1
|
Feng G, Posa S, Sureshkumar A, Simpson S, Bruno T, Morrow SA, Donkers S, Knox K, Feinstein A, Bayley M, Munce S, Simpson R. Experiences of people with multiple sclerosis and clinicians in using cognitive behavioural therapies for hidden symptoms: a systematic review and meta-aggregation. J Neurol 2024; 271:1084-1107. [PMID: 38219252 DOI: 10.1007/s00415-023-12116-z] [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: 08/23/2023] [Revised: 10/31/2023] [Accepted: 11/13/2023] [Indexed: 01/16/2024]
Abstract
PURPOSE Cognitive behavioural therapies (CBTs) are a standard of care for treatment of many 'hidden symptoms' in people with MS (PwMS), such as stress, depression, and fatigue. However, these interventions can vary widely in formatting and may not be tailored for PwMS. To optimize CBTs for MS, understanding the experiences of PwMS and clinicians is essential. This systematic review and meta-aggregation synthesizes existing qualitative data on stakeholder perspectives of CBTs for PwMS. METHODS Systematic searches across five major electronic databases were conducted. Studies reporting qualitative data were identified. Two reviewers performed screening, quality assessment, data extraction, and certainty of evidence assessments. Meta-aggregation was performed as per the Joanna Briggs Institute approach, entailing qualitative data extraction, developing categories, and synthesizing overall findings. RESULTS Twenty-eight studies were included in this review, comprising data from 653 PwMS and 47 clinicians. In the meta-aggregation, 122 qualitative results were extracted and grouped into nine categories. Categories were then combined into six synthesized findings: (1) setting the context-life with MS, (2) reasons for participating in CBTs, (3) acceptability of and experiences with participating in CBTs, (4) perceived benefits of CBTs, (5) perceived challenges with CBTs, and (6) suggestions to improve CBTs for PwMS. CONCLUSIONS A range of benefits including psychological, social, and lifestyle improvements were reported, but varied based on the design of the CBT intervention. Future CBT interventions should be tailored to participant needs, delivered in group settings, offer online options, and be delivered by a trained facilitator familiar with MS. Further exploration of the ideal CBT design for PwMS, as well as engagement with caregivers and clinicians treating MS, is warranted.
Collapse
Affiliation(s)
- Gregory Feng
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Stephanie Posa
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | | | - Sharon Simpson
- Forest Hill Centre for Cognitive Behavioural Therapy, Toronto, Canada
| | - Tania Bruno
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Sarah A Morrow
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- London Health Sciences Centre, University of Western Ontario, London, Canada
| | - Sarah Donkers
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Katherine Knox
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Anthony Feinstein
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Mark Bayley
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Sarah Munce
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Robert Simpson
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
| |
Collapse
|
2
|
Wong D, Pike K, Stolwyk R, Allott K, Ponsford J, McKay A, Longley W, Bosboom P, Hodge A, Kinsella G, Mowszowski L. Delivery of Neuropsychological Interventions for Adult and Older Adult Clinical Populations: An Australian Expert Working Group Clinical Guidance Paper. Neuropsychol Rev 2023:10.1007/s11065-023-09624-0. [PMID: 38032472 DOI: 10.1007/s11065-023-09624-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 10/16/2023] [Indexed: 12/01/2023]
Abstract
Delivery of neuropsychological interventions addressing the cognitive, psychological, and behavioural consequences of brain conditions is increasingly recognised as an important, if not essential, skill set for clinical neuropsychologists. It has the potential to add substantial value and impact to our role across clinical settings. However, there are numerous approaches to neuropsychological intervention, requiring different sets of skills, and with varying levels of supporting evidence across different diagnostic groups. This clinical guidance paper provides an overview of considerations and recommendations to help guide selection, delivery, and implementation of neuropsychological interventions for adults and older adults. We aimed to provide a useful source of information and guidance for clinicians, health service managers, policy-makers, educators, and researchers regarding the value and impact of such interventions. Considerations and recommendations were developed by an expert working group of neuropsychologists in Australia, based on relevant evidence and consensus opinion in consultation with members of a national clinical neuropsychology body. While the considerations and recommendations sit within the Australian context, many have international relevance. We include (i) principles important for neuropsychological intervention delivery (e.g. being based on biopsychosocial case formulation and person-centred goals); (ii) a description of clinical competencies important for effective intervention delivery; (iii) a summary of relevant evidence in three key cohorts: acquired brain injury, psychiatric disorders, and older adults, focusing on interventions with sound evidence for improving activity and participation outcomes; (iv) an overview of considerations for sustainable implementation of neuropsychological interventions as 'core business'; and finally, (v) a call to action.
