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Turkowitch D, Donkers SJ, Costa SL, Vaduvathiriyan P, Williams J, Siengsukon C. Behavioral Interventions to Improve Sleep Outcomes in Individuals With Multiple Sclerosis: A Systematic Review. Int J MS Care 2024; 26:22-29. [PMID: 38213676 PMCID: PMC10779715 DOI: 10.7224/1537-2073.2022-110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
BACKGROUND Sleep disturbances are common in individuals with multiple sclerosis. The objective of this systematic review was to determine effective behavioral interventions to improve their sleep. METHODS Literature searches were performed in December 2021 in Ovid MEDLINE, Elsevier Embase, and Web of Science, along with hand searching for grey literature and cited references. Four reviewers independently reviewed titles and abstracts (2 reviewers for each article; n = 830) and the full-text articles (n = 81). Consensus for inclusion was achieved by a fifth reviewer. Thirty-seven articles were eligible for inclusion. Four reviewers extracted relevant data from each study (2 reviewers for each article) using a standard data extraction table. Consensus was achieved for completeness and accuracy of the data extraction table by a fifth reviewer. The same 4 reviewers conducted a quality appraisal of each article to assess the risk of bias and quality of the articles, and consensus was achieved by a fifth reviewer as needed. Descriptive data were used for types of interventions, sleep outcomes, results, and key components across interventions. RESULTS Overall, the cognitive behavioral therapy for insomnia, cognitive behavioral therapy/psychotherapy, and education/self-management support interventions reported positive improvements in sleep outcomes. Quality appraisal scores ranged from low to high, indicating potential for bias. CONCLUSIONS Variability in the intervention type, intervention dose, outcomes used, training/expertise of interventionist, specific sample, and study quality made it difficult to compare and synthesize results. Further research is necessary to demonstrate the efficacy of most of the interventions.
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Affiliation(s)
- David Turkowitch
- From the Department of Physical Therapy, Rehabilitation Science, and Athletic Training (DT, CS) and AR Dykes Library (PV), University of Kansas Medical Center, Kansas City, KS, USA
| | - Sarah J. Donkers
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK, Canada (SJD)
| | - Silvana L. Costa
- Center for Neuropsychology and Neuroscience Research, Kessler Foundation, East Hanover, NJ, USA (SLC)
- Department of Physical Medicine and Rehabilitation, Rutgers–New Jersey Medical School, Newark, NJ, USA (SLC)
| | - Prasanna Vaduvathiriyan
- From the Department of Physical Therapy, Rehabilitation Science, and Athletic Training (DT, CS) and AR Dykes Library (PV), University of Kansas Medical Center, Kansas City, KS, USA
| | - Joy Williams
- Rehabilitation Services, Kaiser Permanente Sacramento, Sacramento, CA, USA (JW)
| | - Catherine Siengsukon
- From the Department of Physical Therapy, Rehabilitation Science, and Athletic Training (DT, CS) and AR Dykes Library (PV), University of Kansas Medical Center, Kansas City, KS, USA
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Giovannetti AM, Quintas R, Maggiolo S, Quartuccio ME. Online mindfulness program (COndiVIDere) for people with multiple sclerosis in the time of COVID-19: a pilot longitudinal study. Disabil Rehabil 2023:1-9. [PMID: 38042990 DOI: 10.1080/09638288.2023.2290690] [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: 04/13/2023] [Accepted: 11/28/2023] [Indexed: 12/04/2023]
Abstract
PURPOSE This study aims to evaluate the feasibility and effectiveness of a mindfulness-based group intervention (The COndiVIDere program) delivered online to people with MS (PwMS) in the time of COVID-19. MATERIALS AND METHODS This is a single-arm longitudinal study with a nested qualitative study. The COndiVIDere program is composed of five weekly sessions (1-h each) plus three booster monthly sessions. Data were collected immediately before the beginning of the program, after the five weekly sessions, and at 3- and 6-month follow-ups. RESULTS Fifty PwMS participated in the program. Participants improved in anxiety, stress, loneliness and mindfulness ("non-judgmental inner experience" component). Improvements on most outcomes occurred at post-intervention and reached the statistically significant threshold at 3-month follow-up. Mindfulness improvements keep increasing at each time point. Qualitative data confirmed the COndiVIDere program feasibility and the positive psychological impacts on participants. Mindfulness, compassion and the group setting were considered the most important active elements. CONCLUSIONS Study findings support COndiVIDere feasibility and effectiveness with PwMS and its broad applicability in this population.
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Affiliation(s)
- Ambra Mara Giovannetti
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Unit of Neuroimmunology and Neuromuscular Diseases, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Rui Quintas
- Unit of Clinical and Experimental Epileptology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Sara Maggiolo
- Italian Multiple Sclerosis Society and Research Foundation (FISM), Genoa, Italy
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Shah AQ, Noronha N, Chin-See R, Hanna C, Kadri Z, Marwaha A, Rambharack N, Ng JY. The use and effects of telemedicine on complementary, alternative, and integrative medicine practices: a scoping review. BMC Complement Med Ther 2023; 23:275. [PMID: 37533042 PMCID: PMC10394941 DOI: 10.1186/s12906-023-04100-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 07/21/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Telemedicine includes the delivery of health-care services and sharing of health information across distances. Past research has found that telemedicine can play a role in enhancing complementary, alternative, and integrative medicine (CAIM) while allowing the maintenance of cultural values and ancestral knowledge. This scoping review synthesized evidence regarding the use of telemedicine in the context of CAIM. METHODS Following Arksey and O'Malley's scoping review framework, CINAHL, PsycINFO, MEDLINE, EMBASE and AMED databases were searched systematically. The CADTH website was also searched for grey literature. Eligible articles included a CAIM practice or therapy offered through telemedicine, with no restrictions placed on the type of telemedicine technology used. Inductive thematic analysis was conducted to synthesise common themes among the included studies. RESULTS Sixty-two articles were included in this synthesis. The following themes emerged: 1) the practitioner view of CAIM delivered through telemedicine, 2) the patient view of CAIM delivered through telemedicine, and 3) the technological impacts of telemedicine delivery of CAIM. CONCLUSIONS Studies have shown that telemedicine delivery of CAIM is feasible, acceptable, and results in positive health outcomes. Some barriers remain such as the presence of chronic illness and morbidity, inability to form strong patient-provider relationships relative to face-to-face approaches, and technological difficulties. Future intervention research should focus on reducing such barriers, as well as explore which patient population would realize the greatest benefit from CAIM delivered via telemedicine, and the impact of interventions on providers and caregivers.
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Affiliation(s)
- Aimun Qadeer Shah
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Noella Noronha
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Robert Chin-See
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Christina Hanna
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Zeest Kadri
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Amn Marwaha
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Neetu Rambharack
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Jeremy Y Ng
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
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Reangsing C, Trakooltorwong P, Maneekunwong K, Thepsaw J, Oerther S. Effects of online mindfulness-based interventions (MBIs) on anxiety symptoms in adults: a systematic review and meta-analysis. BMC Complement Med Ther 2023; 23:269. [PMID: 37507747 PMCID: PMC10386675 DOI: 10.1186/s12906-023-04102-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 07/23/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND An increasing number of studies have documented the effectiveness on various types of face-to-face and online mindfulness-based interventions (MBIs) in reducing anxiety among general population, but there is a scarcity of systematic reviews evaluating evidence of online MBIs on anxiety in adults. Therefore, we examined the effects of online mindfulness-based interventions (MBIs) on anxiety symptoms in adults and explored the moderating effects of participant, methods, and intervention characteristics. METHODS We systematically searched nine databases through May 2022 without date restrictions. Inclusion criteria were primary studies evaluating online mindfulness-based interventions with adults with anxiety measured as an outcome, a comparison group, and written in English. We used random-effects model to compute effect sizes (ESs) using Hedges' g, a forest plot, and Q and I2 statistics as measures of heterogeneity; we also examined moderator analyses. RESULTS Twenty-six primary studies included 3,246 participants (39.9 ± 12.9 years old). Overall, online mindfulness-based interventions showed significantly improved anxiety (g = 0.35, 95%CI 0.09, 0.62, I2 = 92%) compared to controls. With regards to moderators, researchers reported higher attrition, they reported less beneficial effects on anxiety symptoms (β=-0.001, Qmodel=4.59, p = .032). No other quality indicators moderated the effects of online mindfulness-based interventions on anxiety. CONCLUSION Online mindfulness-based interventions improved anxiety symptoms in adult population. Thus, it might be used as adjunctive or alternative complementary treatment for adults. However, our findings must be interpreted with caution due to the low and unclear power of the sample in primary studies; hence, high-quality studies are needed to confirm our findings.
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Affiliation(s)
| | | | | | - Jintana Thepsaw
- School of Nursing, Mae Fah Laung University, Chiangrai, Thailand
| | - Sarah Oerther
- Trudy Busch Valentine, School of Nursing, Saint Louis University, Missouri, MO, USA
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Guarnaccia JB, Njike VY, Dutton A, Ayettey RG, Treu JA, Comerford BP, Sinha R. A pilot, randomized, placebo-controlled study of mindfulness meditation in treating insomnia in multiple sclerosis. BMC Neurol 2023; 23:263. [PMID: 37434109 PMCID: PMC10334613 DOI: 10.1186/s12883-023-03309-0] [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: 12/30/2022] [Accepted: 06/27/2023] [Indexed: 07/13/2023] Open
Abstract
OBJECTIVE Mindfulness is an established approach to reduce distress and stress reactivity by improving awareness and tolerability of thoughts and emotions. This study compares mindfulness training to sleep hygiene in persons with multiple sclerosis (PWMS) who report chronic insomnia, examining sleep efficiency (SE), self-reported sleep quality and quality of life. METHODS Fifty-three PWMS were randomized (1:1) in a single-blinded, parallel group design to ten, two-hour weekly sessions of Mindfulness Based Stress Intervention for Insomnia (MBSI-I) over a span of ten weeks or a single, one hour sleep hygiene (SH) session over one day. The primary outcome measure was SE, measured by the Fitbit™ Charge 2 wrist device, at 10 and 16 weeks from the start of study interventions. Self-report outcomes included the Pittsburg Sleep Quality Rating Scale (PSQI), Insomnia Severity Index (ISI) and the Multiple Sclerosis Quality of Life Inventory (MSQLI). Nineteen participants in the MBSI-I group and 24 in the SH group completed the primary study. Subsequently, ten participants in the original SH group participated in the 10-week MSBI-I course and their data was added to the MBSI-I cohort (eMSBI-I). RESULTS While neither SE nor the PSQI showed significant differences between MBSI-I, eMBSI-I and SH groups, ISI improved in both the MSBI-I and eMBSI-I vs SH at 10 weeks (p = 0.0014 and p = 0.0275) but not 16 weeks. However, pre and post assessments within the MBSI-I and eMBSI-I cohorts did show significant improvement in the PSQI and ISI at 10 and 16 weeks, while SH was significant in the ISI only at 16 weeks. Several quality of life measurements, including fatigue, mental health and cognitive function favored the mindfulness cohorts. CONCLUSION This pilot study demonstrates beneficial effects of MBSR on insomnia, sleep quality and quality of life in PWMS. TRIAL REGISTRATION NCT03949296. 14 May 2019.
