Symptom Changes in Multiple Sclerosis Following Psychological Interventions: A Systematic Review

Francesco Pagnini; Colin M Bosma; Deborah Phillips; Ellen Langer

BMC Neurol. 2014;14(222)

Abstract and Introduction

Abstract

Background Multiple Sclerosis is a disease of the central nervous system involving a variety of debilitating physical, sensory, cognitive and emotional symptoms. This literature review evaluated the impact of psychological interventions on the physiological symptoms associated with the illness.

Methods A systematic literature search was conducted using Medline, PsycINFO, Scopus, and the Cochrane Library databases, as well as reference lists. Relevant studies were selected and assessed according to a preset protocol.

Results The search produced 220 articles, with 22 meeting inclusion criteria for the review. A total of 5,705 subjects with Multiple Sclerosis were analyzed. Results from the included studies indicate a general improvement in both psychological and physiological outcomes following psychological treatment. The most highly influenced physical symptoms include fatigue, sleep disturbances, pain, and physical vitality.

Conclusions Findings from the review suggest a positive relationship between psychological interventions and physiological Multiple Sclerosis symptoms. Implications for future research are discussed.

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Abstract and Introduction
Background
Methods
Results
Discussion
Conclusions
References

Table 1. Included studies
Study	Patients (n)	Severity of symptoms	Mean disease duration	Mean age	Type of intervention	Duration of the intervention	Type of control	Results on psychological variables	Results on symptoms
Barlow et al. [31]	216	N/R	12 years		Chronic Disease Self-Management Course, a lay-led self-management intervention that provides participants with a range of skills and strategies	6 weeks	Waiting-list	CDSMC had an impact on self-management self- efficacy and trends towards improvement on depression and MS self-efficacy were noted. All improvements were maintained at 12-months	CDSMC had an impact on MSIS physical status
Stuifbergen et al.[32]	113	15.65 on the Incapacity Status Scale	10.76 years	45,79	lifestyle-change classes and telephone follow-up	8 weeks	Waiting-list	Improvement of self-efficacy, health-promoting behaviors and mental health (SF36)	Reduction of Bodily Pain as measured with the SF36, no difference on the severity of impairment as measured with the Incapacity Status Scale
Ghafari et al. [33]	66	EDSS <5.5	2 years	31,5	Progressive Muscle Relaxation Technique	63 sessions during two months	No intervention	One and two months after intervention the experimental group reported better QoL	The physical component of QoL (PCS-8) improved as well
Tesar et al. [34]	29	EDSS <5.5 (mean 3.2)	5.1 years	38.2	Psychological program which combines proven cognitive-behavioral strategies for coping with stress with body exercises	7 weeks	Waiting-list	The therapy group showed long-term improvements in depressive stress coping style	The therapy group showed short-term improvement in "vitality and body dynamics".
Forman & Lincon [35]	40	23 on the Guys Neurological Disability Scale	9.8 years	47.5	The intervention group programme was designed for people with multiple sclerosis and focused on adjustment to illness.	6 weeks	Waiting-list	Patients allocated to the group intervention reported fewer depressive symptoms than those in the control group but there were no significant differences in anxiety symptoms, self-efficacy or quality of life.	No changes on the MS Impact Scale - Physical
O'Hara et al. [36]	183	17 (median) on the Barthel Index	11.8 years	51.5	The intervention comprised discussion of self-care based on client priorities, using an information booklet about self-care.	The discussions lasted between 1 and 2 hours and were conducted on two occasions, over a one month period.	No intervention	At follow-up the intervention group had better SF-36 health scores, in mental health and vitality. Participants in the intervention group had maintained levels of independence at follow-up while the control group showed a signicant decrease in independence	Participants in the intervention group reported that assistance with daily activities was less essential than individuals in the control group at follow-up; However, there were no improvements in independence in daily living, mobility or a reduction in the number of occasions individuals were assisted with activities
Baron et al. [37]	127	22.4 on the Guys Neurological Disability Scale; patients with insomnia	N/R	48.1	telephone administered cognitive behavioral therapy	16 weeks	telephone administered supportive emotion-focused therapy	Improvements in depression and anxiety	Improvement in insomnia
Tompkins et al. [38]	3623	N/R		48.9 RM; 43.5 Control	PREP for participant and partner in workshop sessions or teleconference series; 8 hrs programming (1 or 2 days or 4–6 wks for teleconference)	In person 1–2 days or teleconference 4–6 weeks	No intervention	RM improvement with increased QoL at 3 months	Number of MS symptoms at baseline not signfiicantly different at baseline between groups but comorbidiities did (with control at fewer), controled at analysis stage. Improved communications; willingness to try; better prepared for issues; acquisition of tools to address MS issues with partner