Collapse
Affiliation(s)
- Dana Wong
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.
| | - Kerryn Pike
- School of Psychology and Public Health & John Richards Centre for Rural Ageing Research, La Trobe University, Melbourne, Australia
- School of Applied Psychology, Griffith University, Gold Coast, Australia
| | - Rene Stolwyk
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - Kelly Allott
- , Orygen, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Jennie Ponsford
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - Adam McKay
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- MERRC, Rehabilitation and Mental Health Division, Epworth HealthCare, Richmond, Australia
| | - Wendy Longley
- Rehabilitation Studies Unit, Sydney Medical School, University of Sydney, Sydney, Australia
- The Uniting War Memorial Hospital, Waverley, Sydney, Australia
| | - Pascalle Bosboom
- MindLink Psychology, West Perth, Australia
- School of Psychological Science, University of Western Australia, Crawley, Australia
| | | | - Glynda Kinsella
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Loren Mowszowski
- Faculty of Science, School of Psychology & Brain and Mind Centre, The University of Sydney, Sydney, Australia
| |
Collapse
|
3
|
Renner A, Bätge SJ, Filser M, Lau S, Pöttgen J, Penner IK. Non-pharmacological randomized intervention trial for the management of neuropsychological symptoms in outpatients with progressive multiple sclerosis. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-13. [PMID: 37652158 DOI: 10.1080/23279095.2023.2233648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
PURPOSE Despite typically more pronounced cognitive and mental health issues in progressive disease courses of multiple sclerosis (PMS), rehabilitation research in this subgroup is rare. The efficacy of two non-pharmacological interventions with positive results from prior investigations was therefore examined in PMS specifically. METHODS Persons with PMS (pwPMS) received either computerized cognitive training (BrainStim), standardized cognitive-behavioral group sessions (Metacognitive Training [MaTiMS]), or a combination of both in an ambulatory setting. Neuropsychological assessment was conducted before and after the four-week intervention. RESULTS 37 participants (13 with primary/24 with secondary PMS, meanage = 52.87, SDage = 7.11, meanEDSS = 4.02, SDEDSS = 1.35) entered analyses. The BrainStim group improved in immediate and delayed verbal memory, recognition, verbal working memory, and perceived cognitive deficits while experiencing increased anxiety post-intervention. MaTiMS participants reported high program satisfaction and less cognitive difficulties at retest. The Combination group performed better in immediate and delayed verbal memory, and in information processing speed after training. Descriptive data further indicated positive effects on anxiety and depression in the MaTiMS and Combination group. CONCLUSIONS While objective cognitive performance improved when explicitly trained, psychoeducative sessions contributed to subjective mental health. The combination of both approaches is thus suggested, considering the specific needs of pwPMS treated in an ambulatory setting.
Collapse
Affiliation(s)
- Alina Renner
- Cogito Center for Applied Neurocognition and Neuropsychological Research, Düsseldorf, Germany
| | - Sharon Jean Bätge
- Cogito Center for Applied Neurocognition and Neuropsychological Research, Düsseldorf, Germany
| | - Melanie Filser
- 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
| |
Collapse
|
4
|
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.
Collapse
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.
| |
Collapse
|
5
|
Managing neuropsychological impairment in multiple sclerosis – controlled study on a standardized metacognitive intervention (MATIMS). Mult Scler Relat Disord 2022; 59:103687. [DOI: 10.1016/j.msard.2022.103687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/31/2022] [Accepted: 02/11/2022] [Indexed: 11/22/2022]
|
6
|
Zheng H, Dong Y, Sun Y, Yang J, Yuan C, Wang J, Dong W. Effectiveness of Metacognitive Regulation Intervention on Attention-Deficit-Hyperactivity Disorder Students' Scientific Ability and Motivation. Front Psychol 2021; 12:747961. [PMID: 35002845 PMCID: PMC8732764 DOI: 10.3389/fpsyg.2021.747961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/25/2021] [Indexed: 11/15/2022] Open
Abstract
This study investigated the effect of metacognitive regulation (McR) intervention on attention-deficit-hyperactivity disorder (ADHD) students' astronomy knowledge acquisition and learning motivation. Through a cognitive-behavioural treatment design, this study selected 97 ADHD learners who had poor academic performance. This study divided ADHD students randomly into one experimental group and one control group. After 15 weeks of intervention, results showed that the experimental group students performed significantly better than the control group in scientific abilities, learning motivation, and metacognition. Results suggested that the McR intervention is an effective approach for improving the ADHD students' science knowledge learning abilities.