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Affiliation(s)
- Joseph B Guarnaccia
- Multiple Sclerosis Treatment Center, Griffin Hospital, 350 Seymour Ave., Suite 1C, Derby, Connecticut, 06418, USA.
| | - Valentine Y Njike
- Yale-Griffin Prevention Research Center, Griffin Hospital, 130 Division St., Derby, Connecticut, 06418, USA
| | - Anne Dutton
- Department of Psychiatry, Yale Stress Center, Yale University, New Haven, Connecticut, 06510, USA
| | - Rockiy G Ayettey
- Yale-Griffin Prevention Research Center, Griffin Hospital, 130 Division St., Derby, Connecticut, 06418, USA
| | - Judith A Treu
- Yale-Griffin Prevention Research Center, Griffin Hospital, 130 Division St., Derby, Connecticut, 06418, USA
| | - Beth P Comerford
- Yale-Griffin Prevention Research Center, Griffin Hospital, 130 Division St., Derby, Connecticut, 06418, USA
| | - Rajita Sinha
- Department of Psychiatry, Yale Stress Center, Yale University, New Haven, Connecticut, 06510, USA
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Requier F, Demnitz-King H, Whitfield T, Klimecki O, Marchant NL, Collette F. The Effect of Meditation-Based Interventions on Patients with Fatigue Symptoms: A Systematic Review and Meta-Analysis. Psychol Belg 2023; 63:64-81. [PMID: 37358949 PMCID: PMC10289041 DOI: 10.5334/pb.1182] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 06/07/2023] [Indexed: 06/28/2023] Open
Abstract
Persistent fatigue constitutes a prevalent and debilitating symptom in several diseases. The symptom is not effectively alleviated by pharmaceutical treatments, and meditation has been proposed as a non-pharmacological intervention. Indeed, meditation has been shown to reduce inflammatory/immune problems, pain, stress, anxiety and depression which are associated with pathological fatigue. This review synthesizes data from randomized control trials (RCTs) that explored the effect of meditation-based interventions (MeBIs) on fatigue in pathological conditions. Eight databases were searched from inception to April 2020. Thirty-four RCTs met eligibility criteria and covered six conditions (68% cancer), 32 of which were included in the meta-analysis. The main analysis showed an effect in favor of MeBIs compared to control groups (g = 0.62). Separate moderator analyses assessing control group, pathological condition, and MeBI type, highlighted a significantly moderating role of the control group. Indeed, compared to actively controlled studies, studies using a passive control group were associated with a statistically significantly more beneficial impact of the MeBIs (g = 0.83). These results indicate that MeBIs alleviate pathological fatigue and it seems that the studies with a passive control group showed a greater effect of MeBI on the reduction of fatigue compared to studies using active control groups. However, the specific effect of meditation type and pathological condition should be analyzed with more studies, and there remains a need to assess meditation effects on different types of fatigue (i.e., physical and mental) and in additional conditions (e.g., post-COVID-19).
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Affiliation(s)
- Florence Requier
- GIGA-CRC In Vivo Imaging, Université de Liège, Bâtiment B30, Allée du Six Août, 8, Sart Tilman, 4000 Liège, Belgium
- Department of Psychology, Cognition and Behavior, University of Liège, Liège, Belgium
| | | | - Tim Whitfield
- Division of Psychiatry, University College London, London, UK
| | - Olga Klimecki
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
- Clinical Psychology and Behavioral Neuroscience, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | | | - Fabienne Collette
- GIGA-CRC In Vivo Imaging, Université de Liège, Bâtiment B30, Allée du Six Août, 8, Sart Tilman, 4000 Liège, Belgium
- Department of Psychology, Cognition and Behavior, University of Liège, Liège, Belgium
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Baetge SJ, Filser M, Renner A, Raithel LM, Lau S, Pöttgen J, Penner IK. Supporting brain health in multiple sclerosis: exploring the potential of neuroeducation combined with practical mindfulness exercises in the management of neuropsychological symptoms. J Neurol 2023; 270:3058-3071. [PMID: 36829045 PMCID: PMC9957687 DOI: 10.1007/s00415-023-11616-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/08/2023] [Accepted: 02/08/2023] [Indexed: 02/26/2023]
Abstract
OBJECTIVE We aimed at examining the effects of a known metacognitive training in MS (MaTiMS) and its modification with an additional neuroeducational module and mindfulness-based exercises (MaTiMS-modified) on neuropsychiatric and cognitive outcomes in people with progressive multiple sclerosis (pwpMS). Exploratively, we investigated whether the modification may show an additional benefit. METHODS Both interventions were administered in small groups of ambulatory patients. Neuropsychological testing before and after the 3- to 4-week intervention phase comprised patient reported outcomes and cognitive tests. After 3, 6 and 12 months, participants completed online surveys. Analysis of change scores (between baseline and retest) with t-tests (Mann-Whitney U and Wilcoxon tests, respectively) and mixed ANCOVAs with repeated measures for comparison of both interventions were conducted. RESULTS A total of 65 pwpMS turned to a final sample of 50 (n = 15 excluded due to drop-outs, occurrence of relapse or steroid treatment). Change scores within MaTiMS revealed no significant effect on the PDQ-20 total score and only a significant effect on the subscale retrospective memory lasting 3 months with a moderate effect size. In contrast, MaTiMS-modified revealed a highly significant change in PDQ-20 total compared to baseline and significant improvements with small to moderate effect sizes on all PDQ-20 subscales (lasting until 3 months), in self-efficacy, stress, visuo-spatial working memory (moderate effect sizes), and fatigue (small effect size). While no interaction effect between time and group could be revealed, a significant main effect for time was found in PDQ-20 total. CONCLUSION Both MaTiMS and MaTiMS-modified positively affected perceived cognitive deficits. However, our data speak in favor of additional benefits by adding neuroeducational and mindfulness-based exercises thus being valuable methods to support brain health including self-efficacy, perceived stress, and fatigue, even in patients with a chronic and progressive brain disease.
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Affiliation(s)
- Sharon Jean Baetge
- Cogito Center for Applied Neurocognition and Neuropsychological Research, Düsseldorf, Germany
- Department of Experimental Psychology, Heinrich Heine University, Düsseldorf, Germany
| | - Melanie Filser
- Cogito Center for Applied Neurocognition and Neuropsychological Research, Düsseldorf, Germany
- Department of Experimental Psychology, Heinrich Heine University, Düsseldorf, Germany
| | - Alina Renner
- Cogito Center for Applied Neurocognition and Neuropsychological Research, Düsseldorf, Germany
| | - Lina Marie Raithel
- Cogito Center for Applied Neurocognition and Neuropsychological Research, Düsseldorf, Germany
| | - Stephanie Lau
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jana Pöttgen
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Iris-Katharina Penner
- Cogito Center for Applied Neurocognition and Neuropsychological Research, Düsseldorf, Germany.
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Department of Neurology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.
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Worldwide prevalence of neuromyelitis optica spectrum disorder (NMOSD) and neuromyelitis optica (NMO): a systematic review and meta-analysis. Neurol Sci 2023; 44:1905-1915. [PMID: 36745300 DOI: 10.1007/s10072-023-06617-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/10/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) is a progressive demyelinating disease of the central nervous system that has overlapping symptoms with multiple sclerosis (MS) but differs from it in a variety of ways. Previous studies have reported conflicting results trying to estimate the number of individuals affected by them which is why we designed this systematic review and meta-analysis to estimate the worldwide prevalence and incidence of NMOSD/NMO based on current evidence. METHODS We searched PubMed, Scopus, EMBASE, Web of Science, and gray literature including references from the identified studies, review studies, and conference abstracts which were published up to February 1, 2022. We used all MeSH terms pertaining to "NMOSD," "NMO," and all the terms on "prevalence," "incidence," and "epidemiology" to identify the search components. Pooled effect sizes were measured using random-effect model by DerSimonian-Laird. RESULTS The prevalence and incidence rates of NMOSD/NMO ranged from 0.07 to 10 and 0.029 to 0.880 per 100,000 population, respectively. The overall pooled prevalence of NMO per 100,000 population was 1.54 (I2: 98.4%, 95% CI: 1.13-1.96, P< 0.001) based on the 2006 criteria, 1.51 (I2: 99.4%, 95% CI: 1.21-1.81, P < 0.001) based on the 2015 criteria and 2.16 (I2: 89.4%, 95% CI: 1.46-2.86, P < 0.001) based on the 2006/2015 criteria. The overall annual incidence of NMO per 100,000 population was 0.155 (I2: 95%, 95% CI: 0.115-0.195, P < 0.001) based on the 2006 criteria and 0.278 (I2: 100%, 95% CI: 0.135-0.420, P < 0.001) based on the 2015 criteria. The prevalence rates were highest in French West Indies and South Korea, and lowest in Cuba and Australia, based on the 2006 and 2015 criteria, respectively. Also, the highest annual incidence rates were obtained for Sweden and Slovak republic and the lowest for Cuba and Australia based on the 2006 and 2015 criteria, respectively. All estimated rates were higher among females compared to males. CONCLUSION Although rare, NMOSD/NMO impact affected individuals in devastating ways. Several large-scale prospective studies are required to reach a comprehension of the epidemiological aspects of these notorious demyelinating conditions.
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Conceptualization, use, and outcomes associated with compassion in the care of people with multiple sclerosis: a scoping review. J Neurol 2023; 270:1300-1322. [PMID: 36445508 PMCID: PMC9707147 DOI: 10.1007/s00415-022-11497-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Compassion is widely regarded as an important component of high-quality healthcare. However, its conceptualization, use, and associated outcomes in the care of people with multiple sclerosis (PwMS) have not been synthesized. The aim of this review is to scope the peer reviewed academic literature on the conceptualization, use, and outcomes associated with compassion in the care of PwMS. METHODS Studies were eligible for inclusion if reporting primary research data from quantitative, qualitative, or mixed-methods studies on the conceptualization, use, and outcomes associated with compassion in the care of PwMS. Relevant studies were identified through searching five electronic databases (CINAHL, Cochrane Library, EMBASE, MEDLINE, and PsycINFO) in January 2022. We followed the guidance outlined in the Joanna Briggs Institute (JBI) manual for evidence synthesis, and also referred to the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews Checklist (PRISMA-ScR). Simple descriptive methods were used to chart quantitative findings, and a descriptive approach with basic content analysis was employed to describe qualitative findings. RESULTS Fifteen studies were included (participant n = 1722): eight quantitative, six mixed-methods, one exclusively qualitative. Synthesized qualitative data revealed that PwMS conceptualize compassion as involving self-kindness, agency, and acceptance. PwMS report using self-compassion in response to unpleasant sensations and experiences. Quantitative findings suggest that compassion may mediate benefit finding, reduced distress, and improved quality of life (QoL) in PwMS, that those with the condition may become more compassionate through time, and that self-compassion specifically can be increased through training in mindfulness. In this context, greater self-compassion in PwMS correlates with less depression and fatigue, better resilience and QoL. Among studies, self-compassion was the most common outcome measure for PwMS. CONCLUSIONS A nascent literature exists on the conceptualization, use, and outcomes associated with compassion in the care of PwMS. Further research is required to better understand what compassion means to PwMS and those caring for them. However, self-compassion can be cultivated among PwMS and may be helpful for managing unpleasant somatic symptoms and in benefit finding. Impact on other health outcomes is less clear. The use of compassion by health care providers in the care of PwMS is unstudied.
