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Deodato M, Fornasaro M, Martini M, Zelesnich F, Sartori A, Galmonte A, Buoite Stella A, Manganotti P. Comparison of different telerehabilitation protocols for urogenital symptoms in females with multiple sclerosis: a randomized controlled trial. Neurol Sci 2024:10.1007/s10072-024-07742-y. [PMID: 39223424 DOI: 10.1007/s10072-024-07742-y] [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: 01/30/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024]
Abstract
Telerehabilitation has been suggested to be equally effective than in-person rehabilitation, and could be helpful to increase participation and reduce barriers. People with multiple sclerosis (MS) often present urogenital dysfunctions, impairing independence and quality of life (QoL). Since the different available telerehabilitation protocols, the present study aimed to compare a live video urogenital rehabilitation intervention protocol (REMOTE) with a home-based pre-recorded video protocol (SELF). A randomized-controlled trial was performed, with 14 females with MS being allocated in the REMOTE group (36 ± 9 y) and 14 females in the SELF group (37 ± 7 y). Both telerehabilitation protocols were identical in terms of contents (including pelvic floor training and relaxation exercises), frequency and duration, consisting of 10 sessions of 45 min each, every 5 days. Questionnaires were administered at the beginning and the end of the study: Short Form Health Survey 36 (SF-36), Beck Depression Inventory (BDI), Female Sexual Function Index (FSFI), International Consultation on Incontinence Questionnaire (ICIQ) symptoms and related QoL, the main outcome being ICIQ incontinence score. Despite most of the outcomes improved in both groups, REMOTE was found to be more effective than SELF in most of the SF-36 domains (from p < 0.001 pη2 0.555 to p = 0.044 pη2 0.147), FSFI (p = 0.001 pη2 0.373), ICIQ (p = 0.003 pη2 0.291). Despite the home-based pre-recorded videos could be effective in improving urogenital symptoms, live video urogenital rehabilitation results in larger improvements. Telerehabilitation should be encouraged for urogenital dysfunctions in females with MS, and pre-recorded videos could represent an alternative when live sessions are not available. Clinical trial registration This randomized controlled trial was registered on ClinicalTrials.gov with the number NCT05984095.
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Affiliation(s)
- Manuela Deodato
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34100, Trieste, Italy
| | - Mia Fornasaro
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34100, Trieste, Italy
| | - Miriam Martini
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34100, Trieste, Italy
- PhD program in Personalized Medicine and Innovative Therapies, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Francesca Zelesnich
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34100, Trieste, Italy
| | - Arianna Sartori
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital (ASUGI), University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Alessandra Galmonte
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34100, Trieste, Italy
| | - Alex Buoite Stella
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34100, Trieste, Italy.
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital (ASUGI), University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy.
| | - Paolo Manganotti
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, via Pascoli 31, 34100, Trieste, Italy
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital (ASUGI), University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
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Campese S, Lyons J, Learmonth YC, Metse A, Kermode AG, Marck CH, Karahalios A. Comparing the effectiveness, safety and tolerability of interventions for depressive symptoms in people with multiple sclerosis: A systematic review. Mult Scler Relat Disord 2024; 89:105763. [PMID: 39032399 DOI: 10.1016/j.msard.2024.105763] [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: 12/01/2023] [Revised: 06/06/2024] [Accepted: 07/06/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Depression is more common in people with multiple sclerosis (MS) compared to the general population. While many interventions are available for treating depressive symptoms in people with MS, it is unclear how different intervention modalities compare. This systematic review aimed to compare the reported effectiveness, safety, and tolerability of interventions for treating depressive symptoms in people with MS. METHODS We systematically searched 7 databases for randomised controlled trials (RCTs) of pharmaceutical, psychological, physical, and electromagnetic stimulation interventions which aimed to reduce depressive symptoms amongst adults with MS. Screening, data extraction and risk of bias assessment were completed by at least two independent researchers. We planned to synthesise the data using network meta-analysis, however the high risk of bias of the included trials resulted in synthesis without meta-analysis. RESULTS Of 1,949 citations, 31 trials (21 psychological, seven physical activity, two pharmaceutical, and one combination) were included, comprising 2,289 participants. Of the 31 eligible trials 24 were at high and six at moderate risk of bias, which precluded meta-analysis. Twenty-six trials reported on efficacy and only 16/31 reported safety and/or tolerability, using inconsistent methods. CONCLUSIONS The current strength of the evidence for treating depressive symptoms in MS is low, therefore, we are not able to summarise or make comparisons between the treatment modalities. There is an urgent need for high-quality and diverse trials investigating treatment options for depression in people with MS. This can only be achieved if the conduct and reporting of RCTs are improved.
