The Experience of Persons With Multiple Sclerosis Using MS INFoRm: An Interactive Fatigue Management Resource

Perspectives on fatigue management among veterans living with multiple sclerosis

BACKGROUND

Chronic fatigue is one of the most common, disabling, and least understood symptoms of many chronic health conditions including multiple sclerosis (MS). A multidisciplinary rehabilitative treatment approach is recommended for MS-related fatigue, but few people with MS have access to such treatment. In-person and telehealth cognitive behavioral therapy (CBT) for fatigue is an emerging acceptable and effective treatment for MS-related fatigue in civilians that has not been studied in Veterans with MS, a population that is more likely to be older, male, unemployed, and disabled. The present study aimed to understand how Veterans with MS (1) describe their fatigue and (2) manage their fatigue, and (3) perceive telehealth CBT for MS-related fatigue.

METHOD

Twenty-four Veterans with MS completed semi-structured interviews and a brief survey. For descriptive purposes, the survey included questionnaires on demographics, fatigue, psychosocial functioning, depression, and pain. Thematic analysis with a combined deductive and inductive approach was used to analyze interview transcripts.

RESULTS

Three themes emerged. First, "experience of MS fatigue as 'one big tapestry'" described fatigue as deficits in physical and mental energy that were fluctuating and complex in their interaction with biological factors. Veterans described that MS fatigue negatively impacted daily activities of living, emotions, and cognitive functioning. Second, "managing MS fatigue through trial and error" revealed that Veterans expend significant time and effort learning and trialing fatigue management strategies based on their personal beliefs, military training/experiences, provider recommendations, and iterative learning. Most Veterans described energy management, relaxation, exercise, and adaptive thinking as helpful for managing fatigue. Interestingly, the helpfulness of medication for fatigue was highly variable, and none of the Veterans described medication as a standalone fatigue treatment. The third theme, "practicing flexibility with telehealth CBT for MS fatigue" revealed Veteran's enthusiasm about telehealth CBT for MS-related fatigue and highlighted the importance of flexible delivery to meet individual needs.

CONCLUSION

Veteran participants shared their experience of MS-related fatigue as well as management strategies that are consistent with previous research in civilians with MS fatigue. Notably, Veterans' preference for flexible nonpharmacological intervention can inform adaptation of telehealth CBT for Veterans with MS fatigue.

Informing Digital Programs for Lupus Self-Management Education: A Systematic Scoping Review

OBJECTIVE

We describe the characteristics, content, and effectiveness of digital self-management (SM) education programs for lupus and other chronic conditions to identify gaps and inform the improvement of future programs in lupus.

METHODS

Three bibliographic databases were searched for articles published between May 2012 and April 2022. The search was cast to capture the breadth of digital SM education programs in the following conditions: lupus, epilepsy, fibromyalgia, multiple sclerosis, sickle cell anemia, Sjögren syndrome, psoriatic arthritis, and rheumatoid arthritis. Title and abstract screening, as well as full-text review, was conducted by two independent reviewers. Data extraction was first completed by one author charting all studies and then, a second time, by four members of the research team charting collaboratively.

RESULTS

Of the 1,969 articles identified through the search, 14 met inclusion criteria. Two additional articles were included following bibliography review. The 16 articles represented 12 unique digital SM education programs. Programs covered five conditions: epilepsy (n = 3), fibromyalgia (n = 2), multiple sclerosis (n = 4), lupus (n = 1), and rheumatoid arthritis (n = 2). Most programs were asynchronous and internet-based (n = 9) with a prescribed sequence of content (n = 8). Peer, technical, or specialist support was offered in seven programs. Most programs demonstrated statistically significant improvement of symptoms in the intervention group (n = 8).

CONCLUSION

This scoping review summarizes the current landscape for digital SM education programs in lupus and similar conditions. In lupus, further investigation will fill in the gaps around digital SM education needs, user experience, and evaluation of outcomes.

Comparison of goals set by people with multiple sclerosis during two fatigue management interventions

BACKGROUND

Identifying the meaningful goals of people with multiple sclerosis (PwMS) can facilitate tailored treatment plans.

OBJECTIVES

To describe and compare the goals set by PwMS during two interventions, and explore the strategies used to meet their goals, the barriers and facilitators influencing goal achievement.