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A systematic review and meta-analysis exploring the efficacy of mindfulness-based interventions on quality of life in people with multiple sclerosis. J Neurol 2023; 270:726-745. [PMID: 36348069 PMCID: PMC9643979 DOI: 10.1007/s00415-022-11451-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Quality of life (QoL) is commonly impaired among people with multiple sclerosis (PwMS). The aim of this study was to evaluate via meta-analysis the efficacy of Mindfulness-based interventions (MBIs) for improving QoL in PwMS. METHODS Eligible randomized controlled trials (RCTs) were identified via searching six major electronic databases (MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, AMED, and PsycINFO) in April 2022. The primary outcome was QoL. Study quality was determined using the Cochrane Collaboration risk of bias tool. Meta-analysis using a random effects model was undertaken. Effect sizes are reported as Standardized Mean Difference (SMD). Prospero ID: 139835. RESULTS From a total of 1312 individual studies, 14 RCTs were eligible for inclusion in the meta-analysis, total participant n = 937. Most studies included PwMS who remained ambulatory. Cognitively impaired PwMS were largely excluded. Comorbidities were inconsistently reported. Most MBIs were delivered face-to face in group format, but five were online. Eight studies (n = 8) measured MS-specific QoL. In meta-analysis, overall effect size (SMD) for any QoL measure (n = 14) was 0.40 (0.18-0.61), p = 0.0003, I2 = 52%. SMD for MS-specific QoL measures (n = 8) was 0.39 (0.21-0.57), p < 0.0001, I2 = 0%. MBI effect was largest on subscale measures of mental QoL (n = 8), SMD 0.70 (0.33-1.06), p = 0.0002, I2 = 63%. Adverse events were infrequently reported. CONCLUSIONS MBIs effectively improve QoL in PwMS. The greatest benefits are on mental health-related QoL. However, more research is needed to characterize optimal formatting, mechanisms of action, and effects in PwMS with more diverse social, educational, and clinical backgrounds.
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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.
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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
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Montañés‐Masias B, Bort‐Roig J, Pascual JC, Soler J, Briones‐Buixassa L. Online psychological interventions to improve symptoms in multiple sclerosis: A systematic review: Online psychological interventions in Multiple Sclerosis. Acta Neurol Scand 2022; 146:448-464. [PMID: 36121184 PMCID: PMC9825977 DOI: 10.1111/ane.13709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/22/2022] [Indexed: 01/11/2023]
Abstract
The aim of this systematic review was to assess the effectiveness of Internet-based psychological interventions in the treatment of physical, socio-affective and cognitive symptoms and quality of life (QoL) in people with multiple sclerosis (pwMS) to provide currently available evidence. Systematic searches for eligible studies were carried out in four databases (August 2021) using key words. Studies were screened, data extracted, quality appraised and analysed by three independent reviewers, using predefined criteria and following the PRISMA rules. Study quality was assessed using Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields QUALSYST tool. Physical, socio-affective and cognitive symptoms and QoL were the primary outcomes. Thirteen studies were included. Two principal approaches were reported: Cognitive behavioural therapy (CBT) and mindfulness-based interventions (MBI). Interventions varied from tailored versions to videoconference by a clinician, duration mean 8 weeks, delivered via individually and groups, all online. The review found that iCBT interventions were effective for improve depression, anxiety, fatigue and QoL, and slightly in cognitive functioning in pwMS, whereas MBI interventions reported benefits in depression, anxiety, stress and QoL, and less evidence in fatigue. Generally, study quality was acceptable in most studies; eleven of the studies scored a low risk of bias on all items in the Qualsyst Tool, whereas only two studies were considered unacceptable. Psychological online interventions may improve physical, socio-affective and cognitive symptoms as well as QoL in pwMS, overcoming the face-to-face barriers (i.e. disability). Contact with the therapist and groups sessions have been identified as enablers of the online interventions. Nevertheless, the limited number of studies and the heterogeneity of health outcomes reported made difficult to afford robust conclusions on psychological intervention effects in pwMS.
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Affiliation(s)
- Brenda Montañés‐Masias
- Research group in Mental Health and Social Innovation (SaMIS), Centre for Health and Social Care ResearchUniversitat de Vic – Universitat Central de CatalunyaVicCataloniaSpain
| | - Judit Bort‐Roig
- Sport and Physical Activity Research Group, Centre for Health and Social Care ResearchUniversitat de Vic – Universitat Central de CatalunyaVicCataloniaSpain
| | - Juan Carlos Pascual
- Department of PsychiatryHospital de la Santa Creu i Sant PauBarcelonaSpain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)Institut de Recerca Biomèdica Sant Pau (IIB‐Sant Pau)BarcelonaSpain,Department of Psychiatry and Forensic Medicine & Institute of NeurosciencesUniversitat Autònoma de BarcelonaBellaterraSpain
| | - Joaquim Soler
- Department of PsychiatryHospital de la Santa Creu i Sant PauBarcelonaSpain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)Institut de Recerca Biomèdica Sant Pau (IIB‐Sant Pau)BarcelonaSpain,Department of Psychiatry and Forensic Medicine & Institute of NeurosciencesUniversitat Autònoma de BarcelonaBellaterraSpain
| | - Laia Briones‐Buixassa
- Research group in Mental Health and Social Innovation (SaMIS), Centre for Health and Social Care ResearchUniversitat de Vic – Universitat Central de CatalunyaVicCataloniaSpain
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Cunningham R, Uyeshiro Simon A, Preissner K. Occupational Therapy Practice Guidelines for Adults With Multiple Sclerosis. Am J Occup Ther 2022; 76:23955. [PMID: 36178780 DOI: 10.5014/ajot.2022.050088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Occupational therapy practitioners play an important role in addressing the occupational performance and participation needs of adults with multiple sclerosis (MS) and their caregivers. OBJECTIVE This Practice Guideline aims to help occupational therapy practitioners, as well as the people who manage, reimburse, or set policy regarding occupational therapy services, understand occupational therapy's role in providing services to adults with MS and their caregivers. This guideline can also serve as a reference for health care professionals, health care managers, educators, regulators, third-party payers, managed care organizations, and researchers. METHOD We examined, synthesized, and integrated the results of four systematic reviews into clinical recommendations. Three systematic reviews specified occupational domains as outcomes of interest, and one focused on interventions for caregivers of people with MS. RESULTS Twenty-one articles from the systematic reviews with strong or moderate strength of evidence served as the basis for the clinical recommendations. CONCLUSIONS AND RECOMMENDATIONS Four interventions benefited participation in the domains of activities of daily living or sleep. Two interventions improved participation in the domain of instrumental activities of daily living. One intervention improved work participation. Two interventions benefited caregivers and the quality of the relationship between the caregiver and person with MS. Other potentially appropriate interventions or areas to address on the basis of existing or emerging evidence are discussed in the Limitations: Gaps in the Evidence and Conclusions sections. What This Article Adds: This Practice Guideline provides a summary and application of the current evidence supporting occupational therapy intervention for adults with MS. It includes case examples and decision-making algorithms to support occupational therapy practitioners in addressing client goals.
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Affiliation(s)
- Rebecca Cunningham
- Rebecca Cunningham, OTD, OTR/L, MSCS, is Assistant Professor of Clinical Occupational Therapy, USC Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles;
| | - Ashley Uyeshiro Simon
- Ashley Uyeshiro Simon, OTD, OTR/L, MSCS, is Associate Professor of Clinical Occupational Therapy, USC Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles
| | - Katharine Preissner
- Katharine Preissner, EdD, OTR/L, FAOTA, is Clinical Professor and Occupational Therapy Capstone Coordinator, Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois Chicago
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Liu C, Chen H, Zhou F, Chiang CH, Chen YL, Wu K, Huang DH, Liu CY, Chiou WK. Effects of animated pedagogical agent-guided loving-kindness meditation on flight attendants’ spirituality, mindfulness, subjective wellbeing, and social presence. Front Psychol 2022; 13:894220. [PMID: 35992420 PMCID: PMC9382197 DOI: 10.3389/fpsyg.2022.894220] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/06/2022] [Indexed: 11/13/2022] Open
Abstract
Loving-kindness meditation (LKM) was first practiced by Buddhists and then developed by clinical psychologist. Previous studies on LKM have mainly focused on the impact of real person-guided meditation on depression, anxiety, and other negative psychology. During the COVID-19 pandemic, this study explored the effect and mechanism of media-guided LKM on the improvement of social presence, mindfulness, spirituality, and subjective wellbeing (SWB). From the viewpoint of positive psychology, this study compared the different media effects of animated pedagogical agent (APA)-guided LKM and audio-guided LKM. A total of 82 flight attendants were recruited from airlines; then, they were randomly assigned to two groups: APA group (41 participants) and audio group (41 participants), which both underwent an 8-week LKM training intervention. The aforementioned four main variables were measured pre and post the meditation experiment. The results indicated that both APA-guided meditation and audio-guided meditation significantly improved subjects’ spirituality and SWB. Compared with audio-guided meditation, APA-guided meditation significantly improved the subjects’ spirituality, SWB, and social presence. Audio-guided meditation has no significant effect on social presence. This study highlights APA-guided meditation has a positive effect on spirituality, SWB, and social presence, which may provide individuals with a simple and easy method to improve their mental health.
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Affiliation(s)
- Chao Liu
- School of Journalism and Communication, Huaqiao University, Xiamen, China
- Business Analytics Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Hao Chen
- Business Analytics Research Center, Chang Gung University, Taoyuan, Taiwan
- School of Film Television and Communication, Xiamen University of Technology, Xiamen, China
| | - Fang Zhou
- Department of Economic and Management, Suzhou Vocational Institute of Industrial Technology, Suzhou, China
| | - Chao-Hung Chiang
- Department of Shipping and Transportation Management, National Penghu University of Science and Technology, Magong, Taiwan
| | - Yi-Lang Chen
- Department of Industrial Engineering and Management, Ming Chi University of Technology, New Taipei, Taiwan
| | - Kan Wu
- Business Analytics Research Center, Chang Gung University, Taoyuan, Taiwan
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ding-Hau Huang
- Institute of Creative Design and Management, National Taipei University of Business, Taoyuan, Taiwan
| | - Chia-Yih Liu
- Department of Psychiatry, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wen-Ko Chiou
- Department of Industrial Engineering and Management, Ming Chi University of Technology, New Taipei, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Industrial Design, Chang Gung University, Taoyuan, Taiwan
- *Correspondence: Wen-Ko Chiou,
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15
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Zarotti N, Eccles F, Broyd A, Longinotti C, Mobley A, Simpson J. Third wave cognitive behavioural therapies for people with multiple sclerosis: a scoping review. Disabil Rehabil 2022; 45:1720-1735. [PMID: 35514235 DOI: 10.1080/09638288.2022.2069292] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Multiple sclerosis (MS) is a chronic condition linked to a wide range of psychological difficulties. While traditional cognitive behavioural therapy has been studied extensively with people with MS, much less is known about more recent "third wave" approaches. METHODS A scoping review was carried out by performing a systematic search across MEDLINE Complete, PsycINFO, CINAHL, Academic Search Ultimate, and Cochrane Library up to January 2022. RESULTS From an initial return of 8306 citations, 35 studies were included, 20 of which were randomised controlled trials (RCTs). These showed that four third wave approaches have been investigated with people with MS to date: acceptance and commitment therapy (ACT), dialectical behaviour therapy (DBT), mindfulness-based stress reduction (MBSR), and mindfulness-based cognitive therapy (MBCT). MBSR and MBCT may be helpful to address a range of psychological difficulties up to three months post-intervention. However, MS-specific adaptations may be required, and more evidence is needed on longer-term effectiveness. Limited evidence is also available for DBT and ACT, but additional research is warranted before any recommendation can be made. CONCLUSIONS As third wave approaches keep being refined, further more rigorous investigations are needed to implement them to the benefit of people with MS. Implications for RehabilitationMultiple sclerosis is linked to a wide range of psychological difficulties in adults.Little is currently known on third wave psychotherapies for people with MS.Mindfulness-based stress reduction and mindfulness-based cognitive therapy may be helpful to address a wide range of difficulties in MS.Specific adaptations may be needed to deliver suitable therapies to people with MS.Additional research is warranted to build on preliminary findings for DBT and ACT.