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Affiliation(s)
- Stephanie Campese
- Disability and Health Unit, The Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Julia Lyons
- Population Mental Health Unit, Centre for Mental Health and Community Wellbeing, The Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Yvonne C Learmonth
- School of Allied Health (Exercise Science), Murdoch University, Murdoch, Western Australia, Australia; Perron Institute for Neurological and Translational Science, University of Western Australia, QEII Medical Centre, Western Australia, Australia; Centre for Molecular Medicine and Innovative Therapeutics, Health Futures Institute, Murdoch University, Murdoch, Western Australia, Australia
| | - Alexandra Metse
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia; School of Psychological Sciences, University of Newcastle, Callaghan, New South Wales, Australia
| | - Allan G Kermode
- Perron Institute for Neurological and Translational Science, University of Western Australia, QEII Medical Centre, Western Australia, Australia; Centre for Molecular Medicine and Innovative Therapeutics, Health Futures Institute, Murdoch University, Murdoch, Western Australia, Australia
| | - Claudia H Marck
- Disability and Health Unit, The Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia.
| | - Amalia Karahalios
- Centre for Epidemiology and Biostatistics, The Melbourne School of Population and Global Health, The University of Melbourne, Australia
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Probst Y, Kinnane E. Quality of reporting health behaviors for multiple sclerosis (QuoRH-MS): A scoping review to inform intervention planning and improve consistency of reporting. Brain Behav 2024; 14:e3635. [PMID: 39148370 PMCID: PMC11327400 DOI: 10.1002/brb3.3635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/26/2024] [Accepted: 07/03/2024] [Indexed: 08/17/2024] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a neurological condition that necessitates a multidisciplinary approach to aid those living with MS in managing their disease. Health behavior, or lifestyle modification, is an emerging approach to MS self-management. MS researchers utilize measurement tools to ensure that interventions are best suited to the outcomes, thereby potentially influencing practice. The aim of this study was to investigate which tools are being used for health behavior management studies in people living with MS and develop an aid for tool selection. METHODS A scoping review guided by the PRISMA-Sc checklist and the JBI manual for evidence synthesis was employed with a systematic search strategy executed across four scientific databases: Medline, PubMed, CINAHL, and Cochrane Libraries. The types of assessment tools used were extracted from the included studies. Each tool was categorized into the health behavior intervention discipline (nutrition, exercise, and psychology) and then subcategorized by the tool's purpose. The frequency of use was determined for each tool. Reporting of validation of the assessment tools were collated to inform a tool selection checklist. RESULTS The review identified a total of 248 tools (12 nutrition, 55 exercise, and 119 psychology unique reports) from 166 studies. Seventy-seven multidimensional tools were identified including measures of quality of life, fatigue, and functional scales. Only 88 studies (53%) referred to the validity of the tools. The most commonly reported tools were the dietary habits questionnaire (n = 4, nutrition), 6-minute walk test (n = 17, exercise), Symbol Digits and Modalities Test, and Hospital Anxiety and Depression Scale (n = 15 each, psychology) with the Expanded Disability Status Scale reported 43 times. CONCLUSION Evidence from interventions may inform practice for health professionals. This review provides insights into the range of tools reported across health behavior intervention studies for MS and offers a guide toward more consistent reporting of study methods.