METHODS

Data from 56 community-dwelling PwMS were used in this secondary analysis: 45 used an interactive fatigue self-management website (MS INFoRm), and 11 received MS INFoRm coupled with occupational performance coaching (OPC) for 3 months. The International Classification of Functioning, Disability and Health (ICF) was used to map and compare the goals, strategies, facilitators and obstacles to goal achievement between the groups. Goals were also evaluated for being Specific, Measurable, Attainable, Relevant and Timely (SMART).

RESULTS

Most goals were related to 'looking after one's health' (n = 35) and 'recreation and leisure' (n = 17). Participants who received OPC set more SMART goals (75 vs. 24%, p < 0.01). Fatigue management strategies were identified. Personal and environmental factors were found as facilitators and obstacles to goal achievement.

CONCLUSION AND SIGNIFICANCE

Coaching can help PwMS with goal setting, and to adapt strategies to achieve their goals. Increased awareness of goals set by PwMS may equip clinicians to better assess their clients' needs.

Perceptions of fatigue and fatigue management interventions among people with multiple sclerosis: a systematic literature review and narrative synthesis

Background/Aims

Fatigue is the most common symptom of multiple sclerosis. Evidence supports the effectiveness of fatigue management interventions for people with multiple sclerosis. This review aimed to identify how people with multiple sclerosis experience fatigue and to examine their perceptions of fatigue management interventions.

Methods

The review was conducted systematically, searching the following electronic databases: AMED, CINAHL Complete, eBook Nursing Collection, ERIC, Health Source: Nursing/Academic Edition, MEDLINE, APA PsycArticles, and APA PsycInfo for original peer-reviewed empirical research published in English between January 2000 and June 2020. Qualitative and mixed-methods studies that captured the perspectives of people with multiple sclerosis on their fatigue and/or their perceptions of fatigue management interventions were included. A narrative synthesis was used to synthesise the findings.

Results

A total of 23 qualitative and eight mixed-methods studies were extracted comprising a total of 662 people with multiple sclerosis (relapsing remitting n=293; secondary progressive n=129; primary progressive n=73; relapsing progressive n=3; benign n=2; fulminant n=1; type of multiple sclerosis not reported n=161). Fatigue was perceived by people with multiple sclerosis as a debilitating symptom of the condition and which they felt impacted adversely on their lives. A lack of understanding from others about multiple sclerosis fatigue was challenging for people with multiple sclerosis. People with multiple sclerosis valued the physical and psychosocial-based content of fatigue management interventions and felt fatigue management interventions enabled them to legitimise their fatigue and feel more in control of their fatigue.

Conclusions

From the perspective of people with multiple sclerosis, fatigue is a central and debilitating feature of the everyday experience of living with multiple sclerosis. Research on the potential of fatigue management interventions to foster control for people with multiple sclerosis to help them manage their fatigue is warranted. Healthcare professionals should consider how they can empower people with multiple sclerosis to educate others about their fatigue. Some evidence being generated for practice might not be sufficiently contextualised to different forms of multiple sclerosis.

The "Managing Fatigue" programme - experiences shared by MS participants

BACKGROUND

The "Managing Fatigue" (MF) programme can help people living with Multiple sclerosis (MS) manage fatigue in their everyday lives. The programme has been proven feasible with Swedish occupational therapists, but there is a lack of knowledge of how MS participants experience the programme, and what they learned from participating in the programme.

AIM

To describe how Swedish MS participants experience the content and structure of the Swedish MF programme, as well as what they learned from participating in the programme.

MATERIAL AND METHODS

Qualitative interviews were performed with nine MS participants, and data were analysed according to direct content analysis.

RESULTS

Participants experienced programme material was relevant, and they valued the structured sessions that utilised different teaching forms. Participants described the group format and the experienced course leader nurtured their learning process. They learned occupational skills to save energy, to re-value daily occupations, and initiated a process of change, but individual support is needed after programme completion.

CONCLUSION AND SIGNIFICANCE

Findings support programme feasibility among MS participants, and show the importance of being able to practice skills to handle fatigue in everyday life. Future studies should consider adding outcome measures focussing on engagement in occupations when evaluating programme effectiveness.

Occupational therapy interventions for multiple sclerosis: A scoping review

BACKGROUND

Evidence for the effectiveness of occupational therapy for people with multiple sclerosis (MS) is yet to be established.

AIMS/OBJECTIVES

To review the evidence regarding the effectiveness of occupational therapy interventions in improving outcomes for adults with MS.