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Affiliation(s)
- Nicolò Zarotti
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Fiona Eccles
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Annabel Broyd
- University College London Hospitals NHS Trust, London, UK
| | | | - Amanda Mobley
- Worcestershire Health and Care NHS Trust, Worcester, UK
| | - Jane Simpson
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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16
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Arji G, Rezaeizadeh H, Moghadasi AN, Sahraian MA, Karimi M, Alizadeh M. Complementary and alternative therapies in multiple sclerosis: a systematic literature classification and analysis. Acta Neurol Belg 2022; 122:281-303. [PMID: 35060096 DOI: 10.1007/s13760-021-01847-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 12/06/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND AIM Multiple Sclerosis (MS) is a disease determined by inflammatory demyelination and neurodegeneration in the Central Nervous System (CNS). Despite the extensive utilization of Complementary and Alternative Medicine (CAM) in MS, there is a need to have comprehensive evidence regarding their application in the management of MS symptoms. This manuscript is a Systematic Literature Review and classification (SLR) of CAM therapies for the management of MS symptoms based on the International Classification of Functioning Disability and Health (ICF) model. METHOD Studies published between 1990 and 2020 IN PubMed, Science Direct, Scopus, Pro-Quest, and Google Scholar using CAM therapies for the management of MS symptoms were analyzed. RESULTS Thirty-one papers on the subject were analyzed and classified. The findings of this review clearly show that mindfulness, yoga, and reflexology were frequently used for managing MS symptoms. Moreover, most of the papers used mindfulness and yoga as a CAM therapy for the management of MS symptoms, which mostly devoted to mental functions such as fatigue, depression, cognition, neuromuscular functions such as gait, muscle strength, and spasticity, and sensory function such as balance, in addition to, reflexology is vastly used to management of mental functions of MS patients. CONCLUSION Evidence suggested that CAM therapies in patients with MS have the potential to target and enhancement numerous elements outlined in the ICF model. Although the use of CAM therapies in MS symptom management is promising, there is a need for strict clinical trials. Future research direction should concentrate on methodologically powerful studies to find out the potential efficacy of CAM intervention.
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Affiliation(s)
- Goli Arji
- School of Nursing and Midwifery, Health Information Technology Department, Saveh University of Medical Sciences, Saveh, Iran
| | - Hossein Rezaeizadeh
- Department of Persian Medicine, Tehran University of Medical Science, Tehran, Iran
| | - Abdolrreza Naser Moghadasi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sahraian
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Karimi
- Department of Persian Medicine, Tehran University of Medical Science, Tehran, Iran
| | - Mojtaba Alizadeh
- Department of Computer Engineering, Lorestan University, Khorramabad, Iran.
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17
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Bevens W, Weiland T, Gray K, Jelinek G, Neate S, Simpson-Yap S. Attrition Within Digital Health Interventions for People With Multiple Sclerosis: Systematic Review and Meta-analysis. J Med Internet Res 2022; 24:e27735. [PMID: 35138262 PMCID: PMC8867299 DOI: 10.2196/27735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/06/2021] [Accepted: 10/14/2021] [Indexed: 01/09/2023] Open
Abstract
Background Digital health interventions have revolutionized multiple sclerosis (MS) care by supporting people with MS to better self-manage their disease. It is now understood that the technological elements that comprise this category of digital health interventions can influence participant engagement in self-management programs, and people with MS can experience significant barriers, influenced by these elements, to remaining engaged during a period of learning. It is essential to explore the influence of technological elements in mitigating attrition. Objective This study aimed to examine the study design and technological elements of documented digital health interventions targeted at people with MS—digital health interventions that were intended to support a program of engagement over a defined period—and to explore how these correlated with attrition among participants of randomized controlled trials (RCTs). Methods We conducted a systematic review and meta-analysis of RCTs (n=32) describing digital health self-management interventions for people with MS. We analyzed attrition in included studies, using a random-effects model and meta-regression to measure the association between potential moderators. Results There were no measured differences in attrition between the intervention and control arms; however, some of the heterogeneity observed was explained by the composite technological element score. The pooled attrition rates for the intervention and control arms were 14.7% and 15.6%, respectively. Conclusions This paper provides insight into the technological composition of digital health interventions designed for people with MS and describes the degree of attrition in both study arms. This paper will aid in the design of future studies in this area, particularly for digital health interventions of this type.
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Affiliation(s)
- William Bevens
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Carlton, Australia
| | - Tracey Weiland
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Carlton, Australia
| | - Kathleen Gray
- Centre for Digital Transformation of Health, The University of Melbourne, Carlton, Australia
| | - George Jelinek
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Carlton, Australia
| | - Sandra Neate
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Carlton, Australia
| | - Steve Simpson-Yap
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Carlton, Australia
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18
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Sesel AL, Sharpe L, Beadnall HN, Barnett MH, Szabo M, Naismith SL. A randomized controlled trial of a web-based mindfulness programme for people with MS with and without a history of recurrent depression. Mult Scler 2022; 28:1392-1401. [PMID: 35130768 DOI: 10.1177/13524585211068002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Evidence shows small positive effects associated with psychological treatments for people with multiple sclerosis (PwMS). In a recent meta-analysis, the treatment with the largest effect size was a mindfulness-based intervention (MBI). OBJECTIVES We aimed to determine whether an Internet-delivered MBI was beneficial for PwMS. Furthermore, we aimed to investigate history of recurrent depression as a moderator of treatment outcome. METHODS Participants (N = 132) were assessed based on whether they had a history of recurrent depression, then stratified and randomized to MBI or waitlist. Outcomes were assessed at baseline, post-intervention, and 3 and 6 months. RESULTS The MBI group reported significantly improved depressive symptoms (primary outcome) compared with the waitlist (p = 0.046, Cohen's d = 0.39). Those with a history of recurrent depression benefitted significantly more than those without (p = 0.034, d = 0.66). There were benefits for health-related quality of life (HRQoL) in the MBI, irrespective of depression history (p = 0.009, d = 0.5). Pain interference was less overall in the MBI group (p < 0.001, d = 0.2), but change over time did not differ from waitlist. There were no treatment effects for anxiety, pain severity or fatigue. CONCLUSION The Internet-delivered MBI significantly improved depressive symptoms and HRQoL in PwMS. For depression, the benefits were greater for those with a history of recurrent depression. TRIAL REGISTRATION ACTRN12618001260213, available at: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375598.
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Affiliation(s)
- Amy-Lee Sesel
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Louise Sharpe
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Heidi N Beadnall
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia/Neurology Department, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Michael H Barnett
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia/Neurology Department, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Marianna Szabo
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Sharon L Naismith
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
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Kim DY, Hong SH, Jang SH, Park SH, Noh JH, Seok JM, Jo HJ, Son CG, Lee EJ. Systematic Review for the Medical Applications of Meditation in Randomized Controlled Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031244. [PMID: 35162267 PMCID: PMC8834867 DOI: 10.3390/ijerph19031244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/04/2022] [Accepted: 01/21/2022] [Indexed: 11/23/2022]
Abstract
Background: Meditation has been increasingly adapted for healthy populations and participants with diseases. Its beneficial effects are still challenging to determine due to the heterogeneity and methodological obstacles regarding medical applications. This study aimed to integrate the features of therapeutic meditation in randomized controlled trials (RCTs). Methods: We conducted a systematic review of RCTs with meditation for populations with diseases using the PubMed database through June 2021. We analyzed the characteristics of the diseases/disorders, participants, measurements, and their overall benefits. Results: Among a total of 4855 references, 104 RCTs were determined and mainly applied mindfulness-based (51 RCTs), yoga-based (32 RCTs), and transcendental meditation (14 RCTs) to 10,139 patient-participants. These RCTs were conducted for participants with a total of 45 kinds of disorders; the most frequent being cancer, followed by musculoskeletal and connective tissue diseases and affective mood disorder. Seven symptoms or signs were frequently assessed: depressive mood, feeling anxious, quality of life, stress, sleep, pain, and fatigue. The RCTs showed a higher ratio of positive outcomes for sleep (73.9%) and fatigue (68.4%). Conclusions: This systematic review produced the comprehensive features of RCTs for therapeutic meditation. These results will help physicians and researchers further study clinical adaptations in the future as reference data.
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Affiliation(s)
- Do-Young Kim
- Korean Medical College, Daejeon University, 62, Daehak-ro, Dong-gu, Daejeon 34520, Korea; (D.-Y.K.); (S.-H.H.); (S.-H.J.); (S.-H.P.); (J.-H.N.); (J.-M.S.); (H.-J.J.)
| | - Soo-Hwa Hong
- Korean Medical College, Daejeon University, 62, Daehak-ro, Dong-gu, Daejeon 34520, Korea; (D.-Y.K.); (S.-H.H.); (S.-H.J.); (S.-H.P.); (J.-H.N.); (J.-M.S.); (H.-J.J.)
| | - Seung-Hyeon Jang
- Korean Medical College, Daejeon University, 62, Daehak-ro, Dong-gu, Daejeon 34520, Korea; (D.-Y.K.); (S.-H.H.); (S.-H.J.); (S.-H.P.); (J.-H.N.); (J.-M.S.); (H.-J.J.)
| | - So-Hyeon Park
- Korean Medical College, Daejeon University, 62, Daehak-ro, Dong-gu, Daejeon 34520, Korea; (D.-Y.K.); (S.-H.H.); (S.-H.J.); (S.-H.P.); (J.-H.N.); (J.-M.S.); (H.-J.J.)
| | - Jung-Hee Noh
- Korean Medical College, Daejeon University, 62, Daehak-ro, Dong-gu, Daejeon 34520, Korea; (D.-Y.K.); (S.-H.H.); (S.-H.J.); (S.-H.P.); (J.-H.N.); (J.-M.S.); (H.-J.J.)
| | - Jung-Mi Seok
- Korean Medical College, Daejeon University, 62, Daehak-ro, Dong-gu, Daejeon 34520, Korea; (D.-Y.K.); (S.-H.H.); (S.-H.J.); (S.-H.P.); (J.-H.N.); (J.-M.S.); (H.-J.J.)
| | - Hyun-Jeong Jo
- Korean Medical College, Daejeon University, 62, Daehak-ro, Dong-gu, Daejeon 34520, Korea; (D.-Y.K.); (S.-H.H.); (S.-H.J.); (S.-H.P.); (J.-H.N.); (J.-M.S.); (H.-J.J.)
| | - Chang-Gue Son
- Department of Liver and Immunology Research Center, Daejeon Oriental Hospital of Daejeon University, 75, Daedeok-daero 176, Seo-gu, Daejeon 35235, Korea
- Correspondence: (C.-G.S.); (E.-J.L.)
| | - Eun-Jung Lee
- Department of Korean Rehabilitation Medicine, Daejeon Oriental Hospital of Daejeon University, 75, Daedeok-daero 176, Seo-gu, Daejeon 35235, Korea
- Correspondence: (C.-G.S.); (E.-J.L.)