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Affiliation(s)
- Yasmine Probst
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Emily Kinnane
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
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Poli S, Donisi V, Mazzi MA, Gobbin F, Giusto G, Orlandi R, Schena F, Del Piccolo L, das Nair R, Gajofatto A, Rimondini M. Fostering quality of life in young adults living with multiple sclerosis: a pilot study of a co-created integrated intervention. Front Psychol 2024; 15:1342166. [PMID: 38596329 PMCID: PMC11002131 DOI: 10.3389/fpsyg.2024.1342166] [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: 11/21/2023] [Accepted: 03/12/2024] [Indexed: 04/11/2024] Open
Abstract
Introduction Multiple sclerosis (MS) is generally diagnosed at an early age, making the acceptance of this chronic disease challenging. Research dedicated to young adults with MS (YawMS) is still limited. A biopsychosocial co-created intervention for YawMS integrating social, physical and psychological activities was developed (ESPRIMO intervention) in order to improve the quality of life (QoL) and well-being. This pre-post intervention assessment study examines the feasibility of the ESPRIMO intervention and its signal of efficacy. Methods Inclusion criteria were: age 18-45 years, MS diagnosis, Expanded Disability Status Scale score < 3.5. After giving informed consent, YawMS completed a battery of questionnaires, which was repeated after the intervention. The battery included a bespoke feasibility scale, the COOP/WONCA charts, and the Short Form-12 Health Survey (SF-12). Results Fifty-three YAwMS were enrolled and 43 (81.1%) completed the intervention. The majority of the sample positively rated the pleasantness, usefulness and feasibility of the intervention. A significant change in the COOP/WONCA "general QoL" chart (t = 3.65; p < 0.01) and SF-12 mental wellbeing component (t = -3.17; p < 0.01) was found. Discussion ESPRIMO is an innovative intervention that is feasible; preliminary results show an improvement in QoL and mental wellbeing. Further studies are needed to test its efficacy and evaluate future implementation in health services.Clinical trial registration: ClinicalTrials.gov, NCT04431323.
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Affiliation(s)
- Silvia Poli
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Valeria Donisi
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Maria Angela Mazzi
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Francesca Gobbin
- Section of Neurology, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Giorgia Giusto
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Riccardo Orlandi
- Section of Neurology, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Federico Schena
- Section of Movement Science, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Lidia Del Piccolo
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Roshan das Nair
- Department of Health Research, SINTEF Digital, Trondheim, Norway
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Alberto Gajofatto
- Section of Neurology, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Michela Rimondini
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
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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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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: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [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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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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Yang X, Wong KM, She R, Zhao C, Ding N, Xu H, Tu X, Lai X, Zhang G. Relationship Between Illness Representations and Symptoms of Internet Gaming Disorder Among Young People: Cross-Lagged Model. JMIR Serious Games 2021; 9:e28117. [PMID: 34851298 PMCID: PMC8672285 DOI: 10.2196/28117] [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: 02/22/2021] [Revised: 06/16/2021] [Accepted: 09/09/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The common-sense model of illness suggests that mental representations of health threats may affect one's behavioral reactions to them and health status. Internet gaming disorder is a newly defined mental disorder. Illness representations of internet gaming disorder may affect one's risk of internet gaming disorder. In turn, symptoms of internet gaming disorder may affect one's perceptions of the disorder. OBJECTIVE This study aimed to investigate the relationships between illness representations and symptoms of internet gaming disorder in college students. METHODS A 1-year longitudinal study was conducted with a convenience sample of Chinese college students (n=591; 342/591, 57.9% female). RESULTS Of the participants, 10.1% (60/591) and 9.1% (54/591) were classified as having probable internet gaming disorder at baseline (T1) and follow-up (T2), respectively. The correlations between some dimensions of illness representations regarding internet gaming disorder (ie, consequence, timeline, personal control, treatment control, and concern) at T1 and symptoms of internet gaming disorder at T2 and between symptoms of internet gaming disorder at T1 and the dimensions of illness representations at T2 (ie, consequence, timeline, personal control, and emotional response) were statistically significant. The cross-lagged model fit the data well ((χ2/df=2.28, comparative fit index=.95, root mean square error of approximation=.06) and showed that internet gaming disorder at T1 was positively associated with unfavorable illness representations at T2. CONCLUSIONS Individuals with more severe symptoms of internet gaming disorder had more pessimistic perceptions about the disorder. Such cognitive perceptions may affect one's emotional and behavioral reactions towards the disorder (eg, greater levels of depression and low self-control intention) and should be modified by educational programs and psychological interventions.