MATERIAL AND METHODS

We completed a scoping review of occupational therapy and multiple sclerosis following a scoping review methodological framework. Search included articles published up until June 2019. Studies were included if they were original research that included adults with MS published in English and assessed interventions delivered by occupational therapists.

RESULTS

The search yielded 1646 results. Following screening and review of articles, thirty papers met the inclusion criteria and were included in the review. Studies were charted and discussed in the areas of: (1) fatigue management or energy conservation; (2) upper-limb rehabilitation; (3) occupation-focussed cognitive rehabilitation; and (4) other types of interventions.

CONCLUSIONS

The quality of evidence that exists for occupational therapy with people with MS is mixed but there are studies that show that occupational therapy can improve occupational and other outcomes in this population.

Significance: Patients have reported many benefits of occupational therapy but the evidence-base to support this needs to be developed.Implications for rehabilitationOccupational therapists are well-placed to intervene with multiple sclerosis symptoms.Evidence for the effectiveness of occupational therapy for people with multiple sclerosis is yet to be established.Fatigue management programmes delivered by occupational therapists are effective in reducing symptoms.Additional training in client-centred practice is no more effective than usual occupational therapy.

Energy management education and occupation-related outcomes in adults with chronic diseases: A scoping review

Introduction

Fatigue is a pervasive symptom of chronic disease that often interferes with occupational performance. Our objective was to describe what is known about energy management education and occupation-related outcomes in adults with chronic diseases.

Methods

Seven electronic databases were searched for relevant literature published before August 2019. Eligible articles were full-text, available in English, and studied energy management education in adults with a chronic disease. The first author assessed article eligibility with validation from a second reviewer, extracted characteristics of included studies, and described them using descriptive statistics. A narrative synthesis of findings was conducted for each chronic disease population.

Results

Forty-four studies addressed eight different chronic disease populations. The most common program delivery format was face-to-face in a group setting (42%), 39% of programs were informed by a learning theory, and their median cumulative length was 8 hours. Positive outcomes were associated with a specific, group-based energy management program in people with multiple sclerosis. The evidence on other energy management programs and in other chronic disease populations was more limited and inconclusive.

Conclusions

Further research is needed to understand the impact of energy management education in chronic disease populations beyond multiple sclerosis, and its impact on occupational performance.

Experiences of multiple sclerosis patients with self-management of fatigue: a qualitative systematic review protocol

OBJECTIVE

The objective of this review is to explore and synthesize the evidence on the experience of self-managing multiple sclerosis fatigue among adult patients.

INTRODUCTION

Multiple sclerosis is a growing neurologic auto-immune disease, and fatigue is considered one of the most common and debilitating side effects. Understanding how multiple sclerosis patients experience fatigue, the cause of their fatigue, as well as how they self-manage their fatigue will better inform healthcare providers and patients.

INCLUSION CRITERIA

The review will consider qualitative studies investigating the perceptions, experiences and meaning of fatigue associated with multiple sclerosis, the factors contributing to fatigue and the self-management strategies used to control fatigue in adults. Studies that include adult patients diagnosed with multiple sclerosis and experiencing fatigue, regardless of their participation in pharmacological interventions and non-pharmacological interventions, will be included. Any patients with multiple sclerosis residing in hospital-based care or residential in patient care will not be included.

METHODS

A three-step search strategy will be utilized in this review. The initial step consists of a limited search in MEDLINE and CINAHL using "multiple sclerosis" and "fatigue" as search terms. Studies will be excluded if they have not been translated into English, but will not be limited by date. Each article will go through a preliminary review based on title and abstract to exclude any articles not pertaining to this study. After the search is completed, two reviewers will individually appraise retrieved qualitative studies for methodological quality prior to inclusion in the review. Findings will be pooled using meta-aggregation, and a ConQual Summary of Findings will be presented.

Development and Preliminary Evaluation of a 3-Week Inpatient Energy Management Education Program for People with Multiple Sclerosis-Related Fatigue

Background

Energy conservation strategies and cognitive behavioral therapy techniques are valid parts of outpatient fatigue management education in people with multiple sclerosis (MS). In many European countries, multidisciplinary rehabilitation for people with MS is chiefly delivered in specialized rehabilitation centers, where they benefit from short intensive inpatient rehabilitation annually. However, no evidence-based and standardized fatigue management education program compatible with the inpatient setting is available.