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More than Just a Brain Disorder: A Five-Point Manifesto for Psychological Care for People with Huntington’s Disease. J Pers Med 2022; 12:jpm12010064. [PMID: 35055379 PMCID: PMC8780585 DOI: 10.3390/jpm12010064] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 12/18/2022] Open
Abstract
Huntington’s disease (HD) is a rare and complex condition where affected individuals, family members, caregivers, and clinicians face a number of both long-term and fluctuating challenges. The predominant biomedical framework adopted in HD to date has traditionally viewed it as a brain disorder first and foremost. As a consequence, one of the most challenging aspects of the condition—psychological difficulties and their care—is often not given the emphasis it deserves in everyday clinical practice. Here, we propose a manifesto outlining five points to address the quality, effectiveness, availability, and accessibility of psychological care in HD. These include (1) Listening to People with HD, (2) Reformulating Difficulties Psychologically, (3) Exploring New Interventions, (4) Increasing Psychological Provision, and (5) Learning from Other Conditions. As the search for a cure continues, we hope that this manifesto will create a new impetus towards refining the current approach to psychological difficulties in HD and ultimately improve the quality of life of the tens of thousands of families affected by HD worldwide.
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21
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Currie CL, Larouche R, Voss ML, Trottier M, Spiwak R, Higa E, Scott D, Tallow T. Effectiveness of live health professional-led group eHealth interventions for adult mental health: A systematic review of randomized controlled trials. J Med Internet Res 2021; 24:e27939. [PMID: 34878409 PMCID: PMC8790691 DOI: 10.2196/27939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 11/03/2021] [Accepted: 12/03/2021] [Indexed: 11/29/2022] Open
Abstract
Background The COVID-19 pandemic has had adverse impacts on mental health and substance use worldwide. Systematic reviews suggest eHealth interventions can be effective at addressing these problems. However, strong positive eHealth outcomes are often tied to the intensity of web-based therapist guidance, which has time and cost implications that can make the population scale-up of more effective interventions difficult. A way to offset cost while maintaining the intensity of therapist guidance is to offer eHealth programs to groups rather than more standard one-on-one formats. Objective This systematic review aims to assess experimental evidence for the effectiveness of live health professional–led group eHealth interventions on mental health, substance use, or bereavement among community-dwelling adults. Within the articles selected for our primary aim, we also seek to examine the impact of interventions that encourage physical activity compared with those that do not. Methods Overall, 4 databases (MEDLINE, CINAHL, PsycINFO, and the Cochrane Library) were searched in July 2020. Eligible studies were randomized controlled trials (RCTs) of eHealth interventions led by health professionals and delivered entirely to adult groups by videoconference, teleconference, or webchat. Eligible studies reported mental health, substance use, or bereavement as primary outcomes. The results were examined by outcome, eHealth platform, and intervention length. Postintervention data were used to calculate effect size by study. The findings were summarized using the Synthesis Without Meta-Analysis guidelines. Risk of bias was assessed using the Cochrane Collaboration Tool. Results Of the 4099 identified studies, 21 (0.51%) RCTs representing 20 interventions met the inclusion criteria. These studies examined mental health outcomes among 2438 participants (sample size range: 47-361 participants per study) across 7 countries. When effect sizes were pooled, live health professional–led group eHealth interventions had a medium effect on reducing anxiety compared with inactive (Cohen d=0.57) or active control (Cohen d=0.48), a medium to small effect on reducing depression compared with inactive (Cohen d=0.61) or active control (Cohen d=0.21), and mixed effects on mental distress and coping. Interventions led by videoconference, and those that provided 8-12 hours of live health professional–led group contact had more robust effects on adult mental health. Risk of bias was high in 91% (19/21) of the studies. Heterogeneity across interventions was significant, resulting in low to very low quality of evidence. No eligible RCT was found that examined substance use, bereavement, or physical activity. Conclusions Live eHealth group interventions led by health professionals can foster moderate improvements in anxiety and moderate to small improvements in depression among community-based adults, particularly those delivered by videoconference and those providing 8-12 hours of synchronous engagement. Trial Registration PROSPERO CRD42020187551; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=187551 International Registered Report Identifier (IRRID) RR2-10.1186/s13643-020-01479-3
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Affiliation(s)
- Cheryl L Currie
- Faculty of Health Sciences, University of Lethbridge, 4401 University Drive, Lethbridge, CA
| | - Richard Larouche
- Faculty of Health Sciences, University of Lethbridge, 4401 University Drive, Lethbridge, CA
| | - M Lauren Voss
- Faculty of Health Sciences, University of Lethbridge, 4401 University Drive, Lethbridge, CA
| | - Maegan Trottier
- Faculty of Health Sciences, University of Lethbridge, 4401 University Drive, Lethbridge, CA
| | - Rae Spiwak
- Max Rady College of Medicine, University of Manitoba, Winnipeg, CA
| | - Erin Higa
- Faculty of Health Sciences, University of Lethbridge, 4401 University Drive, Lethbridge, CA
| | - David Scott
- Library Services, University of Lethbridge, Lethbridge, CA
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22
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Sauder T, Hansen S, Bauswein C, Müller R, Jaruszowic S, Keune J, Schenk T, Oschmann P, Keune PM. Mindfulness training during brief periods of hospitalization in multiple sclerosis (MS): beneficial alterations in fatigue and the mediating role of depression. BMC Neurol 2021; 21:390. [PMID: 34625058 PMCID: PMC8499486 DOI: 10.1186/s12883-021-02390-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/31/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Persons with MS (PwMS) are frequently affected by fatigue and depression. Mindfulness-based interventions may reduce these symptoms in PwMS and consequently their application has been extended to various settings. Only few efforts have been made to explore effects of short-term mindfulness training during brief periods of hospitalization. In the current study, the feasibility and potential effects of short-term mindfulness training on depression, fatigue, rumination and cognition were explored in PwMS in an acute-care hospital setting. Based on previous work, it was further examined whether the relation between trait mindfulness and fatigue prior to and following the intervention was mediated by depression and whether a mediation effect was also observable throughout the intervention. METHODS A short-term mindfulness training protocol was developed, tailored to the requirements of the acute-care setting. Subsequently, 30 PwMS were recruited sequentially and received mindfulness training during the routine clinical process (median duration in hospital: eight days, number of sessions: four). Participants completed relevant self-report measures (depression, fatigue, rumination) and a neuropsychological assessment before and after training. RESULTS Participants reported significantly increased trait mindfulness and decreased depression and fatigue following the intervention. Respective change scores were highly correlated so that increased trait mindfulness was associated with decreased symptoms. In the rumination domain, patients reported a tendency for an increased adaptive ability to engage in distractive behavior during arising negative mood. Other measures of trait rumination and cognition remained relatively stable. Results of the mediation analyses indicated that depression mediated the negative relationship between trait mindfulness and fatigue symptoms at pre and post assessments. With regards to the change scores, an association between mindfulness and cognitive fatigue ceased to be significant when depression was controlled, albeit in this case, the mediation effect did not reach significance. CONCLUSION Results of the current study indicate that short-term mindfulness training during brief periods of hospitalization may be beneficial for PwMS. They further complement previous work by identifying depression as a potential mediator of the antagonistic relationship between mindfulness and fatigue. Based on the current exploratory study, future trials are warranted to address this mechanism of mindfulness training in more detail.
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Affiliation(s)
- Torsten Sauder
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany.,Department of Psychology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Sascha Hansen
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany.,Department of Physiological Psychology, Otto-Friedrich-University of Bamberg, Bamberg, Germany
| | - Carina Bauswein
- Department of Physiological Psychology, Otto-Friedrich-University of Bamberg, Bamberg, Germany
| | - Roy Müller
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany
| | - Sonja Jaruszowic
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany.,Department of Physiological Psychology, Otto-Friedrich-University of Bamberg, Bamberg, Germany
| | - Jana Keune
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany
| | - Thomas Schenk
- Department of Psychology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Patrick Oschmann
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany
| | - Philipp M Keune
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany. .,Department of Physiological Psychology, Otto-Friedrich-University of Bamberg, Bamberg, Germany.
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23
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Harrison AM, Safari R, Mercer T, Picariello F, van der Linden ML, White C, Moss-Morris R, Norton S. Which exercise and behavioural interventions show most promise for treating fatigue in multiple sclerosis? A network meta-analysis. Mult Scler 2021; 27:1657-1678. [PMID: 33876986 PMCID: PMC8474304 DOI: 10.1177/1352458521996002] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/19/2021] [Accepted: 01/29/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Fatigue is a common, debilitating symptom of multiple sclerosis (MS) without a current standardised treatment. OBJECTIVE The aim of this systematic review with network meta-analyses was to estimate the relative effectiveness of both fatigue-targeted and non-targeted exercise, behavioural and combined (behavioural and exercise) interventions. METHODS Nine electronic databases up to August 2018 were searched, and 113 trials (n = 6909) were included: 34 were fatigue-targeted and 79 non-fatigue-targeted trials. Intervention characteristics were extracted using the Template for Intervention Description and Replication guidelines. Certainty of evidence was assessed using GRADE. RESULTS Pairwise meta-analyses showed that exercise interventions demonstrated moderate to large effects across subtypes regardless of treatment target, with the largest effect for balance exercise (SMD = 0.84). Cognitive behavioural therapies (CBTs) showed moderate to large effects (SMD = 0.60), with fatigue-targeted treatments showing larger effects than those targeting distress. Network meta-analysis showed that balance exercise performed significantly better compared to other exercise and behavioural intervention subtypes, except CBT. CBT was estimated to be superior to energy conservation and other behavioural interventions. Combined exercise also had a moderate to large effect. CONCLUSION Treatment recommendations for balance and combined exercise are tentative as the certainty of the evidence was moderate. The certainty of the evidence for CBT was high.