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Affiliation(s)
- Xue Yang
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Kei Man Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Rui She
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Chengjia Zhao
- Department of Psychology, School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Nani Ding
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Huihui Xu
- Department of Psychology, School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Xiaolian Tu
- Renji College, Wenzhou Medical University, Wenzhou, China
| | - Xinyi Lai
- Department of Psychology, School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Guohua Zhang
- The Affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou, China
- Institute of Aging, Key Laboratory of Alzheimer's Disease of Zhejiang Province, Wenzhou Medical University, Wenzhou, China
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11
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Psychological well-being in people with multiple sclerosis: a descriptive review of the effects obtained with mindfulness interventions. Neurol Sci 2021; 43:211-217. [PMID: 34697659 PMCID: PMC8724219 DOI: 10.1007/s10072-021-05686-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/08/2021] [Indexed: 11/16/2022]
Abstract
Multiple sclerosis is a neuroinflammatory and neurodegenerative disease causing several psychosocial problems that significantly impairs quality of life. The most common physical and mental symptoms are anxiety, depression, stress, fatigue, and pain. Several studies investigated the effectiveness of non-pharmacological approaches in improving psychological well-being. This review focused on the impact of mindfulness interventions in patients with multiple sclerosis to reduce psychopathological symptoms and improve well-being. We searched on PubMed database and screening references of included studies and review articles for additional citations. From initial 107 studies, only 8 met search criteria. Our studies showed the efficacy of mindfulness treatment with a reduction in depressive symptoms, a better quality of life (both mental and physical), and a decreased level of fatigue. Findings demonstrated that mindfulness is useful for the improvement of psychological symptoms and pain management and this improvement has also been shown to have a positive impact on the quality of life and coping and adaptation strategies. However, according to the poor available clinics evidence, on cannot conclude that mindfulness interventions are superior to other active interventions in the treatment of psychological symptoms of SM.
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12
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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: 33] [Impact Index Per Article: 11.0] [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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13
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Rosendahl S, Sattel H, Lahmann C. Effectiveness of Body Psychotherapy. A Systematic Review and Meta-Analysis. Front Psychiatry 2021; 12:709798. [PMID: 34566712 PMCID: PMC8458738 DOI: 10.3389/fpsyt.2021.709798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/03/2021] [Indexed: 12/12/2022] Open
Abstract
Despite the growing relevance and applicability of elements based on and derived from the embodied mind paradigm, body psychotherapy (BPT) appears not to be a well-established treatment option. This might be due to a lack of proof for its efficacy. We searched electronic databases (Pubmed MEDLINE, PsycInfo, and PSYNDEX) for randomized controlled trials (RCTs) examining predefined BPT interventions. A total of 2,180 references were screened, of which 113 studies were scrutinized in detail and 18 RCTs finally included. The observed effect size (ES) demonstrated medium effects of BPT on primary outcomes psychopathology and psychological distress. In case of significant statistical heterogeneity, exploratory subgroup analyses revealed diagnosis and the degree of control group activity as noteworthy moderators. For secondary outcomes, evidence was scarce, and an improvement could be demonstrated only for coping abilities. The identified evidence indicates that BPT is beneficial for a wide spectrum of psychic suffering. There is a strong need for high-quality studies with bigger samples and for well-defined diagnostic entities to underpin its effectiveness.
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Affiliation(s)
- Sophie Rosendahl
- Department of Pneumology and Respiratory Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Heribert Sattel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Claas Lahmann
- Faculty of Medicine, Department of Psychosomatic Medicine and Psychotherapy, Medical Center—University of Freiburg, University of Freiburg, Freiburg im Breisgau, Germany
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14
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Abbadessa G, Lavorgna L, Trojsi F, Coppola C, Bonavita S. Understanding and managing the impact of the Covid-19 pandemic and lockdown on patients with multiple sclerosis. Expert Rev Neurother 2021; 21:731-743. [PMID: 34278928 DOI: 10.1080/14737175.2021.1957673] [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] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Covid-19 has been sweeping over the world for more than a year. People with Multiple Sclerosis (MS) might be particularly vulnerable either for the disease iteself or for the ongoing immune treatment. The aim of this review is to understand the impact of the Covid-19 pandemic and lockdown on patients with MS and to provide evidence-based advice to ensure them a high standard of care even during the pandemic. AREAS COVERED Literature search was conducted in the Scopus, Web of Science, Pubmed electronic databases, and articles reference lists to investigate the effect of Covid-19 on MS patients' treatment, access to health-care services and mental-health.The search terms 'multiple sclerosis' AND 'Covid-19' were combined with each of the following term 'disease modifying treatment,' 'steroids,' 'vaccination,' 'mental health,' 'stress,' 'quality of life,' 'management,' 'impact,' 'recommendations,'. EXPERT OPINION To ensure MS control during the pandemic, minimizing the risk of Covid-19 contagion, face-to-face visits may be implemented with televisits. Management of relapses and DMTs schedule should be adapted based on the specific benefit/risk ratio for each patient, considering disease activity, disability, comorbidities. Vaccination should be strongly recommended. Telerehabilitation and online psychological support programs should be encouraged to preserve motor performances and mental health.