Methods

Based on a literature search and the expertise of occupational therapists (OTs), a manualized group-based Inpatient Energy Management Education (IEME) program for use during 3-week inpatient rehabilitation that incorporates energy conservation and cognitive behavioral management approaches was developed. An IEME pilot program operated by trained OTs included 13 people with MS-related fatigue. The experiences of the IEME users and OTs were collected during focus groups to refine the program's materials and verify its feasibility in the inpatient setting.

Results

The program was feasible in an inpatient setting and met the needs of the people with MS. Targeted behaviors were taught to all participants in a clinical context. In-charge OTs were able to effect behavioral change through IEME.

Conclusions

Users evaluated the evidence-based IEME program positively. The topics, supporting materials, and self-training tasks are useful for the promotion and facilitation of behavioral change. The next step is a clinical trial to investigate the efficacy of IEME and to evaluate relevant changes in self-efficacy, fatigue impact, and quality of life after patients return home.

Managing the (In)visibility of Chronic Illness at Work: Dialogism, Parody, and Reported Speech

Interactionally, the workplace may be dilemmatic for a person with "invisible" chronic illness. Risks of stigmatization exist if they disclose their condition to colleagues. Meanwhile, not disclosing threatens well-being and entitlements. Using Bakhtin's dialogism as a theoretical framework, we explored these social aspects of illness: inductively analyzing narratives from 20 participants with multiple sclerosis (MS). Capitalizing on concepts from dialogical and conversation analysis, links between (in)visibility, knowledge, and belief were examined with respect to symptoms and co-worker judgment. Perceived medical legitimacy creates a core social dilemma. At the intersection of genre and action, participants systematically used parody to subvert the traditional workplace hierarchy. "Oh-prefaced" direct reported speech (OPDRS) was deployed to exaggerate workplace interactions, undermining managers/colleagues who misattributed (in)visible symptoms. Parodic OPDRS index emotive interactional dilemmas. As subversions of organizational power, OPDRS denote those very areas where employees feel disempowered. Sensitivity to OPDRS can provide diagnostic support and complement evaluation frameworks.

A multi-site, randomized controlled trial of MS INFoRm, a fatigue self-management website for persons with multiple sclerosis: rationale and study protocol

BACKGROUND

Fatigue is one of the most common and debilitating symptoms of multiple sclerosis (MS). The majority of approaches for managing MS fatigue typically require participation in a structured, time-limited program with a fixed sequence of topics and activities. MS INFoRm (Multiple Sclerosis: An Interactive Fatigue Management Resource) is a self-directed MS fatigue management resource incorporating principles of self-management and adult learning. Positive results from a feasibility pilot study of a USB-delivered version of MS INFoRm led to the current trial and adaptation of MS INFoRm to a website format. The specific aims of the proposed study are to (a) to determine the effectiveness and efficacy of 3-month use of MS INFoRm on fatigue impact (primary outcome) among persons with MS, (b) to determine whether 3-month use of MS INFoRm results in improvement in secondary outcomes of self- efficacy for managing MS fatigue, self-reported cognitive function, participation and autonomy, and depression, and (c) to determine whether any improvements in primary and secondary outcomes are maintained among the MS INFoRm users after 6-months.

METHODS/DESIGN

Parallel group, two arm, double-blinded superiority trial with a 1:1 allocation. Two hundred persons with MS will be randomly assigned to either an intervention (MS INFoRm) or usual care control group in which they will be given 3-month access to either the MS INFoRm website (intervention group) or a control webpage containing widely available resources on MS fatigue (control group). Baseline, immediate post-intervention (3-months), and follow-up (6-months post intervention) evaluations will take place on primary (Modified Fatigue Impact Scale) and secondary (Multiple Sclerosis Self-Efficacy Scale, Perceived Deficits Questionnaire, Center for Epidemiologic Studies Depression Scale, and Impact on Participation and Autonomy Questionnaire) measures. Hypothesis testing will involve independent samples t-tests and mixed effects ANOVAs.

DISCUSSION

People with MS may benefit from easily accessible and self-directed fatigue management resources based on self-management and adult learning principles. The proposed study will provide crucial evidence about the potential of MS INFoRm as a self-management tool that can be made widely available to persons with MS as a means to effectively reduce the daily impact of MS fatigue.

TRIAL REGISTRATION

ClinicalTrials.gov : NCT03362541 . Posting date December 5, 2017.