Collapse
Affiliation(s)
- Haoyuan Zheng
- Department of Teacher Education, Guangzhou Huashang College, Guangzhou, China
- Research Center for Overseas Studies and Media Reports on Hainan, Hainan University, Haikou, China
| | - Yang Dong
- Research Center for Overseas Studies and Media Reports on Hainan, Hainan University, Haikou, China
- Department of English, Hainan University, Haikou, China
| | - YuanKe Sun
- Department of Science and Environmental Studies, Education University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Jie Yang
- Department of English, Hainan University, Haikou, China
| | - Chongbo Yuan
- Department of Chinese Studies, Hong Kong Open University, Hong Kong, Hong Kong SAR, China
| | - JinDao Wang
- Department of Teacher Education, Guangzhou Huashang College, Guangzhou, China
| | - Weiyang Dong
- Research Center for Overseas Studies and Media Reports on Hainan, Hainan University, Haikou, China
| |
Collapse
|
7
|
Feinstein A, Meza C, Stefan C, Staines WR. Impaired awareness: Why people with multiple sclerosis continue using cannabis despite evidence to the contrary. Brain Behav 2021; 11:e2220. [PMID: 34087949 PMCID: PMC8413765 DOI: 10.1002/brb3.2220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 04/07/2021] [Accepted: 05/16/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND With widespread moves toward legalization of cannabis, increasing numbers of people with multiple sclerosis (pwMS) are using the drug. Emerging MS-related data show that cannabis can cause or exacerbate cognitive dysfunction. OBJECTIVE To understand why people with MS continue using cannabis despite adverse cognitive consequences. It was hypothesized that lack of awareness, a component of metacognition, could explain this decision, in part. METHOD Forty pwMS who smoked cannabis almost daily were assigned by odd-even case number selection to either a cannabis continuation (CC) or cannabis withdrawal (CW) group. Both groups were followed for 28 days. All participants completed, at baseline and day 28, the brief repeatable battery of neuropsychological tests (BRNB) in MS for measures of processing speed, memory and executive function; Modified fatigue impact scale (mFIS) for self-report indices of cognitive functioning. RESULTS No significant baseline differences between the groups on the BRNB and mFIS. At day 28, significant improvement within group was seen on all measures of the BRNB, but only in the CW group (p = .0001 for all indices). A repeat measure ANOVA did not find any significant group (CC vs. CW) × time (baseline and day 28) interactions for the self-report cognitive measures on the mFIS. Cannabis abstainers did report less ability to function away from home. All 19 participants in the CW group reverted to using cannabis on study completion despite being informed individually of their cognitive improvement. CONCLUSIONS AND RELEVANCE The inability of pwMS to accurately appraise their memory and executive function can help explain, in part, why they continue to smoke cannabis despite objective evidence of the deleterious cognitive side effects of this behavior.
Collapse
Affiliation(s)
- Anthony Feinstein
- Sunnybrook Research Institute, Division of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Cecilia Meza
- Sunnybrook Research Institute, Division of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Cristiana Stefan
- Clinical Laboratory and Diagnostic Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - William R Staines
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| |
Collapse
|
8
|
Krause N, Riemann-Lorenz K, Steffen T, Rahn AC, Pöttgen J, Stellmann JP, Köpke S, Friede T, Icks A, Vomhof M, Temmes H, van de Loo M, Gold SM, Heesen C. Study protocol for a randomised controlled trial of a web-based behavioural lifestyle programme for emPOWERment in early Multiple Sclerosis (POWER@MS1). BMJ Open 2021; 11:e041720. [PMID: 33593774 PMCID: PMC7888332 DOI: 10.1136/bmjopen-2020-041720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Multiple sclerosis (MS) is an inflammatory and degenerative disease of the central nervous system that mainly affects young adults. Uncertainty is a major psychological burden of the disease from diagnosis to prognosis, enhanced by the pressure to make early decisions on a diverse set of immunotherapies. Watchful waiting for 1-2 years while adapting goals and lifestyle habits to life with a chronic disease represents another reasonable option for persons with MS (PwMS). A behaviour change programme based on evidence-based patient information (EBPI) is not available in standard care. This randomised controlled trial (RCT) with an embedded process evaluation investigates the efficacy and cost-effectiveness of a web-based behavioural lifestyle programme to change lifestyle behaviour and reduce inflammatory disease activity in PwMS. METHODS AND ANALYSIS A web-based behavioural intervention will be evaluated in an RCT aiming to recruit 328 persons with clinically isolated syndrome, suspected MS or confirmed MS for less than 1 year, who have not yet started immunotherapy. Moreover, a mixed-methods process evaluation and a health economic evaluation will be carried out. Participants will be recruited in at least 16 MS centres across Germany and randomised to an intervention group with 12 months of access to EBPI about lifestyle factors in MS, combined with a complex behaviour change programme or to a control group (optimised standard care). The combined primary endpoint is the incidence of new T2 lesions on MRI or confirmed relapses. ETHICS AND DISSEMINATION The study has been approved by the Ethics Committee of the Hamburg Chamber of Physicians (PV6015). Trial results will be communicated at scientific conferences and meetings and presented on relevant patient websites and in patient education seminars. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03968172); Pre-results.
Collapse
Affiliation(s)
- Nicole Krause
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karin Riemann-Lorenz
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tanja Steffen
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Christin Rahn
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Jana Pöttgen
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan-Patrick Stellmann
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- APHM, Timone Hospital, CEMEREM, Marseille, France
| | - Sascha Köpke
- University of Cologne, Faculty of Medicine and University Hospital Cologe, Institute of Nursing Science, Cologne, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Centre Göttingen, Göttingen, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Markus Vomhof
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Herbert Temmes
- German Multiple Sclerosis Society, Federal Association, Hannover, Germany
| | - Markus van de Loo
- German Multiple Sclerosis Society, Federal Association, Hannover, Germany
| | - Stefan M Gold
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychiatry and Medical Department, Section Psychosomatic Medicine, Charité-University Medicine Berlin, Berlin, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
9
|
Treatment and management of cognitive dysfunction in patients with multiple sclerosis. Nat Rev Neurol 2020; 16:319-332. [PMID: 32372033 DOI: 10.1038/s41582-020-0355-1] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2020] [Indexed: 01/19/2023]
Abstract
Cognitive impairment is a common and devastating manifestation of multiple sclerosis (MS). Although disease-modifying therapies have been efficacious for reducing relapse rates in MS, such treatments are ineffective for treating cognitive dysfunction. Alternative treatment approaches for mitigating cognitive problems are greatly needed in this population. To date, cognitive rehabilitation and exercise training have been identified as possible candidates for treating MS-related cognitive impairment; however, cognitive dysfunction is still often considered to be poorly managed in patients with MS. This Review provides a comprehensive overview of recent developments in the treatment and management of cognitive impairment in people with MS. We describe the theoretical rationales, current states of the science, field-wide challenges and recent advances in cognitive rehabilitation and exercise training for treating MS-related cognitive impairment. We also discuss future directions for research into the treatment of cognitive impairment in MS that should set the stage for the inclusion of cognitive rehabilitation and exercise training into clinical practice within the next decade.