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Affiliation(s)
- Gianmarco Abbadessa
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luigi Lavorgna
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesca Trojsi
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Cinzia Coppola
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Simona Bonavita
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.,Neurological Institute for Diagnosis and Care "Hermitage Capodimonte", Naples, Italy
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15
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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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16
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Buttolph L, Corn J, Hanes D, Bradley R, Senders A. Community qigong for People with Multiple Sclerosis: A Pragmatic Feasibility Study. J Altern Complement Med 2021; 27:506-514. [PMID: 33769837 PMCID: PMC9030260 DOI: 10.1089/acm.2020.0481] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objectives: qigong, a traditional Chinese mind-body exercise, has been shown to improve balance and gait in several neurological conditions; however, community-delivered qigong has never been assessed for people with multiple sclerosis (MS). The authors assessed the feasibility of community qigong classes for people with MS and explored outcomes of balance, gait, and quality of life (QOL). Design: Twenty adults with MS were randomly assigned to 10 weeks of community qigong classes or wait-list control. Settings/Location: Portland, Oregon. Subjects: People with MS. Intervention: Community qigong classes. Outcome measures: Feasibility criteria included recruitment, retention, adherence, and ability to participate in qigong movements. Secondary outcome measures included physical tests of mobility, gait, and balance and participant-reported mobility, depression, anxiety, fatigue, and QOL. Results: Recruitment of eligible and interested people with MS was feasible. Retention in the trial was 60%. Completers attended a mean of 7 of 10 classes. All completers participated with no or minor modifications to qigong movements. Exploratory within-group analyses showed trends toward improved mental health, QOL, and reduced fatigue and depression. Several participants spontaneously reported improved energy, flexibility, sleep, and mobility. Conclusions: Community qigong may be a feasible form of exercise for people with MS. To improve retention and capture potential effects of qigong on physical function and quality of life, future studies might consider pragmatic trials with tiered level classes, simpler forms of qigong, and/or refined inclusion criteria (CTR#: NCT04585659).
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Affiliation(s)
- Lita Buttolph
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
| | - Joshua Corn
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
- Oregon College of Oriental Medicine, Portland, OR, USA
- AOMA School of Integrative Medicine, Austin, TX, USA
- Whole Systems Research Institute, Portland, OR, USA
| | - Douglas Hanes
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
| | - Ryan Bradley
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
| | - Angela Senders
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
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17
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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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18
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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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19
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Donisi V, Gajofatto A, Mazzi MA, Gobbin F, Busch IM, Ghellere A, Klonova A, Rudi D, Vitali F, Schena F, Del Piccolo L, Rimondini M. A Bio-Psycho-Social Co-created Intervention for Young Adults With Multiple Sclerosis (ESPRIMO): Rationale and Study Protocol for a Feasibility Study. Front Psychol 2021; 12:598726. [PMID: 33708157 PMCID: PMC7940381 DOI: 10.3389/fpsyg.2021.598726] [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: 08/25/2020] [Accepted: 01/18/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS), the most common neurological disease that causes disability in youth, does not only affect physical functions but is also associated with cognitive impairment, fatigue, depression, and anxiety and can significantly impact health-related quality of life (HRQoL). Since MS is generally diagnosed at a young age-a period of great significance for personal, relational, and professional development-adaptation can become highly challenging. Therefore, enhancing the competence of young people to adaptively cope with these potential challenges is of utmost importance in order to promote their potentialities and talents. It has been shown that psychological interventions targeting MS patients can enhance resilience and HRQoL and that regular physical activity (PA) and social engagement can improve psychological well-being. However, literature on the development of global interventions based on the bio-psycho-social model of the disease is missing. Even less attention has been paid to interventions dedicated to young adults with MS (YawMS) and to the involvement of patients in the development of such programs. AIMS In collaboration with MS patients, this study aims to develop a bio-psycho-social intervention (ESPRIMO) for YawMS, aiming to improve their HRQoL and to explore its feasibility, acceptability, and effects. METHODS To tailor the intervention to the specific needs of YawMS, "patient engagement principles" will be adopted in the co-creation phase, performing a web survey and focus groups with patients and healthcare professionals. In the intervention phase, a pilot sample of 60 young adults with MS will be enrolled. The co-created intervention, composed of group sessions over a 12-week period, will cover psycho-social strategies and include physical activities. Adopting a longitudinal, pre-post evaluation design, self-report questionnaires measuring HRQoL and other bio-psycho-social features (e.g., resilience, well-being, mindfulness traits, self-efficacy, perceived social support, psychological symptoms, illness perception, committed action, fatigue, attitudes, subjective norms, perceived behavioral control, motivation, perception of autonomy support for PA, barriers and intentions to PA) will be administered, the quantity and quality of PA will be measured, and a questionnaire developed by the authors will be used to evaluate the feasibility and acceptability of the ESPRIMO intervention.