Khan et al. [39]	101	EDSS between 2 and 8; KFS 0–2	10.69 (TR); 9.73 (Control)	49.5 TR; 51.1 Control	Individualised rehabilitation programme	12 months	waiting-list	MSIS and GHQ-28 assessed participation and QoL; no differences between control and treatment on MSIS physical or psychological or GHQ subscales	FIM motor scores improvement at statistically significant levels for 2 groups.
Sutherland et al. [40]	22	EDSS < = 5.0; no prior CB techniques for 6 months prior to study	Diagnosis : 9.36 yrs (TR); 6.45 yrs (Control)		AT program supervised training	10 weeks	No intervention	HRQOL positively affected;participants in relaxation less limited by physical findings but not for the AT . AT group positively impacted regarding role limitations due to emotional problems.	Pain dimension large effect of MSQOL indicates AT practice may associate with diminished pain perception.; Improved vigor (POMS); decreased perception of fatigue
Maguire [41]	33	N/R	N/R	45.13	Relaxation training and ongoing work with biologically oriented imagery.	6 days	Standard care	Imagery group subjects demonstrated significant reductions in state anxiety and significant alteration in their illness imagery	No significant differences were found between the two groups with regard to decrease in MS symptoms across time
Mathiowetz et al. [42]	169	Multiple Sclerosis Functional Composite score: −.97	15 years	48,8	Energy Conservation course	6 weeks	Waiting-list	increase self-efficacy and some aspects of quality of life	significant effects on reducing the physical and social subscales of Fatigue Impact Scale and on increasing the Vitality subscale of the SF-36 scores
Grossman et al. [43]	150	EDSS =3	8.7 years	47.29	A modified version of the Mindfulness-Based Stress Reduction (MBSR)	8 weeks	Usual Care	improvement on Quality of Life and other measures of well-being, for at least 8 months	Improvement on fatigue
Tavee et al. [44]	17	3,25 (Experimental group); 2,79 (controls)	10,4 (Experiemental group); 19,4 (Controls)	48,7	Meditation	2 months	Standard care	General improvement on mental health	Improvements on pain perception, phisical health, fatigue and vitality
Van Kessel et al. [45]	72	EDSS =3,45	6 years	45	CBT based on a cognitive behavior model of fatigue	8 weeks	relaxation training	A significant time effect was obtained for depression, anxiety and perceived stress, with both groups. CBT performed better, on this regard, at the post-treatment, but not at follow-up evaluations	Both CBT and RT appear to be clinically effective treatments for fatigue in MS patients, although the effects for CBT are greater than those for RT.
Mohr et al. [46]	121	EDSS =3,1	7,05 since diagnosis	42.66	individual stress management program	20–24 weeks	Waiting-list	Participants in the experiemental group reported lower level of distress	Reduction of brain lesions in comparison with the control group (lower number of new gadolinium-enhancing brain lesions on MRI)
Mohr et al. [47]	60	N/R	8.5 years	44,6	individual cognitive behavioral therapy, group psychotherapy	16 weeks	sertraline	Reductions on depression for each group	treatment for depression is associated with reductions in the severity of fatigue symptoms, and that this relationship is due primarily to treatment related changes in mood
Schwartz [48]	132	EDSS =4,7	7,9	43	coping skills group	8 weeks	peer telephone support	coping skills intervention yielded gains in psychosocial role performance, coping behavior, and numerous aspects of well-being. In contrast, the peer support intervention increased external health locus of control but did not influence psychosocial role performance or well-being	No differences between the two groups on physical limitations and fatigue
Wassem & Dudley [49]	27	EDSS =3,36	3,49	44	nursing intervention in promoting adjustment and symptom management	4 weeks	Not specified	Treatment participants had significant improvements in symptom management at the 4-yearfollow up	significant improvements in sleep and fatigue levels
Lincon et al. [50]	240				The assessment group received a detailed cognitive assessment; the treatment group received the same cognitive assessment and a treatment programme designed to help reduce the impact of their cognitive problems		No intervention	no effect of the interventions on mood, quality of life, subjective cognitive impairment or independence.	No differences among the three groups on perceived health
Mohr et al. [51]	14	EDSS =3,6	11.3	47.4	individual cognitive behavioral therapy, group psychotherapy	16 weeks	Sertraline	Reductions on depression for each group	successful treatment of MS depression (either pharmacologically or with psychotherapy) can reduce IFNg production by OKT3 or MBP-stimulated immune cells
Kopke et al. [52]	150	United Kingdom Neurological Disability Scale =7,9	5,2	38	Patient education program to enhance decision autonomy	4 hours	Standard care	The patient education program led to more autonomous decision making in patients with relapsing MS	The number of relapses reported by subjects in the experimental group was considerably lower than the one from controls