Collapse
|
10
|
Harand C, Defer G. Psychological interventions in multiple sclerosis: Improving cognition and quality of life. Ann Phys Rehabil Med 2020. [DOI: 10.1016/j.rehab.2018.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
11
|
Lenzo V, Sardella A, Martino G, Quattropani MC. A Systematic Review of Metacognitive Beliefs in Chronic Medical Conditions. Front Psychol 2020; 10:2875. [PMID: 31998178 PMCID: PMC6965316 DOI: 10.3389/fpsyg.2019.02875] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 12/04/2019] [Indexed: 12/19/2022] Open
Abstract
Background: Psychological functioning plays an important role in medical conditions and impacts patients' quality of life. Previously, many studies have highlighted the association of metacognition to both the development and maintenance of emotional disorders. Recently, several researchers pointed out the relevant role of dysfunctional metacognitive beliefs in the context of chronic diseases. Hence, dysfunctional metacognitive beliefs could be directly related to anxiety and depression, regardless of the medical condition's expression. The aim of this systematic review was to summarize the available evidence regarding the association of metacognition with anxiety, depression, and perceived quality of life, in the context of medical conditions, according to Wells' theory. Methods: A systematic review based on electronic bibliographic databases (PsycINFO, PubMed, Scopus, Web of Science, and Web of Knowledge) of scientific literature was carried out. Studies involving patients evaluated in clinical settings were included in the analysis. Results: Our findings indicated that metacognition appears to be related to anxiety, depression, and quality of life in patients with medical chronic conditions. Therefore, dysfunctional metacognitive beliefs might be a relevant factor associated with the process of adapting to illness. Conclusions: The additional evaluation of metacognitive factors in the context of several medical chronic conditions appears valuable. Due to the rising interest in the study of metacognition, suggestions for future research have also been provided.
Collapse
Affiliation(s)
- Vittorio Lenzo
- Department of Human, Social and Health Sciences, University of Cassino and South Latium, Cassino, Italy
| | - Alberto Sardella
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Gabriella Martino
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Maria C Quattropani
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| |
Collapse
|
12
|
Oreja-Guevara C, Ayuso Blanco T, Brieva Ruiz L, Hernández Pérez MÁ, Meca-Lallana V, Ramió-Torrentà L. Cognitive Dysfunctions and Assessments in Multiple Sclerosis. Front Neurol 2019; 10:581. [PMID: 31214113 PMCID: PMC6558141 DOI: 10.3389/fneur.2019.00581] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 05/16/2019] [Indexed: 12/22/2022] Open
Abstract
Cognitive impairment has been reported at all phases and all subtypes of multiple sclerosis. It remains a major cause of neurological disability in young and middle-aged adults suffering from the disease. The severity and type of cognitive impairment varies considerably among individuals and can be observed both in early and in later stages. The areas which have commonly shown more deficits are: information processing speed, complex attention, memory, and executive function. Even though an alteration in both the white matter and in the gray matter has been found in patients with multiple sclerosis and cognitive impairment, the underlying process still remains unknown. Standardized neurological examinations fail to detect emerging cognitive deficits and self-reported cognitive complaints by the patients can be confounded by other subjective symptoms. This review is a comprehensive and short update of the literature on cognitive dysfunctions, the possible confounders and the impact of quality of life in patients with multiple sclerosis.