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Affiliation(s)
- Valeria Donisi
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Alberto Gajofatto
- Section of Neurology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Maria Angela Mazzi
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesca Gobbin
- Section of Neurology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Isolde Martina Busch
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Annamaria Ghellere
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Alina Klonova
- Section of Movement Sciences, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Latvian Academy of Sport Education, Riga, Latvia
| | - Doriana Rudi
- Section of Movement Sciences, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesca Vitali
- Section of Movement Sciences, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Federico Schena
- Section of Movement Sciences, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Lidia Del Piccolo
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michela Rimondini
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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20
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Bonavita S, Sparaco M, Russo A, Borriello G, Lavorgna L. Perceived stress and social support in a large population of people with multiple sclerosis recruited online through the COVID-19 pandemic. Eur J Neurol 2021; 28:3396-3402. [PMID: 33368849 DOI: 10.1111/ene.14697] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 10/31/2020] [Accepted: 12/15/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE The COVID-19 emergency may cause post-traumatic stress disorder (PTSD), and with regard to people with MS (pwMS) chronic exposure to a wide range of challenging life events has been shown to be correlated with worsening of neurological symptoms, increased lesion burden on brain magnetic resonance imaging and relapses. The aim was to investigate perceived stress, depression, perceived social support, habits and behaviour changes in pwMS through COVID-19 in comparison to a control group. METHODS A web-based survey was posted on SMsocialnetwork.com to investigate perceived stress (using the Perceived Stress Scale), depression (with Patient Health Questionnaire 2) and perceived social support (using Social Provision Scale 10 item) in pwMS and a control group through the COVID-19 pandemic. A secondary group of people with migraine was investigated. RESULTS In all, 1286 answers from 612 pwMS and 674 control people were included in the final analysis. The answers from 318 people with migraine were included for a secondary analysis. A higher proportion of pwMS were depressed (43.1% vs. 23.1%; p < 0.001), had a high level of perceived stress (58% vs. 39.8%; p < 0.001) and felt significantly less social support (median 33 vs. 35; Q1-Q3 28-36 vs. 32-37; p < 0.001) compared to the control group. A higher percentage of people with migraine were depressed (50% vs. 43%, p = 0.04) compared to pwMS. CONCLUSIONS Considering the negative impact that prolonged stress may have on clinical and radiological disease activity of pwMS, and bearing in mind that a beneficial effect has been demonstrated and achieved with stress management, it is suggested to promote stress control in these patients during the COVID-19 pandemic.
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Affiliation(s)
- Simona Bonavita
- Department of Advanced Medical and Surgical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy.,Neurological Institute for Diagnosis and Care 'Hermitage Capodimonte', Naples, Italy
| | - Maddalena Sparaco
- Department of Advanced Medical and Surgical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Antonio Russo
- Department of Advanced Medical and Surgical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | | | - Luigi Lavorgna
- Department of Advanced Medical and Surgical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
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21
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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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22
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Gil-González I, Martín-Rodríguez A, Conrad R, Pérez-San-Gregorio MÁ. Quality of life in adults with multiple sclerosis: a systematic review. BMJ Open 2020; 10:e041249. [PMID: 33257490 PMCID: PMC7705559 DOI: 10.1136/bmjopen-2020-041249] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE In recent years, quality of life (QoL) in multiple sclerosis (MS) has been gaining considerable importance in clinical research and practice. Against this backdrop, this systematic review aimed to provide a broad overview of clinical, sociodemographic and psychosocial risk and protective factors for QoL in adults with MS and analyse psychological interventions for improving QoL. METHOD The literature search was conducted in the Scopus, Web of Science and ProQuest electronic databases. Document type was limited to articles written in English, published from January 1, 2014, to January 31, 2019. Information from the selected articles was extracted using a coding sheet and then qualitatively synthesised. RESULTS The search identified 4886 records. After duplicate removal and screening, 106 articles met the inclusion and exclusion criteria for qualitative synthesis and were assessed for study quality. Disability, fatigue, depression, cognitive impairment and unemployment were consistently identified as QoL risk factors, whereas higher self-esteem, self-efficacy, resilience and social support proved to be protective. The review analysed a wide spectrum of approaches for QoL psychological intervention, such as mindfulness, cognitive behavioural therapy, self-help groups and self-management. The majority of interventions were successful in improving various aspects of QoL. CONCLUSION Adequate biopsychosocial assessment is of vital importance to treat risk and promote protective factors to improve QoL in patients with MS in general care practice.
