Occupational Therapy in Fatigue Management in Multiple Sclerosis: An Umbrella Review

Characterizing fatigue phenotypes with other symptoms and clinically relevant outcomes among people with multiple sclerosis

PURPOSE

Fatigue is a common symptom of multiple sclerosis (MS) and can adversely affect all aspect of quality of life. The etiology of fatigue remains unclear, and its treatments are suboptimal. Characterizing the phenotypes of fatigued persons with MS may help advance research on fatigue's etiology and identify ways to personalize fatigue interventions to improve quality of life. The purpose of this study was to identify fatigue phenotypes; examine phenotype stability overtime; and characterize phenotypes by health and function, social and environmental determinants, psychosocial factors, and engagement in healthy behaviors.

METHODS

We conducted a longitudinal study over a 3-month period with 289 fatigued participants with MS. To identify fatigue phenotypes and determine transition probabilities, we used latent profile and transition analyses with valid self-report measures of mental and physical fatigue severity, the mental and physical impact of fatigue, depression, anxiety, and sleep quality. We used ANOVAs and effect sizes to characterize differences among phenotypes.

RESULTS

The best fitting model included six subgroups of participants: Mild Phenotype, Mild-to-Moderate Phenotype, Moderate-to-Severe Phenotype, Severe Phenotype, Fatigue-dominant Phenotype, and Mental Health-dominant Phenotype. The transition analysis indicated that phenotypic membership was highly stable. Variables with a large eta squared effect size included environmental barriers, self-efficacy, and fatigue catastrophizing.

CONCLUSION

These results indicate that the magnitude of fatigue experienced may be more important to consider than the type of fatigue when characterizing fatigue phenotypes. Future research should explore whether tailoring interventions to environmental barriers, self-efficacy, and fatigue catastrophizing reduce the likelihood of transitioning to a more severe phenotype.

More gain, less pain: How resistance training affects immune system functioning in multiple sclerosis patients: A review

Multiple sclerosis (MS) is characterized by a complex etiology that is mirrored by the perplexing and inconsistent treatment responses observed across different patients. Although epigenetic research has garnered rightful interest in its efforts towards demystifying and understanding aberrant responses to treatment, the interim undoubtedly requires alternative non-pharmacological approaches towards attaining more effective management strategies. Of particular interest in this review is resistance training (RT) as a non-pharmacological exercise-based interventional strategy and its potential role as a disease-modifying tool. RT has been reported across literature to positively influence numerous aspects in the quality of life (QoL) and functional capacity of MS patients, and one of the attributes of these benefits may be a shift in the immune system of these individuals. RT has also been proven to affect different immune system key players associated with MS pathology. Ultimately, this brief review aims to provide a potential yet crucial link between RT, alterations in the expression profile of the immune system, and finally an imminent improvement in the overall well-being and QoL of MS patients, suggesting that utilizing RT as an interventional exercise modality may be an effective strategy that would aid in managing such a complex and debilitating disease.

Multiple Sclerosis in Saudi Arabia: Clinical, Social, and Psychological Aspects of the Disease

Introduction

Multiple sclerosis (MS) is a chronic autoimmune disorder that affects the central nervous system characterized by demyelinating lesions that are disseminated in space and time. Depression is a common symptom in MS, and the pathogenesis is multifactorial. In Saudi Arabia, there is limited current literature about the incidence and relationship between depression and MS. This study is an attempt meant to address the point prevalence of depression, risk factors, and relationship to disease-modifying therapy. In addition, we describe several clinical, nutritional, and social aspects of MS.

Methods

A descriptive cross-sectional study was conducted in Jeddah, Saudi Arabia. The target sample in this study consisted of patients in Saudi Arabia with MS. Data collected included a depression questionnaire based on PHQ9, compliance on therapy, the preferred therapy, and the impact of the disease on daily activity and economic state.

Results

A total of 341 Saudi MS patients were enrolled in the present study. The gender distribution showed that 65.4% (n=223) of the study population were females. The mean age of the patients was 34.80±9.907 years. Most of the patients who were included in this study (95.6%) had depressive symptoms in variant levels. Variable changes in depression levels were detected in both genders specifically moderate depression was most common in males (33%) while females had moderately severe depression (38%). Numbers of relapses, future vision, and changes in workout were associated with statistically significant depression levels.

Conclusion

Depressive symptoms are common in patients with MS. Although all disease-modifying therapies are available in Saudi Arabia, MS clinics with multidisciplinary care are not yet efficiently activated. Non-pharmacological interventions such as smoking cessation, exercise, and psychological health should be part of the management of any patient with MS.

Role of Rehabilitation in Promoting Engagement in Daily Life in Multiple Sclerosis: Facing the Challenges of the 21st Century

The purpose of this narrative review is to define the theoretical constructs of engagement, participation, and balance. The implementation of these constructs in multiple sclerosis (MS) rehabilitation are described because MS symptoms such as fatigue and cognitive decline may affect engagement in daily life. The constructs of engagement and participation can be considered to be different when they are studied. The constructs related to balance are of interest when targeting engagement. Multidisciplinary rehabilitation programs may have beneficial effects in optimizing engagement. Therefore, the measurement of these constructs is primordial because they give us a deeper understanding of the meaning of activity performance that reflects engagement in daily life. Future research may focus on describing engagement in both men and women at all stages of MS and may explore variables that influence engagement in daily life to integrate engagement optimization in MS rehabilitation. Engagement may have beneficial effects as part of multidisciplinary rehabilitation in MS.

[Effects of rehabilitation on fatigue, disability and quality of life in people with multiple sclerosis: A systematic review]

OBJECTIVE

To assess the effectiveness of rehabilitation, highlighting the role of Occupational Therapy, in people with multiple sclerosis, in terms of disability, fatigue and quality of life.

MATERIALS AND METHODS

A literature search was carried out in the BVS, Cochrane, OT-Seeker, PubMed and PEDro databases.

INCLUSION CRITERIA

Controlled clinical trials published between January 2011 and April 2019 in Spanish or English with a score of ≥5 on the PEDro scale whose purpose was rehabilitation through the use of assistive technology, skills training, vestibular rehabilitation, behaviour modification, therapeutic education or specific Occupational Therapy interventions.

RESULTS

A total of 16 studies (1,279 subjects) were included. Rehabilitation improved patients' fatigue and disability and slightly enhanced their quality of life.

CONCLUSIONS

Rehabilitation can provide benefits to the performance of people with multiple sclerosis by reducing their perceived fatigue and disability.

LIMITATIONS

The heterogeneity of the sample, the type and duration of the interventions and variability of the instruments for measuring results.