Collapse
Affiliation(s)
- Celia Oreja-Guevara
- Servicio de Neurología, Hospital Clínico San Carlos, IdISSC, Departamento de Medicina, Universidad Complutense, Madrid, Spain
| | | | | | - Miguel Ángel Hernández Pérez
- Servicio de Neurología, Hospital Universitario Nuestra Señora de Candelaria, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - Virginia Meca-Lallana
- Unidad de Esclerosis Múltiple, Servicio de Neurología, Fundación de Investigación Biomédica, Hospital Universitario de la Princesa, Madrid, Spain
| | - Lluís Ramió-Torrentà
- Unidad de Esclerosis Múltiple y Neuroinmunología de Girona, Servicio de Neurología, IDIBGI, Hospital Universitario Dr. Josep Trueta, Girona, Spain
| |
Collapse
|
13
|
Pineau F, Socha J, Corvol JC, Louapre C, Assouad R, Maillart E, Lubetzki C, Papeix C. Impact of an adaptive program for cognitive and emotional deficits (ADACOG program) in multiple sclerosis patients with cognitive impairments. Rev Neurol (Paris) 2019; 175:305-312. [PMID: 30910222 DOI: 10.1016/j.neurol.2018.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 07/05/2018] [Accepted: 08/01/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cognitive impairment is frequent in multiple sclerosis (MS), affecting approximately 40 to 70% of patients. We developed a psycho-educational program (ADACOG program) to allow patients to cope with cognitive deficits. The purpose of this exploratory study was to investigate the impact of the ADACOG program on subjective self-reported cognitive impairments, quality of life, anxiety, depression and self-esteem in MS patients. METHODS ADACOG program is a psycho-educational program focusing on cognitive and emotional dysfunctions in MS consisting of three modules in small groups lasting two hours every two weeks. Forty-five MS patients with self-reported cognitive impairments and objective cognitive deficits were enrolled consecutively in two groups: (i) the ADACOG group (N=24) and (ii) the control group (N=21). Both groups of patients completed questionnaires evaluating self-reported cognitive impairments (Multiple Sclerosis Neuropsychological Screening Questionnaire), quality of life (Multiple Sclerosis Impact Scale), anxiety and depression (Hospital Anxiety and Depression Scale, HAD) and self-esteem (Rosenberg Scale) at inclusion (M0), one month later (M1) and seven months after inclusion (M7). The evolution of outcomes within ADACOG group and between both groups was analyzed. RESULTS The analyses within the ADACOG group showed that patients reported better quality of life and fewer anxiety symptoms at M1 compared to M0 (respectively P=0.03 and P=0,04). Moreover, patients presented less subjective self-reported cognitive deficits at M7 compared to M0 (P=0.003). Score evolution for HAD depression and self-esteem were not significant within the ADACOG group. The change M1-M0 for MSIS-29 and HAD anxiety scores was significantly different between both groups (respectively P=0.04 and P=0.008), with improvement of quality of life and anxiety in the ADACOG group. The evolution of scores between groups was not significant for the other outcomes. DISCUSSION This study showed a small effect of a psycho-educational program focusing on cognitive and emotional disorders in MS patients with subjective self-reported cognitive deficits and objective cognitive deficits. Interest of psycho-education focusing on cognition in MS patients is discussed.
Collapse
Affiliation(s)
- F Pineau
- Assistance publique hôpitaux de Paris, département de neurologie, hôpital Pitié-Salpêtrière, 75013 Paris, France; UMR S1127, Sorbonne université, université Pierre et Marie Curie Paris 06, institut de la Moelle Épinière, 75013 Paris, France; UMR S1127 and centre d'investigation clinique, institut national de santé et en recherche médicale, 1422, 75013 Paris, France; UMR 7225, centre national de la recherche scientifique, 75013 Paris, France.
| | - J Socha
- Assistance publique hôpitaux de Paris, département de neurologie, hôpital Pitié-Salpêtrière, 75013 Paris, France; UMR S1127, Sorbonne université, université Pierre et Marie Curie Paris 06, institut de la Moelle Épinière, 75013 Paris, France; UMR S1127 and centre d'investigation clinique, institut national de santé et en recherche médicale, 1422, 75013 Paris, France; UMR 7225, centre national de la recherche scientifique, 75013 Paris, France
| | - J-C Corvol
- Assistance publique hôpitaux de Paris, département de neurologie, hôpital Pitié-Salpêtrière, 75013 Paris, France; UMR S1127, Sorbonne université, université Pierre et Marie Curie Paris 06, institut de la Moelle Épinière, 75013 Paris, France; UMR S1127 and centre d'investigation clinique, institut national de santé et en recherche médicale, 1422, 75013 Paris, France; UMR 7225, centre national de la recherche scientifique, 75013 Paris, France
| | - C Louapre
- Assistance publique hôpitaux de Paris, département de neurologie, hôpital Pitié-Salpêtrière, 75013 Paris, France; UMR S1127, Sorbonne université, université Pierre et Marie Curie Paris 06, institut de la Moelle Épinière, 75013 Paris, France; UMR S1127 and centre d'investigation clinique, institut national de santé et en recherche médicale, 1422, 75013 Paris, France; UMR 7225, centre national de la recherche scientifique, 75013 Paris, France
| | - R Assouad
- Assistance publique hôpitaux de Paris, département de neurologie, hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - E Maillart
- Assistance publique hôpitaux de Paris, département de neurologie, hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - C Lubetzki
- Assistance publique hôpitaux de Paris, département de neurologie, hôpital Pitié-Salpêtrière, 75013 Paris, France; UMR S1127, Sorbonne université, université Pierre et Marie Curie Paris 06, institut de la Moelle Épinière, 75013 Paris, France; UMR S1127 and centre d'investigation clinique, institut national de santé et en recherche médicale, 1422, 75013 Paris, France; UMR 7225, centre national de la recherche scientifique, 75013 Paris, France
| | - C Papeix
- Assistance publique hôpitaux de Paris, département de neurologie, hôpital Pitié-Salpêtrière, 75013 Paris, France; UMR S1127, Sorbonne université, université Pierre et Marie Curie Paris 06, institut de la Moelle Épinière, 75013 Paris, France; UMR S1127 and centre d'investigation clinique, institut national de santé et en recherche médicale, 1422, 75013 Paris, France; UMR 7225, centre national de la recherche scientifique, 75013 Paris, France
| |
Collapse
|
14
|
Cognitive Deficits in Multiple Sclerosis: Recent Advances in Treatment and Neurorehabilitation. Curr Treat Options Neurol 2018; 20:53. [PMID: 30345468 DOI: 10.1007/s11940-018-0538-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE OF REVIEW This article highlights recent progress in research on treatment and neurorehabilitation of cognitive impairment in multiple sclerosis (MS) including pharmacological interventions, physical exercise, and neuropsychological rehabilitation, both in conventional and technology-assisted settings. RECENT FINDINGS The most consistent evidence in terms of improvement or preservation of circumscribed cognitive scores in MS patients comes from moderately sampled randomized clinical trials on multimodal approaches that combine conventional or computerized neuropsychological training with psychoeducation or cognitive behavioral therapy. Disease-modifying treatments also appear to have beneficial effects in preventing or attenuating cognitive decline, whereas there is little evidence for agents such as donepezil or stimulants. Finally, physical exercise may yield some cognitive improvement in MS patients. Despite substantial and often promising research efforts, there is a lack of validated and widely accepted clinical procedures for cognitive neurorehabilitation in MS. Development of such approaches will require collaborative efforts towards the design of interventions that are fundamentally inspired by cognitive neuroscience, potentially guided by neuroimaging, and composed of conventional neuropsychological training and cognitive behavioral therapy as well as physical exercise and therapeutic video games. Subsequently, large-scale validation will be needed with meaningful outcome measures reflecting transfer to everyday cognitive function and maintenance of training effects.
