was found at follow-up. There was no significant effect of MABIs on reducing pain at follow-up. CONCLUSIONS Fewer studies were included in meta-analyses for pain at the immediate posttest and follow-up and stress and fatigue at follow-up. The overall risk of bias was unclear. Future high-quality studies with follow-up evaluations are needed to support effects of MABIs on reducing symptoms in individuals with MS and examine intervention features that increase and maintain effects.
Collapse
Affiliation(s)
- Areum Han
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, AL.
| |
Collapse
|
7
|
Han A. Effects of mindfulness-and acceptance-based interventions on quality of life, coping, cognition, and mindfulness of people with multiple sclerosis: a systematic review and meta-analysis. PSYCHOL HEALTH MED 2021; 27:1514-1531. [PMID: 33629885 DOI: 10.1080/13548506.2021.1894345] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This systematic review and meta-analysis of randomized controlled trials (RCTs) examined effects of mindfulness- and acceptance-based interventions (MABIs) on quality of life (QoL), coping, cognition, and mindfulness among people with multiple sclerosis (MS). Four electronic databases were searched to 3 July 2020. Data was combined in a random-effects meta-analysis model. Eighteen RCTs met the eligibility criteria. Meta-analyses at the immediate posttest found: moderate effects of MABIs on QoL, coping, and attention; and a large effect on memory. A large effect of MABIs on QoL was found at follow-up. There was no significant effect of MABIs on mindfulness. Relatively fewer studies in outcomes other than QoL were found, and the overall risk of bias across the included 18 RCTs was unclear. Future high-quality studies with follow-up evaluations are needed to support effects of MABIs on QoL, coping, cognition, and mindfulness in people with MS and examine intervention features that increase and maintain effects.
Collapse
Affiliation(s)
- Areum Han
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA
| |
Collapse
|