Behavioral Interventions to Improve Sleep Outcomes in Individuals With Multiple Sclerosis: A Systematic Review

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.

Effect of hand reflexology in ameliorating anxiety, pain, and fatigue among patients undergoing coronary angiography

BACKGROUND

Reflexology is a popular non-invasive complementary medicine technique to enhance anxiety, pain, and fatigue among patients undergoing coronary angiography.

OBJECTIVE

This study aimed to investigate the effect of hand reflexology in ameliorating anxiety, pain, and fatigue among patients undergoing coronary angiography.

METHODS

A quasi-experimental research design was used on 60 patients undergoing coronary angiography at Alexandria Main University Hospital's cardiology department (30 patients in each study and control group). Four tools were used to collect data: the socio-demographic and clinical data assessment sheet, the visual analogue scale, the Rhoten fatigue scale, and the Beck anxiety inventory.

RESULTS

Scores of moderate anxiety, intractable pain, and severe fatigue among the study group significantly decreased after 2 h and three days of applying hand reflexology.

CONCLUSION

The current study findings showed that hand reflexology is a simple, non-invasive nursing intervention that is effective and useful for managing pain, fatigue, and anxiety in patients undergoing coronary angiography as it resulted in a significant reduction in the severity of pain, fatigue, and anxiety after coronary angiography in the study group compared to the control group.

TRIAL REGISTRATION

The study was registered in the clinical trial.gov database (Clinicaltrials.gov NCT05887362 , 23/05/2023).

Social stigma and its relationship with quality of life in multiple sclerosis patients

INTRODUCTION

Multiple sclerosis (MS) is the most prevalent disease of the central nervous system that affects the behavioral characteristics and lifestyle of patients. This study aimed to determine the social stigma and its relationship with quality of life in people with MS referring to the Jahrom MS Association.

METHOD

This cross-sectional study was conducted on MS patients who are members of the MS Association of Jahrom City in Fars province, southern Iran in 2022. The samples were selected by census method. The number of participants remain 223 people. The data was collected using a standard two-part demographic and Multiple Sclerosis Quality of Life-54 (MSQOL-54) questionnaire and a researcher-made 20-question Social stigma questionnaire which validity and reliability were measured. Data analysis was done in a descriptive way (frequency, percentage, mean and standard deviation), univariate regression and multivariable linear regression. Data analysis was done using SPSS version 17 and at a significance level of less than 0.05.

RESULT

Based on univariate regression, marriage [B = 0.2, p-value = 0.004], physical health [B = 0.4, p-value < 0.001], emotional well-being [B = 0.4, p-value = 0.001], cognitive functioning [B = 0.4, p-value < 0.001], health distress [B = 0.5, p-value < 0.001] had a positive and significant relationship with patients' quality of life. Duration of disease [B=-0.2, p-value < 0.001], physical role limitations [B=-0.4, p-value < 0.001], emotional role limitations [B=-0.5, p-value < 0.001], pain [B=-0.4, p-value < 0.001], energy [B=-0.3, p-value = 0.02], health perception [B=-0.3, p-value = 0.001], social functioning [B=-0.4, p-value < 0.001], sexual function [B=-0.3, p-value < 0.001], change in health [B=-0.3, p-value < 0.001], sexual function satisfaction [B=-0.3, p-value < 0.001] and social stigma [B=-0.3, p-value < 0.001] had a negative and significant relationship with patients' quality of life (p < 0.05).

CONCLUSION

The study has emphasized the relationship between the extent and severity of symptoms and disorders with the quality of life of people with MS. The results of the study showed factors such as marriage, physical health and health distress have a positive relationship and factors like duration of disease, physical role limitations, and social stigma have a negative relationship with the quality of life of people with MS. The quality of life of people with MS is more influenced by mental and psychological factors than the physical limitations of these patients.

Comparing the influence of foot reflexology and fasting mimicking diet on quality of life and sleep quality in obesity hypoventilation syndrome

OBJECTIVES

Obesity hypoventilation syndrome is one of the most serious outcomes of obesity-related respiratory difficulties, resulting in higher healthcare costs as well as increased cardio-respiratory morbidity and mortality.