Collapse
|
15
|
Assis MRD, Maraglia PH, Brandão MAG, Peixoto MAP. Metacognition as an educational technology in self-care learning: the case of prevention of post-surgical lymphedema of breast cancer. ESCOLA ANNA NERY 2018. [DOI: 10.1590/2177-9465-ean-2017-0440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Aim: To introduce metacognition as an educational technology for learning self-care. In order to achieve this goal, it discusses the prevention of lymphedema after breast cancer surgery. Method: Reflexion paper based on philosophical and theoretical reasoning in adition of empirical evidence to support the use of metacognition for self care learnig. It states that using metacognitive resources as educational technology may promote more effective both teaching-learning process, stimulates critical and reflexive thinking, increasing conscious and autonomous decision-making. Results: The characteristics of metacognition and self-care interpenetrate. In addition metacognition has been beneficial in other disorders and diseases. Final considerations and implications for practice: It was concluded that the metacognitive approach, used as technology, opens wide possibilities for nursing in its teaching-learning actions for self-care, making them more effective, resulting in the empowerment of women, specifically enabling clients to make decisions, making the process more conscious, deliberate and autonomous.
Collapse
|
16
|
Perceived cognitive deficits and depressive symptoms in patients with multiple sclerosis: Perceived stress and sleep quality as mediators. Mult Scler Relat Disord 2018; 25:150-155. [PMID: 30081314 DOI: 10.1016/j.msard.2018.07.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 05/11/2018] [Accepted: 07/10/2018] [Indexed: 11/24/2022]
Abstract
Multiple Sclerosis (MS), an autoimmune disorder marked by inflammation of the central nervous system, is associated with a myriad of symptoms. Individuals with MS are more likely to experience depressive symptoms, perhaps due to perceived cognitive impairments. Thus, we aimed to explore perceived stress and sleep deficits as potential mediators of the association between perceived cognitive deficits and depressive symptoms. We recruited a sample of 77 MS participants from an outpatient, university-based MS clinic in the United States. Participants ranged in age between 30 and 75 years old (M = 51.12; SD = 9.6), with more females than males (83% female; n = 64). Participants completed the Perceived Deficits Questionnaire, the Pittsburgh Sleep Quality Index, the Perceived Stress Scale, and the Center for Epidemiological Studies Depression Scale - Revised. Correlation analyses and mediation analyses were conducted with bootstrapping technique. Statistical analyses revealed that higher levels of perceived cognitive deficits were associated with lower quality of sleep, more perceived stress, and higher levels of depressive symptoms. Additionally, both perceived stress and sleep quality served as a significant mediator in the perceived cognitive impairments and depressive symptoms linkage. Our novel findings demonstrate the importance of underlying mechanisms (e.g., sleep quality and perceived stress) in the conceptualization of MS. Perceived stress and sleep quality are potentially modifiable factors, perhaps serving as a target for future treatment, to buffer risk of MS patients developing depression.
Collapse
|
17
|
Goverover Y, Chiaravalloti ND, O'Brien AR, DeLuca J. Evidenced-Based Cognitive Rehabilitation for Persons With Multiple Sclerosis: An Updated Review of the Literature From 2007 to 2016. Arch Phys Med Rehabil 2018; 99:390-407. [DOI: 10.1016/j.apmr.2017.07.021] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 07/11/2017] [Accepted: 07/19/2017] [Indexed: 01/24/2023]
|
18
|
Hansen S, Lautenbacher S. Neuropsychological Assessment in Multiple Sclerosis. ZEITSCHRIFT FUR NEUROPSYCHOLOGIE 2017. [DOI: 10.1024/1016-264x/a000197] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Abstract. Neuropsychological deficits in multiple sclerosis (MS) are common. Over the past decades, many different procedures have been employed in diagnosing these deficits. Even though certain aspects of cognitive performance such as information processing speed and working memory may be affected more frequently than other cognitive functions, no specific deficit profile has been established in MS. This article provides an overview of the neuropsychological diagnostic procedures in MS and allows the reader to reach an informed decision on the applicability of specific procedures and the availability of study data in the context of MS. Additionally, it makes recommendations on the compilation of both screening procedures and extensive test batteries.