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Affiliation(s)
- Irene Gil-González
- Personality, Assessment, and Psychological Treatment, University of Seville, Seville, Spain
| | | | - Rupert Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
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Simpson R, Simpson S, Ramparsad N, Lawrence M, Booth J, Mercer SW. Effects of Mindfulness-based interventions on physical symptoms in people with multiple sclerosis – a systematic review and meta-analysis. Mult Scler Relat Disord 2020; 38:101493. [DOI: 10.1016/j.msard.2019.101493] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 10/28/2019] [Accepted: 10/31/2019] [Indexed: 12/14/2022]
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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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25
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The effects of cognitive behavioral and mindfulness-based therapies on psychological distress in patients with multiple sclerosis, Parkinson's disease and Huntington's disease: Two meta-analyses. J Psychosom Res 2019; 122:43-51. [PMID: 31126411 DOI: 10.1016/j.jpsychores.2019.05.001] [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: 08/07/2018] [Revised: 05/07/2019] [Accepted: 05/08/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Psychological distress has a high impact on quality of life in patients with multiple sclerosis (MS), Parkinson's disease (PD), and Huntington's disease (HD). Studies have shown that cognitive behavioral therapy (CBT) and mindfulness-based therapies (MBTs) are successful in reducing psychological distress in patients with anxiety, depressive, and chronic somatic disorders. We aimed to investigate the effectiveness of these therapies in MS, PD, and HD patients. METHODS We performed a comprehensive literature search in PubMed, PsycINFO, Embase and the Cochrane Central Register of Controlled Trials up to March 2018. Randomized controlled trials (RCTs) investigating a CBT or MBT and reporting psychological outcome measures were included. Two separate meta-analyses were performed; one on studies comparing psychological therapy with a treatment as usual or waitlist condition and one on studies with active treatment control conditions. RESULTS The first meta-analysis (N = 12 studies, 8 in MS and 4 in PD populations) showed a significant effect size of g = 0.51 in reducing psychological distress. The second meta-analysis (N = 7 studies, in MS populations) showed a mean effect size of g = 0.36. No RCTs were found in HD populations. The overall quality of the included studies was low and considerable heterogeneity was found. No evidence was found for publication bias. CONCLUSION CBT and MBTs have a small to moderate effect on reducing psychological distress in patients with PD and MS. However, more research with better methodological quality and larger study samples is warranted, especially in HD patient populations.
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26
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Mindfulness and physical disease: a concise review. Curr Opin Psychol 2018; 28:204-210. [PMID: 30785067 DOI: 10.1016/j.copsyc.2018.12.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 12/13/2018] [Accepted: 12/17/2018] [Indexed: 12/18/2022]
Abstract
Many of today's most common, chronic, and costly diseases-from high blood pressure, to chronic pain-are related to stress. Mindfulness, considered a state, a trait, and a training, might help treat or prevent stress-related physical symptoms. A concise review of current scientific evidence shows that both higher levels of trait mindfulness as well as mindfulness training are associated with better psychological well-being, coping, and quality of life. Effects on objective measures of disease, however, are often non-significant or await replication. Larger trials with active control groups, clear diagnostic criteria, objective outcome measures, and longer-term follow-up are needed to generate better quality evidence. Yet, many studies do support integrating mindfulness into health care as part of self-care and disease management.