METHODS

Sixty-two males who had a high risk of obstructive sleep apnea according to the STOP-BANG Sleep Apnea Questionnaire were enrolled in the study. Their age is 50-60 years old, and they have a BMI of 35-40 kg/m², daytime hypercapnia, and sleep breathing problems. The patients were divided into two equal groups at random reflexology fasting-mimicking diet groups. Weight, height, waist, and neck circumference were assessed at the beginning of the study and after two months of the intervention. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI), which is used to evaluate sleep quality. The Maugeri Obstructive Sleep Apnea Syndrome (MOSAS) questionnaire was used to assess a patient's quality of life.

RESULTS

There was a significant change in the MOSAS and PSQI questionnaires for both groups post-intervention, as the p-value was less than 0.05. The percentage change in the MOSAS questionnaire score and PSQI questionnaire was higher in the mimic diet group than in the reflexology group. Also, the mimic diet group's weight and neck circumference were considerably reduced after the intervention, with no change in the reflexology group.

CONCLUSIONS

Reflexology and a fasting-mimicking diet were found to have a substantial impact on enhancing the quality of life and sleep in people with obesity hypoventilation syndrome.

Systematic review and meta-analysis of reflexology for people with multiple sclerosis: Systematic Review and Meta-Analysis

BACKGROUND

Research on reflexology therapy for multiple sclerosis (MS) is limited, and the evaluation is mixed. Our aim is to confirm the efficacy of reflexology therapy for MS.

METHODS

The preferred reporting items for systematic reviews and meta-analyses guidelines were followed. The search strategy was conducted in PubMed, Embase, the Cochrane Library, and the Science Citation Index. The quality of the included trials was assessed by the Cochrane Handbook. The main results were summarized and analyzed in RevMan 5.4.

RESULTS

A total of 11 studies were included in the final analysis. There were significant differences [mean difference (MD) -0.90, 95% confidence interval (CI) -1.37 to -0.43, heterogeneity I2  = 0%] between the Precision Reflexology and Sham Reflexology groups in visual analogue scale pain. There was a significant difference (MD -1.00, 95% CI -1.42 to -0.58, heterogeneity I2  = 93%) between the Precision Reflexology and Sham Reflexology groups on the fatigue severity scale. There was no difference between the Precision Reflexology and Sham Reflexology groups in physical function (MD 6.88, 95% CI -3.36 to 17.13, heterogeneity I2  = 31%), role disorder due to physical problems (MD 10.20, 95% CI -4.91 to 25.30, heterogeneity I2  = 0%), physical pain (MD 7.68, 95% CI -0.09 to 15.45, heterogeneity I2  = 0%), role disorder due to emotional problems (MD 3.41, 95% CI -11.55 to 18.37, heterogeneity I2  = 0%), energy (MD 3.27, 95% CI -4.32 to 10.87, heterogeneity I2  = 0%), emotional well-being (MD 1.79, 95% CI -4.76 to 8.34, heterogeneity I2  = 0%), social function (MD 5.72, 95% CI -3.48 to 14.91, heterogeneity I2  = 0%), or general health (MD 2.63, 95% CI -4.36 to 9.62, heterogeneity I2  = 0%).

CONCLUSIONS

Reflexology therapy can be used as an effective intervention for the pain and fatigue of MS patients while improving the quality of life.

The Efficacy and Safety of Manual Therapy for Symptoms Associated with Multiple Sclerosis: A Systematic Review and Meta-Analysis

Background:

Multiple sclerosis (MS) is a chronic neurological autoimmune disease, affecting the psychological and physical health of patients. Manual therapies have been proven to relieve pain, strengthen muscles, and improve bladder and bowel problems with a high safety and low adverse event profile. Previous studies have reported the results of manual therapy in alleviating symptoms associated with MS, but the conclusions were controversial.

Objective:

The purpose of this meta-analysis is to comprehensively analyze and determine the efficacy and safety of manual therapy in relieving symptoms associated with MS.

Methods:

Eight electronic databases were searched from inception of the database to April 30, 2021. Randomized controlled trials (RCTs) using manual therapy in patients to relieve symptoms associated with MS were considered eligible for this study. Two reviewers independently extracted data using pre-established standards.

Results:

Finally, 10 eligible RCTs with 631 subjects were included in this meta-analysis. These data establish that massage therapy can significantly ameliorate fatigue, pain, and spasms, while reflexology was only effective in relieving pain in MS patients. No adverse events were reported in eligible RCTs.