Collapse
Affiliation(s)
- Sascha Hansen
- Klinikum Bayreuth GmbH, Betriebsstätte Hohe Warte, Department of Neurology, Bayreuth, Germany
- Otto-Friedrich-University, Department of Physiological Psychology, Bamberg, Germany
| | - Stefan Lautenbacher
- Otto-Friedrich-University, Department of Physiological Psychology, Bamberg, Germany
| |
Collapse
|
19
|
Novais PGN, Batista KDM, Grazziano EDS, Amorim MHC. The effects of progressive muscular relaxation as a nursing procedure used for those who suffer from stress due to multiple sclerosis. Rev Lat Am Enfermagem 2016; 24:e2789. [PMID: 27598379 PMCID: PMC5016008 DOI: 10.1590/1518-8345.1257.2789] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 03/15/2016] [Indexed: 11/22/2022] Open
Abstract
Objective: to evaluate the effect of progressive muscle relaxation as a nursing procedure on the levels of stress for sufferers of multiple sclerosis. Method: random clinical trials conducted at the Neurology outpatients unit at a University Hospital. The sample consisted of 40 patients who were being monitored as outpatients (20 in a control group and 20 in an experimental group). The Progressive Muscle Relaxation technique was used. The control variables were collected through interviews that were recorded on forms and on the Perceived Stress Scale that we used. Five meetings were held every fortnight covering a period of eight weeks. The experimental group was advised to carry out daily progressive muscle relaxation activities. After eight weeks of these activities, they were evaluated again to measure their levels of stress. In order to analyze the data used, the software package Statistics for Social Sciences version 19.0 was used. Results: the application of the t test showed a significant reduction in the Perceived Stress Scale scores in the experimental group (p<0.001), which in turn proved that there was a reduction in the levels of stress after the application of the relaxation practic-es. Conclusion: the progressive muscle relaxation activities contributed to the reduction in stress levels for multiple sclerosis suffers and thus can be used in nursing for patients. Clinical Trials Identifier: NCT 02673827.
Collapse
Affiliation(s)
| | - Karla de Melo Batista
- PhD, Adjunct Professor, Departamento de Enfermagem, Universidade Federal do Espírito Snto, Vitória, ES, Brazil
| | - Eliane da Silva Grazziano
- PhD, Adjunct Professor, Departamento de Enfermagem, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Maria Helena Costa Amorim
- PhD, Associate Professor, Departamento de Enfermagem, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
| |
Collapse
|
20
|
Hämäläinen P, Rosti-Otajärvi E. Cognitive impairment in MS: rehabilitation approaches. Acta Neurol Scand 2016; 134 Suppl 200:8-13. [PMID: 27580900 DOI: 10.1111/ane.12650] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 11/29/2022]
Abstract
Cognitive deficits have been reported in 45%-70% of patients with multiple sclerosis (MS). Like other symptoms of MS, cognitive deficits are highly variable. Slowed information processing and memory and learning dysfunction are regarded as the most frequent cognitive deficits in MS. Both white and gray matter damages have been suggested to contribute to cognitive impairments in MS. There is no direct relationship between cognitive deficits and physical disability, disease duration or course of the disease. In addition to cognitive impairments, neuropsychiatric symptoms are observed in MS, the most common being alterations in mood state. Neurobehavioral deficits have multidimensional effects on the activities of daily living and quality of life. Consequently, attention should be paid to early diagnosis and treatment. Based on studies on cognitive retraining and more multimodal neuropsychological rehabilitation, both approaches show promise in the treatment of cognitive impairments and their harmful effects. This review introduces the frequency and characteristics of cognitive impairments, as well as main findings on the effects of neuropsychological rehabilitation in MS.
Collapse
Affiliation(s)
- P. Hämäläinen
- Masku Neurological Rehabilitation Centre; Masku Finland
| | - E. Rosti-Otajärvi
- Department of Neurology and Rehabilitation; Tampere University Hospital; Tampere Finland
| |
Collapse
|
21
|
Wendebourg MJ, Feddersen LK, Lau S, Köpke S, Moss-Morris R, Heesen C, Pöttgen J. Development and Feasibility of an Evidence-Based Patient Education Program for Managing Fatigue in Multiple Sclerosis: The "Fatigue Management in MS" Program (FatiMa). Int J MS Care 2016; 18:129-37. [PMID: 27252600 DOI: 10.7224/1537-2073.2014-105] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is an inflammatory and neurodegenerative disease of the central nervous system. Fatigue is a common and disabling symptom, often causing decreased quality of life, social withdrawal, and unemployment. We developed and studied the feasibility of a cognitive-behavioral group intervention to manage fatigue in MS. We aimed to integrate the concepts of cognitive-behavioral therapy and evidence-based patient information. METHODS We conducted patient interviews and a focus group to assess patients' interest in and need for fatigue self-management training and developed the program accordingly. The program consists of six 90-minute modules, which were structured with the use of moderation cards, helping to guarantee treatment fidelity. The program was tested on three pilot groups (N = 16) in a rehabilitation center. Fatigue, depression, and coping self-efficacy were assessed at baseline and after the intervention. Acceptance and general satisfaction with the program were also evaluated. RESULTS Patient interviews elicited different characteristics of fatigue, suggesting that patients had different requirements. The program was very acceptable to patients. Pre-post assessments of the pilot study showed significantly improved scores on the Coping Self-Efficacy Scale (P = .013) but not on the Fatigue Scale for Motor and Cognitive Functions and the 30-item Inventory of Depressive Symptomatology. CONCLUSIONS These preliminary results suggest that this program is a feasible cognitive-behavioral group training program that may improve coping self-efficacy and has the potential to subsequently reduce fatigue. The next step is evaluation of the program in a randomized controlled trial.