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Taylor KL, Simpson S, Jelinek GA, Neate SL, De Livera AM, Brown CR, O'Kearney E, Marck CH, Weiland TJ. Longitudinal Associations of Modifiable Lifestyle Factors With Positive Depression-Screen Over 2.5-Years in an International Cohort of People Living With Multiple Sclerosis. Front Psychiatry 2018; 9:526. [PMID: 30425659 PMCID: PMC6218592 DOI: 10.3389/fpsyt.2018.00526] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/04/2018] [Indexed: 12/24/2022] Open
Abstract
Background: Depression is common and has a significant impact on quality of life for many people with multiple sclerosis (MS). A preventive management approach via modification of lifestyle risk factors holds potential benefits. We examined the relationship between modifiable lifestyle factors and depression risk and the change in depression over 2.5 years. Methods: Sample recruited using online platforms. 2,224 (88.9%) at baseline and 1,309 (93.4%) at 2.5 years follow up completed the necessary survey data. Depression risk was measured by the Patient Health Questionnaire-2 (PHQ-2) at baseline and Patient Health Questionniare-9 (PHQ-9) at 2.5-years follow-up. Multivariable regression models assessed the relationships between lifestyle factors and depression risk, adjusted for sex, age, fatigue, disability, antidepressant medication use, and baseline depression score, as appropriate. Results: The prevalence of depression risk at 2.5-years follow-up in this cohort was 14.5% using the PHQ-2 and 21.7% using the PHQ-9. Moderate alcohol intake, being a non-smoker, diet quality, no meat or dairy intake, vitamin D supplementation, omega 3 supplement use, regular exercise, and meditation at baseline were associated with lower frequencies of positive depression-screen 2.5 years later. Moderate alcohol intake was associated with greater likelihood of becoming depression-free and a lower likelihood of becoming depressed at 2.5-years follow-up. Meditating at least once a week was associated with a decreased frequency of losing depression risk, against our expectation. After adjusting for potential confounders, smoking, diet, physical activity, and vitamin D and omega-3 supplementation were not associated with a change in risk for depression. Conclusion: In a large prospective cohort study of people with MS and depression, in line with the emerging treatment paradigm of early intervention, these results suggest a role for some lifestyle factors in depression risk. Further studies should endeavor to explore the impact of positive lifestyle change and improving depression in people living with MS.
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Affiliation(s)
- Keryn L. Taylor
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
- Department of Psychiatry and Psychosocial Cancer Care, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Steve Simpson
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - George A. Jelinek
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Sandra L. Neate
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Alysha M. De Livera
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Chelsea R. Brown
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Emily O'Kearney
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Claudia H. Marck
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - Tracey J. Weiland
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
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28
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Senders A, Hanes D, Bourdette D, Carson K, Marshall LM, Shinto L. Impact of mindfulness-based stress reduction for people with multiple sclerosis at 8 weeks and 12 months: A randomized clinical trial. Mult Scler 2018; 25:1178-1188. [PMID: 29985095 DOI: 10.1177/1352458518786650] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Mindfulness training is often used as a therapeutic intervention to manage stress and enhance emotional well-being, yet trials for multiple sclerosis (MS) are limited and few have used an active control. OBJECTIVE Assess the feasibility of mindfulness-based stress reduction (MBSR) for people with MS and evaluate the efficacy of MBSR compared to an education control. METHODS We conducted a single-blind, randomized trial of MBSR versus education control among 62 adults with MS. Primary outcomes were measures of feasibility. Secondary outcomes included perceived stress, anxiety, depression, fatigue, pain, resilience, and the Paced Auditory Serial Addition Test, assessed at baseline, 8 weeks, and 12 months. Mean scores for secondary outcome measures were compared between groups at each time point and within groups across time by analyses of covariance or paired t-tests, respectively. RESULTS Successful recruitment and retention demonstrated feasibility. Improvements in several secondary outcomes were observed among both MBSR and control groups. However, differences between the groups were not statistically significant at either 8 weeks or 12 months. CONCLUSION Emotional well-being improved with both MBSR and education. Spontaneous improvement cannot be ruled out as an explanation for findings and additional studies that evaluate the impact of mindfulness training to improve emotional health are warranted.
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Affiliation(s)
- Angela Senders
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA/Department of Neurology, Oregon Health & Science University, Portland, OR, USA/OHSU-PSU School of Public Health, Portland, OR, USA
| | - Douglas Hanes
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
| | - Dennis Bourdette
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Kimberly Carson
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Lynn M Marshall
- Department of Orthopedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA/OHSU-PSU School of Public Health, Portland, OR, USA
| | - Lynne Shinto
- Department of Neurology, Oregon Health & Science University, Portland, OR, 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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