Conclusions:

The present study provides strong evidence that massage therapy could alleviate fatigue, pain, and spasms in MS patients, while reflexology plays a positive role in relieving pain. Physicians could consider massage therapy or reflexology as a safe and effective complementary and alternative treatment. Larger RCTs with higher methodological quality are needed in the future, which aim to provide more meaningful evidence for further proof of efficacy.

The effectiveness of aromatherapy and reflexology in neurodegenerative disorders: a systematic review and meta-analysis

Many neurodegenerative conditions are chronic disorders and result in a range of debilitating symptoms, with many people turning to complementary therapies. A systematic review and meta-analysis were conducted to investigate the evidence on effectiveness of aromatherapy and reflexology on all neurodegenerative conditions. We identified nine eligible studies (total sample n = 504 participants) all of which were on multiple sclerosis only. A meta-analysis was conducted including data from six studies, which demonstrated no significant benefit of aromatherapy/reflexology; however, the sample sizes were small and of low quality. This systematic review confirmed that it is not possible to draw conclusions regarding the effectiveness of reflexology and aromatherapy in multiple sclerosis. Larger high-quality studies are required to test these widely used therapies.

Comparison of the Effect of Reflexology and Swedish Massage on Restless Legs Syndrome and Sleep Quality in Patients Undergoing Hemodialysis: a Randomized Clinical Trial

Background

Patients undergoing hemodialysis experience painful complications such as restless leg syndrome and poor sleep quality, which negatively affect their quality of life.

Purpose

This study aimed to compare the effect of reflexology and Swedish massage on restless leg syndrome and sleep quality in patients undergoing hemodialysis.

Method

This is a randomized clinical trial conducted on 90 patients undergoing hemodialysis. The two intervention groups received either foot reflexology (n = 30) or Swedish massage (n = 30) for four weeks. In the sham group (n = 30), a simple touch of the knee down was performed with the same conditions as the intervention groups. Each sample completed the International Restless Leg Syndrome and Pittsburgh Sleep Quality Index Questionnaires before, immediately after, and one month after the intervention.

Result

The results showed that immediately after the intervention, restless leg syndrome and sleep quality were significantly better in the foot reflexology massage group than the Swedish massage and sham groups (PRLS < 0.001, PPSQI < 0.001); also, changes in restless leg syndrome and sleep quality, respectively, before and one-month follow-up after the intervention were not significant in all three groups (PRLS = 0.47, PPSQI = 0.95), (PRLS = 0.91, PPSQI = 0.87).

Conclusion

Reflexology and Swedish massage, as complementary methods, can improve the restless leg syndrome and sleep quality of patients undergoing hemodialysis. However, foot reflexology massage had been more effective.

Massage therapy as a complementary and alternative approach for people with multiple sclerosis: a systematic review

PURPOSE

Multiple sclerosis (MS) causes a range of different symptoms. Patients with MS (PwMS) have looked for alternative therapies to control their MS progress and treat their symptoms. Non-invasive therapeutic approaches such as massage can have benefits to mitigate some of these symptoms. However, there is no rigorous review of massage effectiveness for PwMS. The present systematic review aims to examine the effectiveness of different massage approaches on common MS symptoms, including fatigue, pain, anxiety, depression, and spasticity.

MATERIALS AND METHODS

A systematic search of related trials was conducted in electronic databases including Cochrane Library, PubMed, Scopus, Web of Science, and Google Scholar, using search terms related to Multiple Sclerosis and massage therapy. The PEDro scale was used to evaluate the methodological quality of reviewed studies.

RESULTS

A total of 12 studies met the inclusion criteria. We rated 5 studies as fair and 7 studies as good. Fatigue was improved by different massage styles, such as reflexology, nonspecific therapeutic massage, and Swedish massage. Pain, anxiety, and depression were effectively improved by reflexology techniques. Spasticity was reduced by Swedish massage and reflexology techniques.

CONCLUSIONS

Different massage approaches effectively improved MS symptoms such as fatigue, pain, anxiety, depression, and spasticity.Implications for rehabilitationThe present review results indicate that massage may have beneficial effects on motor and non-motor symptoms in MS.Massage could be considered a complementary and alternative treatment combined with conventional medicine in people with MS.Pain and fatigue are best improved by Swedish massage, while anxiety and depression are effectively improved by reflexology.