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Affiliation(s)
- Anthony M Harrison
- Department of Clinical and Health Psychology,
Leeds Teaching Hospitals National Health Service Trust, Leeds, UK
| | - Reza Safari
- Health and Social Care Research Centre, College
of Health, Psychology and Social Care, University of Derby, Derby, UK
| | - Tom Mercer
- Centre for Health, Activity and Rehabilitation
Research, Queen Margaret University, Edinburgh, UK
| | - Federica Picariello
- Health Psychology Section, Institute of
Psychiatry, Psychology and Neuroscience, King’s College London, London,
UK
| | | | - Claire White
- School of Population Health & Environmental
Sciences, Faculty of Life Sciences & Medicine, King’s College London,
London, UK
| | - Rona Moss-Morris
- Health Psychology Section, Institute of
Psychiatry, Psychology and Neuroscience, King’s College London, London,
UK
| | - Sam Norton
- Health Psychology Section, Institute of
Psychiatry, Psychology and Neuroscience, King’s College London, London,
UK
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24
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Paradisi P, Raglianti M, Sebastiani L. Online Communication and Body Language. Front Behav Neurosci 2021; 15:709365. [PMID: 34557076 PMCID: PMC8452979 DOI: 10.3389/fnbeh.2021.709365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/09/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Paolo Paradisi
- Istituto di Scienza e Tecnologie Dell'Informazione "A. Faedo" (ISTI-CNR), Pisa, Italy.,BCAM-Basque Center for Applied Mathematics, Bilbao, Spain
| | - Marina Raglianti
- Departamento de Educación de la Facultad de Educación y Humanidades, Universidad de Tarapacá, Arica, Chile
| | - Laura Sebastiani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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25
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Bonnechère B, Rintala A, Spooren A, Lamers I, Feys P. Is mHealth a Useful Tool for Self-Assessment and Rehabilitation of People with Multiple Sclerosis? A Systematic Review. Brain Sci 2021; 11:brainsci11091187. [PMID: 34573208 PMCID: PMC8466296 DOI: 10.3390/brainsci11091187] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/30/2021] [Accepted: 09/02/2021] [Indexed: 12/19/2022] Open
Abstract
The development of mobile technology and mobile Internet offers new possibilities in rehabilitation and clinical assessment in a longitudinal perspective for multiple sclerosis management. However, because the mobile health applications (mHealth) have only been developed recently, the level of evidence supporting the use of mHealth in people with multiple sclerosis (pwMS) is currently unclear. Therefore, this review aims to list and describe the different mHealth available for rehabilitation and self-assessment of pwMS and to define the level of evidence supporting these interventions for functioning problems categorized within the International Classification of Functioning, Disability and Health (ICF). In total, 36 studies, performed with 22 different mHealth, were included in this review, 30 about rehabilitation and six for self-assessment, representing 3091 patients. For rehabilitation, most of the studies were focusing on cognitive function and fatigue. Concerning the efficacy, we found a small but significant effect of the use of mHealth for cognitive training (Standardized Mean Difference (SMD) = 0.28 [0.12; 0.45]) and moderate effect for fatigue (SMD = 0.61 [0.47; 0.76]). mHealth is a promising tool in pwMS but more studies are needed to validate these solutions in the other ICF categories. More replications studies are also needed as most of the mHealth have only been assessed in one single study.
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Affiliation(s)
- Bruno Bonnechère
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, B-3590 Diepenbeek, Belgium; (A.S.); (I.L.); (P.F.)
- Correspondence:
| | - Aki Rintala
- Faculty of Social Services and Health Care, LAB University of Applied Sciences, FI-15210 Lahti, Finland;
| | - Annemie Spooren
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, B-3590 Diepenbeek, Belgium; (A.S.); (I.L.); (P.F.)
| | - Ilse Lamers
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, B-3590 Diepenbeek, Belgium; (A.S.); (I.L.); (P.F.)
- University MS Center Hasselt-Pelt, B-3500 Hasselt, Belgium
| | - Peter Feys
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, B-3590 Diepenbeek, Belgium; (A.S.); (I.L.); (P.F.)
- University MS Center Hasselt-Pelt, B-3500 Hasselt, Belgium
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26
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Sommers-Spijkerman M, Austin J, Bohlmeijer E, Pots W. New Evidence in the Booming Field of Online Mindfulness: An Updated Meta-analysis of Randomized Controlled Trials. JMIR Ment Health 2021; 8:e28168. [PMID: 34279240 PMCID: PMC8329762 DOI: 10.2196/28168] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/05/2021] [Accepted: 05/16/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND There is a need to regularly update the evidence base on the effectiveness of online mindfulness-based interventions (MBIs), especially considering how fast this field is growing and developing. OBJECTIVE This study presents an updated meta-analysis of randomized controlled trials assessing the effects of online MBIs on mental health and the potential moderators of these effects. METHODS We conducted a systematic literature search in PsycINFO, PubMed, and Web of Science up to December 4, 2020, and included 97 trials, totaling 125 comparisons. Pre-to-post and pre-to-follow-up between-group effect sizes (Hedges g) were calculated for depression, anxiety, stress, well-being, and mindfulness using a random effects model. RESULTS The findings revealed statistically significant moderate pre-to-post effects on depression (g=0.34, 95% CI 0.18-0.50; P<.001), stress (g=0.44, 95% CI 0.32-0.55; P<.001), and mindfulness (g=0.40, 95% CI 0.30-0.50; P<.001) and small effects on anxiety (g=0.26, 95% CI 0.18-0.33; P<.001). For well-being, a significant small effect was found only when omitting outliers (g=0.22, 95% CI 0.15-0.29; P<.001) or low-quality studies (g=0.26, 95% CI 0.12-0.41; P<.001). Significant but small follow-up effects were found for depression (g=0.25, 95% CI 0.12-0.38) and anxiety (g=0.23, 95% CI 0.13-0.32). Subgroup analyses revealed that online MBIs resulted in higher effect sizes for stress when offered with guidance. In terms of stress and mindfulness, studies that used inactive control conditions yielded larger effects. For anxiety, populations with psychological symptoms had higher effect sizes. Adherence rates for the interventions ranged from 35% to 92%, but most studies lacked clear definitions or cut-offs. CONCLUSIONS Our findings not only demonstrate that online MBIs are booming but also corroborate previous findings that online MBIs are beneficial for improving mental health outcomes in a broad range of populations. To advance the field of online MBIs, future trials should pay specific attention to methodological quality, adherence, and long-term follow-up measurements.
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Affiliation(s)
- Marion Sommers-Spijkerman
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht, Netherlands
| | - Judith Austin
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Ernst Bohlmeijer
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Wendy Pots
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
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27
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Mindfulness-Based Interventions for the Improvement of Well-Being in People With Multiple Sclerosis: A Systematic Review and Meta-Analysis. Psychosom Med 2021; 82:600-613. [PMID: 32541543 DOI: 10.1097/psy.0000000000000819] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The study aims to meta-analytically review studies about the effects of mindfulness-based interventions (MBIs) on well-being of people with multiple sclerosis (MS). METHODS Seven electronic databases were searched from June 2018 to September 2018. A systematic review and a meta-analysis were conducted. RESULTS Twenty-one studies were included in qualitative synthesis, and 10 studies were included in meta-analysis. MBIs are effective with an overall moderate effect size (Hedges' g = 0.70) in improving well-being in people with MS, with lasting effects at the follow-up (g = 0.55). In particular, MBIs demonstrated to highly reduce stress (g = 1.07) and to improve depression and anxiety symptoms with a moderate to large effect at postintervention (g = 0.77 and g = 0.63, respectively). CONCLUSIONS MBIs represent a valid and effective mind-body intervention to improve the well-being of patients with MS. Further studies should investigate which components of MBIs could be more beneficial for patients with progressive MS. PROSPERO REGISTRATION CRD42018099704.
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28
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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.
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Affiliation(s)
- Areum Han
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, AL.
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29
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Zaccari V, Santonastaso O, Mandolesi L, De Crescenzo F, Foti F, Crescentini C, Fabbro F, Vicari S, Curcio G, Menghini D. Clinical application of mindfulness-oriented meditation in children with ADHD: a preliminary study on sleep and behavioral problems. Psychol Health 2021; 37:563-579. [PMID: 33678073 DOI: 10.1080/08870446.2021.1892110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE High incidence of sleep problems in children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD) has been described. Mindfulness meditation has emerged as a novel approach to sleep disturbances and insomnia remediation. This preliminary study tested the efficacy of Mindfulness-Oriented Meditation (MOM) training on sleep quality and behavioral problems in children with ADHD. DESIGN Twenty-five children with ADHD aged 7-11 years underwent two programs three times per week for eight-weeks: the MOM training (15 children) and an Active Control Condition (10 children). MAIN OUTCOME MEASURES Objective and subjective measures of sleep quality and behavioral measures were collected before and after the programs. RESULTS Positive effects on sleep and behavioral measures were found only in the MOM group. CONCLUSION Although they are preliminary, our results indicate that MOM training is a promising tool for ameliorating sleep quality and behavioral manifestations in ADHD.
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Affiliation(s)
- Vittoria Zaccari
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy
| | - Ornella Santonastaso
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy
| | - Laura Mandolesi
- Department of Humanities, University of Naples Federico II, Napoli, Italy
| | - Franco De Crescenzo
- Department of Psychiatry, University of Oxford, Oxford, UK.,Clinical Trial Unit, University Department of Paediatrics, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy.,Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Francesca Foti
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Cristiano Crescentini
- Department of Languages and Literatures, Communication, Education and Society, University of Udine, Udine, Italy
| | - Franco Fabbro
- Department of Languages and Literatures, Communication, Education and Society, University of Udine, Udine, Italy
| | - Stefano Vicari
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy.,Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giuseppe Curcio
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Deny Menghini
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy
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30
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Sesel AL, Sharpe L, Beadnall HN, Barnett MH, Szabo M, Naismith SL. Development of a Web-Based Mindfulness Program for People With Multiple Sclerosis: Qualitative Co-Design Study. J Med Internet Res 2021; 23:e19309. [PMID: 33650980 PMCID: PMC7967236 DOI: 10.2196/19309] [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: 04/17/2020] [Revised: 08/05/2020] [Accepted: 10/26/2020] [Indexed: 01/01/2023] Open
Abstract
Background Mindfulness-based stress reduction is an efficacious treatment for people with chronic health problems; however, it is highly intensive and time-consuming, which is a barrier for service provision. Objective This study aims to develop an internet-delivered adapted version of mindfulness-based stress reduction for people with multiple sclerosis to make the intervention more accessible. Methods We co-designed a web-based mindfulness program with end users, that is, people with multiple sclerosis (N=19). Iterative feedback was also collected from a subsample of the initial group of end users (n=11), and the program was reviewed by experts (n=8). Results We identified three main themes common to people with multiple sclerosis: dealing with uncertainty and fears for the future, grief and loss, and social isolation. These themes were incorporated into narratives throughout the program. People with multiple sclerosis who reviewed the program gave feedback that the program was relatable, feasible, and acceptable. Experts agreed that the program appropriately represented the main tenets of mindfulness. Iterative feedback was used to further refine the program. Conclusions The web-based mindfulness program that we developed was viewed positively by both experts and end users. The program reflects common concerns for people with multiple sclerosis and has the potential to meet important unmet psychological needs. A randomized controlled trial was planned to determine the efficacy of the program.
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Affiliation(s)
- Amy-Lee Sesel
- School of Psychology, University of Sydney, Sydney, Australia
| | - Louise Sharpe
- School of Psychology, University of Sydney, Sydney, Australia
| | - Heidi N Beadnall
- Brain and Mind Centre, University of Sydney, Sydney, Australia.,Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia
| | - Michael H Barnett
- Brain and Mind Centre, University of Sydney, Sydney, Australia.,Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia
| | - Marianna Szabo
- School of Psychology, University of Sydney, Sydney, Australia
| | - Sharon L Naismith
- School of Psychology, University of Sydney, Sydney, Australia.,Brain and Mind Centre, University of Sydney, Sydney, Australia
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31
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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.