Collapse
Affiliation(s)
- Maria Janina Wendebourg
- Institute of Neuroimmunology and Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (MJW, LKF, SL, CH, JP); Nursing Research Unit, Institute of Social Medicine, University of Lübeck, Lübeck, Germany (SK); and Health Psychology Section, Institute of Psychiatry, King's College London, London, UK (RM-M)
| | - Lena Katharina Feddersen
- Institute of Neuroimmunology and Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (MJW, LKF, SL, CH, JP); Nursing Research Unit, Institute of Social Medicine, University of Lübeck, Lübeck, Germany (SK); and Health Psychology Section, Institute of Psychiatry, King's College London, London, UK (RM-M)
| | - Stephanie Lau
- Institute of Neuroimmunology and Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (MJW, LKF, SL, CH, JP); Nursing Research Unit, Institute of Social Medicine, University of Lübeck, Lübeck, Germany (SK); and Health Psychology Section, Institute of Psychiatry, King's College London, London, UK (RM-M)
| | - Sascha Köpke
- Institute of Neuroimmunology and Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (MJW, LKF, SL, CH, JP); Nursing Research Unit, Institute of Social Medicine, University of Lübeck, Lübeck, Germany (SK); and Health Psychology Section, Institute of Psychiatry, King's College London, London, UK (RM-M)
| | - Rona Moss-Morris
- Institute of Neuroimmunology and Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (MJW, LKF, SL, CH, JP); Nursing Research Unit, Institute of Social Medicine, University of Lübeck, Lübeck, Germany (SK); and Health Psychology Section, Institute of Psychiatry, King's College London, London, UK (RM-M)
| | - Christoph Heesen
- Institute of Neuroimmunology and Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (MJW, LKF, SL, CH, JP); Nursing Research Unit, Institute of Social Medicine, University of Lübeck, Lübeck, Germany (SK); and Health Psychology Section, Institute of Psychiatry, King's College London, London, UK (RM-M)
| | - Jana Pöttgen
- Institute of Neuroimmunology and Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (MJW, LKF, SL, CH, JP); Nursing Research Unit, Institute of Social Medicine, University of Lübeck, Lübeck, Germany (SK); and Health Psychology Section, Institute of Psychiatry, King's College London, London, UK (RM-M)
| |
Collapse
|
22
|
Brown CL, Colbeck M, Fogarty D, Funk S. Learning to live with multiple sclerosis cognitive impairment and how it influences readiness for group cognitive intervention. Disabil Health J 2016; 9:638-45. [PMID: 27297229 DOI: 10.1016/j.dhjo.2016.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 03/26/2016] [Accepted: 04/26/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Up to 65% of people with multiple sclerosis (MS) have cognitive impairment that negatively affects quality of life, social functioning, and work. Evidence is building to suggest cognitive rehabilitation is a helpful intervention strategy, and that a group approach can be effective for individuals with MS. Further exploration of how to maximize the potential of group cognitive interventions is warranted. OBJECTIVE To describe how the psychological process of learning to live with MS-related cognitive changes influences participation in a group cognitive intervention. METHODS A qualitative design with interpretive description approach was used to ask consumers with MS the important features of a group cognitive intervention. Ten females with self-reported physician-diagnosed MS participated in two focus groups. Focus groups were audio recorded and transcribed. Inductive analysis resulted in content and process categories and themes. RESULTS The focus groups echoed the processes and relationships that occur in a group intervention program. The main three themes represented stages in a process of learning to live with cognitive changes. The three themes were: 1) coming to know yourself with cognitive changes, 2) learning to cope with cognitive changes and 3) living a changed life. Relationships exist between these stages and the extent to which an individual will benefit from a group cognitive intervention program. CONCLUSIONS Knowledge of group process and the psychological processes involved in behavioral change are essential skills for facilitating a cognitive intervention group for people with MS.
Collapse
Affiliation(s)
- Cara L Brown
- Department of Occupational Therapy, College of Rehabilitation Sciences, University of Manitoba, R106 - 771 McDermot Avenue, Winnipeg, MB, Canada R3T 2N2.
| | - Melissa Colbeck
- Department of Occupational Therapy, College of Rehabilitation Sciences, University of Manitoba, R106 - 771 McDermot Avenue, Winnipeg, MB, Canada R3T 2N2
| | - Danielle Fogarty
- Department of Occupational Therapy, College of Rehabilitation Sciences, University of Manitoba, R106 - 771 McDermot Avenue, Winnipeg, MB, Canada R3T 2N2
| | - Sara Funk
- Department of Occupational Therapy, College of Rehabilitation Sciences, University of Manitoba, R106 - 771 McDermot Avenue, Winnipeg, MB, Canada R3T 2N2
| |
Collapse
|