Psychosocial interventions in people with multiple sclerosis
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Upon diagnosis individuals with Multiple Sclerosis (MS) must cope with both day to day and disease-related stressors in addition to unpredictable, fluctuating and confusing symptoms. Furthermore, disease progression may interfere with employment, family life, relationships and social activities. Psychosocial interventions aim to help individuals manage these psychological, social and emotional challenges. However, there are no specific guidelines available regarding the most effective intervention content, format or delivery. Therefore, a review of the research that has utilised these interventions, specifically those which, by definition, aimed to improve quality of life (QoL) and/or well-being in people with MS, was considered essential in order to identify which aspects of these interventions may help alleviate the psychosocial challenges associated with MS.
To identify all randomised controlled trials (RCTs), quasi-experimental, cohort, case control and case series studies that have investigated psychosocial interventions in people with MS which aimed to improve QoL and/or well-being, to establish the methodological quality of such studies, and to determine the effectiveness of the interventions.
Searches were carried out using computerised databases with predefined search terms; this was supplemented by manual searches of reference lists of all retrieved articles. Relevant journals were also hand searched.
Studies written in English and published before January 2006, investigating the effectiveness of psychosocial interventions on QoL and/or well-being in people with MS, were eligible for inclusion.
Data collection and analysis
Methodological quality was independently assessed by two reviewers using the Downs and Black quality scoring checklist. The qualitative and quantitative characteristics of studies were extracted using a data extraction sheet.
Thirty-three studies fulfilled the inclusion criteria; however, interventions varied widely in content, delivery and duration. Furthermore, failure to report full methodological details, as well as weaknesses in study design, reduced the strength of inferences that could be drawn from these studies. These notwithstanding, there were three studies of sufficient quality to provide some evidence regarding the value of education/information, goal setting, homework assignments, exercise, discussion forums and multidisciplinary team support. Thus, this review has identified the potential benefit of the aforementioned activities in the psychosocial management of this population. However, further well designed clinical trials are warranted to determine, definitively, the effectiveness, or otherwise, of these components.
KeywordsMultiple sclerosis psychosocial interventions systematic review emotional well-being quality of life
- 3.Centre for Reviews and Dissemination (2001) Undertaking systematic reviews of research on effectiveness. CRD Report Number 4 (2nd Edition)Google Scholar
- 5.Crawford JD, McIvor GP (1985) Group psychotherapy: benefits in multiple sclerosis. ArchPhys MedRehab 66(12):810–813Google Scholar
- 6.Crawford JD, McIvor GP (1987) Stress management for multiple sclerosis patients. PsycholReports 61(2):423–429Google Scholar
- 7.Department of Health (2005) The National Service Framework for Long-term conditions. DH Long-term Conditions NSF team (ed). Crown Copyright, London, pp19–23Google Scholar
- 9.Diener E and Lucas RE (2000) Subjective emotional well being in Lewis M and Haviland JM (eds) Handbook of emotions 2nd Ed, New York, Guilford, pp 325–337Google Scholar
- 10.Di Fabio RP, Choi T, Soderberg J, Hansen CR (1997) Health related quality of life for patients with progressive multiple sclerosis: influence of rehabilitation. Phy Therapy 77:1704–1716Google Scholar
- 11.Dix O, Glickman M (1997) Executive summary: Occasional paper 13. Working party on psychosocial care ISSN 1351–9941, pp 1–5Google Scholar
- 19.Greenstein JI (2002) Problems in clinical trial design in multiple sclerosis. Int Jf MS Care 4(3):3–7Google Scholar
- 20.Hammer A, Nilsagard Y, Forsberg A, Pepa H, Skargren E, Oberg B (2005) Evaluation of therapeutic riding (Sweden)/hippotherapy (United States). A single-subject experimental design replicated in eleven patients with multiple sclerosis. Physiother Theory Practice 21(1):51–77Google Scholar
- 23.Husted C, Pham L, Hekking A, Niederman R (1999) Improving quality of life for people with chronic conditions: the example of T’ai Chi and multiple sclerosis. Altern Therapies 5(5):70–74Google Scholar
- 25.Johnson SK, Frederick J, Kaufman M, Mountjoy B (1999) A controlled investigation of bodywork in multiple sclerosis. The Journal of Alternative and Complementary Medicine 8(3):237–243Google Scholar
- 27.Lenth RV (2001) Some practical guidelines for effective sample size determination. Department of Statistics, University of IowaGoogle Scholar
- 28.Mackay-Lyons M, Conway C, Roberts W (1988) Effects of therapeutic riding on patients with multiple sclerosis: a preliminary trial. Physiother Can 40(2):104–109Google Scholar
- 29.Maguire BL (1996) The effects of imagery on attitudes and moods in multiple sclerosis. Alternative Therapies 2(5):75–79Google Scholar
- 34.Moher D (1998) CONSORT an evolving tool to help improve the quality of reports of randomised controlled trials. JAMA 273:408–412Google Scholar
- 42.National Multiple Sclerosis Society (2000) Consortium of Multiple Sclerosis Centres, Multiple Sclerosis in 2000; a model of psychosocial support (AUTHOR PLEASE GIVE DETAILS FOR OBTAINING THIS)Google Scholar
- 43.NICE (2003) Multiple Sclerosis: Management of multiple sclerosis in primary and secondary care. Clinical Guideline 8Google Scholar
- 52.Schmid W, Aldridge D (2004) Active music therapy in the treatment of multiple sclerosis patients: a matched control study. J Music Therapy 3:225–240Google Scholar
- 57.Sullivan CL, Wilkin JA, Rabin BM, Demorest M, Bever C (2004) Psychosocial adjustment to Multiple Sclerosis. International Journal of MS Care 6:98–105Google Scholar
- 58.Sutherland G, Anderson MB, Stoove MA (2001) Can aerobic exercise training affect health related quality of life for people with multiple sclerosis? J Sport Exercise Psychol 23:122–135Google Scholar