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Affiliation(s)
- Areum Han
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA
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32
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Abstract
Amyotrophic lateral sclerosis and multiple sclerosis are neurodegenerative diseases requiring interdisciplinary rehabilitation services to maximize function, manage symptoms, prevent complications, and promote higher quality of life. Distance and disability may pose barriers to access of subspecialized care. Telehealth is one solution to facilitate access and was rapidly expanded during the COVID-19 pandemic. This article details the utility of telehealth services across the disease spectrum-including to establish a diagnosis, monitor progression for ongoing management, and identify and manage symptoms and provide therapy interventions. The challenges and promise of telehealth services for clinical care and research will be explored.
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33
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Raimo S, Santangelo G, Trojano L. The emotional disorders associated with multiple sclerosis. HANDBOOK OF CLINICAL NEUROLOGY 2021; 183:197-220. [PMID: 34389118 DOI: 10.1016/b978-0-12-822290-4.00009-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Multiple sclerosis (MS) is associated with a high prevalence of emotional and mood disorders. Emotional disorders may worsen during illness progression and affect the quality of life of patients and their families. MS is often associated with depression, with an increased risk of suicide, poor adherence to treatment, decreased functional status, and quality of life. The diagnosis and treatment of emotional and mood disorders in these patients is often challenging since several symptoms of these disorders overlap with those of MS. Other prevalent emotional disorders in MS include bipolar disorder, anxiety disorders, emotional blunting (apathy), and pseudobulbar affect. Early recognition and treatment of these comorbidities could contribute to the reduction of disability and even to decreased mortality. The aim of this chapter is to provide an up-to-date review of mood and emotional disorders that are often associated with MS, focusing on their epidemiology, clinical features, pathogenesis, assessment, and treatment. The interplay between the psychosocial impact of the chronic disability and the demyelinating structural lesions of the brain in precipitating emotional and mood disorders is discussed, as well as its implications for diagnosis and treatment.
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Affiliation(s)
- Simona Raimo
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy.
| | - Gabriella Santangelo
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Luigi Trojano
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
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Dunne J, Chih HJ, Begley A, Daly A, Gerlach R, Schütze R, Castell E, Byrne J, Black LJ. A randomised controlled trial to test the feasibility of online mindfulness programs for people with multiple sclerosis. Mult Scler Relat Disord 2020; 48:102728. [PMID: 33477003 DOI: 10.1016/j.msard.2020.102728] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/23/2020] [Accepted: 12/27/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Practicing mindfulness may improve mental health and reduce pain in people with multiple sclerosis (MS). Since participating in face-to-face mindfulness programs can be challenging for people with MS, exploring alternative ways of delivering these programs is necessary. The objective of this trial was to assess feasibility of two different eight-week online mindfulness programs across five domains: recruitment, practicality, acceptability, integration of mindfulness practice, and limited efficacy testing on mental health, quality of life and pain. METHODS In a three-arm randomised controlled mixed-method trial, participants were assigned to: 1) Mindfulness for Multiple Sclerosis (M4MS) (n=18); 2) Chair Yoga (n=18); or 3) wait-list control group (n=19) for eight weeks. Daily home practice diaries and weekly reflective journals were collected along with online questionnaires at baseline and post-intervention. Feasibility was assessed using descriptive statistics, multilevel mixed-effects regression, and content analysis. RESULTS Online recruitment, online program delivery and online data collection were all found to be feasible. The sign up rate was 65% and overall, 87% of the participant completed the eight-week online programs. The programs were perceived as practical and acceptable by the participants. Integration of mindfulness practice into daily life varied, with time and fatigue reported as common barriers to practice. No statistically significant differences in efficacy measures were found among groups (p>0.05). CONCLUSION Online mindfulness programs are feasible and acceptable for people with MS. This study provides useful insights for future trials when designing online mindfulness programs for people with MS.
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Affiliation(s)
- Jennifer Dunne
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Hui Jun Chih
- School of Public Health, Curtin University, Perth, Western Australia, Australia.
| | - Andrea Begley
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Alison Daly
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | | | - Robert Schütze
- School of Physiotherapy and Exercise Sciences, Curtin University, Perth, Western Australia, Australia
| | - Emily Castell
- School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Jean Byrne
- Wisdom Yoga Institute, Western Australia, Australia
| | - Lucinda J Black
- School of Public Health, Curtin University, Perth, Western Australia, Australia
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Effects of a mind-body program on symptoms of depression and perceived stress among adults with neurofibromatosis type 2 who are deaf: A live-video randomized controlled trial. Complement Ther Med 2020; 56:102581. [PMID: 33197677 DOI: 10.1016/j.ctim.2020.102581] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 09/14/2020] [Accepted: 09/22/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Neurofibromatosis type 2 (NF2) is a rare, progressive and incurable genetic disorder associated with progressive hearing loss and eventual deafness. As a group, patients with NF report high levels of stress and depressive symptoms. However, no studies have explored improvement in these symptoms after psychosocial interventions. We have previously shown that a mind-body program tailored to adults with NF2 who are deaf (the Relaxation Response and Resiliency Program for Deaf NF2, d3RP-NF2) improves quality of life and resiliency over and above a Health Enhancement program when both are delivered via live-video and assisted by Communication Access Realtime Translation (CART). Here we tested the effects of the programs on depression and perceived stress. METHODS Forty-five patients with NF2 and significant hearing loss were randomized to the d3RP-NF2 or Health-Enhancement program and completed measures of depression (PHQ-9) and perceived stress (PSS-10) at baseline, post-intervention, and six-month follow-up. RESULTS Patients randomized to the d3RP-NF2 program, but not to the control condition, experienced significant decreases on both measures from baseline to post-test, which were maintained at follow-up (within group tests). However, improvements following the d3RP-NF2 program was not significantly higher than those observed in the control group (between group tests). CONCLUSION Results provide the first evidence of improvement in symptoms of depression and perceived stress among deaf patients living with NF2 who participate in a virtual mind-body program.
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Motl R, Ehde D, Shinto L, Fernhall B, LaRocca N, Zackowski K. Health Behaviors, Wellness, and Multiple Sclerosis Amid COVID-19. Arch Phys Med Rehabil 2020; 101:1839-1841. [PMID: 32868038 PMCID: PMC7455788 DOI: 10.1016/j.apmr.2020.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/02/2020] [Accepted: 06/08/2020] [Indexed: 01/15/2023]
Affiliation(s)
- Robert Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama
| | - Dawn Ehde
- Department of Rehabilitation Medicine University of Washington, Seattle, Washington
| | - Lynne Shinto
- Department of Neurology, Oregon Health & Science University, Portland, Oregon
| | - Bo Fernhall
- College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois
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Eccles FJR, Craufurd D, Smith A, Davies R, Glenny K, Homberger M, Peeren S, Rogers D, Rose L, Skitt Z, Theed R, Simpson J. A feasibility investigation of mindfulness-based cognitive therapy for people with Huntington's disease. Pilot Feasibility Stud 2020; 6:90. [PMID: 32595978 PMCID: PMC7315515 DOI: 10.1186/s40814-020-00631-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 06/11/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Huntington's disease (HD) is an inherited neurodegenerative condition which affects movement, coordination and cognitive functioning. Psychological difficulties are commonly experienced; however, psychological interventions have been little researched with this population. We investigated the feasibility of conducting a randomised controlled trial (RCT) of mindfulness-based cognitive therapy (MBCT) with people with the HD genetic mutation, either pre-manifest (before onset of movement symptoms) or at an early disease stage. Specifically, we evaluated the willingness of participants to be recruited into and complete the intervention; the acceptability of the study measures in relation to completion; the feasibility of offering the standard MBCT course to people with HD; the acceptability of the intervention and the estimated effect sizes. METHODS Participants were recruited from two UK HD centres and took part in an 8-week course of MBCT, with three reunions throughout the following year. Stress, depression, anxiety, and mindfulness were measured pre-, mid-, and post-course, at 3 months and at 1 year. Sleep, quality of life, positive affect and coping were measured pre- and post-course, at 3 months and at 1 year. Descriptive data and approximate effect sizes were calculated. Interviews were conducted post-course and at 1 year and data pertaining to the acceptability of the course were extracted. RESULTS Twelve participants took part in two groups; all were pre-manifest. Levels of depression and anxiety were low pre-course leaving little room for improvement. Changes in stress and in some aspects of mindfulness were medium to large. The qualitative data suggested participants rated the course highly and found it helpful and no changes to the standard course were needed. Recruitment levels were below those anticipated. Most measures were found to be acceptable. CONCLUSIONS Although the course was acceptable to those who took part, given the difficulties in recruiting and the rarity of HD, conducting an RCT of MBCT teaching groups in person does not seem feasible. However, alternative modes of course delivery (e.g. online) would allow the recruitment of people from a greater geographical area and may make an RCT feasible; this revised focus would be suitable for future feasibility studies. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT02464293, registered 8 June 2015.
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Affiliation(s)
- Fiona J. R. Eccles
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YT UK
| | - David Craufurd
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL UK
- Manchester Centre for Genomic Medicine, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL UK
| | - Alistair Smith
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YT UK
| | - Rhys Davies
- The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, Liverpool, L9 7LJ UK
| | - Kristian Glenny
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YT UK
| | - Max Homberger
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YT UK
| | - Siofra Peeren
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL UK
- Manchester Centre for Genomic Medicine, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL UK
| | - Dawn Rogers
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL UK
- Manchester Centre for Genomic Medicine, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL UK
| | - Leona Rose
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YT UK
| | - Zara Skitt
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL UK
- Manchester Centre for Genomic Medicine, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL UK
| | - Rachael Theed
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YT UK
| | - Jane Simpson
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YT UK
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O'Donnell JM, Jelinek GA, Gray KM, De Livera A, Brown CR, Neate SL, O'Kearney EL, Taylor KL, Bevens W, Weiland TJ. Therapeutic utilization of meditation resources by people with multiple sclerosis: insights from an online patient discussion forum. Inform Health Soc Care 2020; 45:374-384. [PMID: 32508186 DOI: 10.1080/17538157.2020.1755975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We aimed to describe website traffic and qualitatively analyze an e-health community discussion forum. Participants in this study were people affected by multiple sclerosis visiting the Overcoming Multiple Sclerosis (OMS) website. This mixed methods study combined descriptive analysis of website traffic over 7 years and 1 month, and qualitative analysis of 1 week of posts in the meditation topic, coded into theme groups using qualitative thematic analysis. There were 166 meditation topics posted with 21,530 initial views of primary post and 785 sub-post responses. Meditation posts and sub-posts received 368,713 replies. Number of views increased from 4,684 in 2011 to over 80,000 in 2017, a considerably greater rate of increase than overall traffic. Qualitative analysis of posts on the meditation forum identified themes of barriers and enablers to utilization of meditation resources. Enablement themes dominated, observed across six of the seven theme groups with various forms of positive social and emotional support to learn and practice meditation. One theme, negative emotion, was identified as a barrier. The OMS peer-to-peer patient online discussion forum serves important functions in encouraging, educating and enabling its growing online community. Our analysis may help improve and innovate online support for lifestyle management in many chronic diseases.
