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 |