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Affiliation(s)
- Jodi Millicent O'Donnell
- Neuroepidemiology Unit (NEU), Melbourne School of Population and Global Health, The University of Melbourne , Carlton, Australia.,School of Allied Health, Australian Catholic University , Fitzroy, Australia
| | - George Alexander Jelinek
- Neuroepidemiology Unit (NEU), Melbourne School of Population and Global Health, The University of Melbourne , Carlton, Australia
| | - Kathleen Mary Gray
- Health and Biomedical Informatics Centre, The University of Melbourne , Carlton, Australia
| | - Alysha De Livera
- Neuroepidemiology Unit (NEU), Melbourne School of Population and Global Health, The University of Melbourne , Carlton, Australia
| | - Chelsea Rae Brown
- Neuroepidemiology Unit (NEU), Melbourne School of Population and Global Health, The University of Melbourne , Carlton, Australia
| | - Sandra Leanne Neate
- Neuroepidemiology Unit (NEU), Melbourne School of Population and Global Health, The University of Melbourne , Carlton, Australia
| | - Emily Louise O'Kearney
- Neuroepidemiology Unit (NEU), Melbourne School of Population and Global Health, The University of Melbourne , Carlton, Australia
| | - Keryn Louise Taylor
- Neuroepidemiology Unit (NEU), Melbourne School of Population and Global Health, The University of Melbourne , Carlton, Australia
| | - William Bevens
- Neuroepidemiology Unit (NEU), Melbourne School of Population and Global Health, The University of Melbourne , Carlton, Australia
| | - Tracey Joy Weiland
- Neuroepidemiology Unit (NEU), Melbourne School of Population and Global Health, The University of Melbourne , Carlton, Australia
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Russell RD, Black LJ, Pham NM, Begley A. The effectiveness of emotional wellness programs on mental health outcomes for adults with multiple sclerosis: a systematic review and meta-analysis. Mult Scler Relat Disord 2020; 44:102171. [PMID: 32554283 DOI: 10.1016/j.msard.2020.102171] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/22/2020] [Accepted: 04/28/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND People with multiple sclerosis (MS) have a greater prevalence of depression and anxiety than the general population. Emotional wellness programs (any psychological or psychosocial interventions that focus on awareness, acceptance, managing, or challenging thoughts and feelings) could be important for people with MS. However, there have been no reviews on the effectiveness of emotional wellness programs for people with MS. The objective of this review was to determine the effectiveness of emotional wellness programs on mental health outcomes for adults with MS. INCLUSION CRITERIA Randomised controlled trials (RCTs) and quasi-experimental trials evaluating emotional wellness programs for adults with any form of MS were included. Mental health outcomes included were depression, anxiety, quality of life, and stress. The comparator groups were waitlist controls, usual care, or another intervention. METHODS This review was registered with PROSPERO (registration number CRD42019131082) and conducted in accordance with PRISMA guidelines. CINAHL, Cochrane, MEDLINE, PsycInfo, Web of Science, ProQuest Dissertations and Theses, Cochrane register of Controlled Trials, and Google Scholar were searched for English- language publications. Titles and abstracts were initially screened, followed by a screen of full text articles. Studies were critically appraised for methodological quality using the JBI standardised critical appraisal checklists. Data were extracted on intervention details, study outcome measures, behaviour change techniques, and results. Random effects meta-analyses were performed for outcomes assessed in at least five studies, with results reported as the standardised mean difference (SMD). RESULTS This review comprised 25 RCTs and four quasi-experimental studies (n participants=2323); 21 were included in meta-analyses. Meta-analyses produced statistically significant results favouring the interventions (SMD (95% CI) for depression -0.55 (-0.87, -0.24); anxiety -0.42 (-0.70, -0.14); quality of life 0.28 (0.14, 0.43); and stress -1.00 (-1.58, -0.43)). The most commonly used behaviour change techniques were behaviour practice/rehearsal, social comparison, and social support. CONCLUSIONS This review provides evidence to support the effectiveness of emotional wellness programs for improving mental health outcomes in adults with MS. However, these findings should be interpreted with caution given the high degree of heterogeneity between the studies, and potential for biases in analysis due to missing data and/or incomplete reporting.
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Affiliation(s)
- R D Russell
- School of Public Health, Curtin University, Perth, Australia
| | - L J Black
- School of Public Health, Curtin University, Perth, Australia
| | - N M Pham
- School of Public Health, Curtin University, Perth, Australia; Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Vietnam
| | - A Begley
- School of Public Health, Curtin University, Perth, Australia.
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Simpson R, Simpson S, Ramparsad N, Lawrence M, Booth J, Mercer SW. Mindfulness-based interventions for mental well-being among people with multiple sclerosis: a systematic review and meta-analysis of randomised controlled trials. J Neurol Neurosurg Psychiatry 2019; 90:1051-1058. [PMID: 31196913 DOI: 10.1136/jnnp-2018-320165] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/17/2019] [Accepted: 05/22/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Impairment of mental well-being (anxiety, depression, stress) is common among people with multiple sclerosis (PwMS). Treatment options are limited, particularly for anxiety. The aim of this study was to update our previous systematic review (2014) and evaluate via meta-analysis the efficacy of mindfulness-based interventions (MBIs) for improving mental well-being in PwMS. METHODS Systematic searches for eligible randomised controlled trials (RCTs) were carried out in seven major databases (November 2017, July 2018), using medical subject headings and key words. Studies were screened, data extracted, quality appraised and analysed by two independent reviewers, using predefined criteria. Study quality was assessed using the Cochrane Collaboration risk of bias tool. Mental well-being was the primary outcome. Random effects model meta-analysis was performed, with effect size reported as standardised mean difference (SMD). RESULTS Twelve RCTs including 744 PwMS were eligible for inclusion in the systematic review, eight had data extractable for meta-analysis; n=635. Ethnicity, socioeconomic status, comorbidity and disability were inconsistently reported. MBIs varied from manualised to tailored versions, lasting 6-9 weeks, delivered individually and via groups, both in person and online. Overall SMD for mental well-being (eight studies) was 0.40 (0.28-0.53), p<0.01, I2=28%; against active comparators only (three studies) SMD was 0.17 (0.01-0.32), p<0.05, I2 =0%. Only three adverse events were reported. CONCLUSIONS MBIs are effective at improving mental well-being in PwMS. More research is needed regarding optimal delivery method, cost-effectiveness and comparative-effectiveness. PROSPERO REGISTRATION NUMBER CRD42018093171.
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Affiliation(s)
- Robert Simpson
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sharon Simpson
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Nitish Ramparsad
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Margaret Lawrence
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Jo Booth
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Stewart W Mercer
- General Practice and Primary Care, University of Glasgow, Glasgow, UK
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Sakkas GK, Giannaki CD, Karatzaferi C, Manconi M. Sleep Abnormalities in Multiple Sclerosis. Curr Treat Options Neurol 2019; 21:4. [DOI: 10.1007/s11940-019-0544-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Pagnini F, Cavalera C, Rovaris M, Mendozzi L, Molinari E, Phillips D, Langer E. Longitudinal associations between mindfulness and well-being in people with multiple sclerosis. Int J Clin Health Psychol 2019; 19:22-30. [PMID: 30619494 PMCID: PMC6300715 DOI: 10.1016/j.ijchp.2018.11.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/13/2018] [Indexed: 12/29/2022] Open
Abstract
Background/Objective: Depression, anxiety, fatigue, and sleep problems are typical conditions reported in people with multiple sclerosis (MS), often resulting in a reduction of their quality of life (QOL) and well-being. Mindfulness is a multifaceted and complex construct that has been increasingly explored for its correlated to well-being. Despite preliminary evidence, longitudinal data about the impact of mindfulness on QOL in MS remain limited. In addition, Langerian mindfulness, one of the prominent approaches to mindfulness, is yet unexplored in this field. The study aims to examine the longitudinal relationships between two forms of mindfulness (Langerian and contemplative) and QOL, anxiety, depression, fatigue, and sleep. Method: Within a larger randomized controlled trial of an online mindfulness-based stress reduction intervention, a cohort of 156 people with MS was recruited and assessed for both mindfulness constructs, QOL, anxiety, depression, fatigue, and sleep problems. Assessments were repeated after 2 and after another 6 months. Results: Both mindfulness constructs were highly correlated with all investigated outcomes. Both Langerian and contemplative mindfulness predicted higher QOL, lower anxiety, depression, fatigue, and sleep, over time. Conclusions: In both approaches dispositional mindfulness is a protective factor against depression, anxiety, fatigue, and sleep in people with MS.
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Affiliation(s)
- Francesco Pagnini
- Department of Psychology, Università Cattolica del Sacro Cuore, Milano, Italy
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Cesare Cavalera
- Department of Psychology, Università Cattolica del Sacro Cuore, Milano, Italy
| | - Marco Rovaris
- Multiple Sclerosis Center and Rehabilitation Unit, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Laura Mendozzi
- Multiple Sclerosis Center and Rehabilitation Unit, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Enrico Molinari
- Department of Psychology, Università Cattolica del Sacro Cuore, Milano, Italy
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milano, Italy
| | - Deborah Phillips
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Ellen Langer
- Department of Psychology, Harvard University, Cambridge, MA, USA
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Willekens B, Perrotta G, Cras P, Cools N. Into the Moment: Does Mindfulness Affect Biological Pathways in Multiple Sclerosis? Front Behav Neurosci 2018; 12:103. [PMID: 29872382 PMCID: PMC5972188 DOI: 10.3389/fnbeh.2018.00103] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 04/30/2018] [Indexed: 01/01/2023] Open
Abstract
Mindfulness was introduced in the Western world by Jon Kabat-Zinn in 1979. He defined it as "awareness that arises through paying attention, on purpose, in the present moment, non-judgmentally." Since then, research on mindfulness-based interventions (MBIs) has increased exponentially both in health and disease, including in patients with neurodegenerative diseases such as dementia and Parkinson's disease. Research on the effect of mindfulness and multiple sclerosis (MS) only recently gained interest. Several studies completed since 2010 provided evidence that mindfulness improves quality of life (QoL), depression and fatigue in MS patients. In addition to patient-reported outcome measures, potential effects on cognitive function have been investigated only to a very limited extent. However, research on laboratory biomarkers and neuroimaging, capable to deliver proof-of-concept of this behavioral treatment in MS, is mainly lacking. In this perspective, we illustrate possible neurobiological mechanisms, including the tripartite interaction between the brain, the immune system and neuroendocrine regulation, through which this treatment might affect multiple sclerosis symptoms. We propose to (1) include immunological and/or neuroimaging biomarkers as standard outcome measures in future research dedicated to mindfulness and MS to help explain the clinical improvements seen in fatigue and depression; (2) to investigate effects on enhancing cognitive reserve and cognitive function; and (3) to investigate the effects of mindfulness on the disease course in MS.
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Affiliation(s)
- Barbara Willekens
- Department of Neurology, Antwerp University Hospital, Antwerp, Belgium.,Laboratory of Experimental Hematology, Faculty of Medicine and Health Sciences, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | | | - Patrick Cras
- Department of Neurology, Antwerp University Hospital, Antwerp, Belgium.,Department of Neurology, Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Neurology, Laboratory for Neurobiology, Born-Bunge Institute, University of Antwerp, Antwerp, Belgium
| | - Nathalie Cools
- Laboratory of Experimental Hematology, Faculty of Medicine and Health Sciences, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
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