Abstract
Background
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.
Objectives
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.
Search strategy
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.
Selection criteria
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.
Main results
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.
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Received in revised form: 16 March 2006
Appendix 1: Search Strategy Employed
Appendix 1: Search Strategy Employed
The following databases were searched:
AMED (Jan 1985-)
ASSIA (Jan 1987-)
BNID (Jan 1985-)
CAB (Jan 1973-)
CareData (Jan 1920-)
CINAHL (Jan 1982-)
EMBASE (Jan 1988-)
IBSS (Jan 1987-)
MEDLINE (Jan 1966-)
Proquest (Jan 1990-)
PsycINFO (Jan 1985-)
Pubmed (Jan 1990-)
The Cochrane Central Register of Controlled trials (CENTRAL) (1800-)
The Cochrane Multiple Sclerosis Group Specialised register (1800-)
Web of Science (Jan 1981-)
Zetoc (Jan 1993-)
The following keywords were identified following an extensive review of the literature:
Multiple Sclerosis/MS and anxiety
Multiple Sclerosis/MS and appraisal/personal appraisal
Multiple Sclerosis/MS and cognition
Multiple Sclerosis/MS and cognitive behavioural therapy/CBT
Multiple Sclerosis/MS and cognitive rehabilitation
Multiple Sclerosis/MS and cognitive therapy
Multiple Sclerosis/MS and control/personal control
Multiple Sclerosis/MS and coping
Multiple Sclerosis/MS and coping strategy
Multiple Sclerosis/MS and counselling
Multiple Sclerosis/MS and depression
Multiple Sclerosis/MS and education
Multiple Sclerosis/MS and educational intervention
Multiple Sclerosis/MS and emotional well-being
Multiple Sclerosis/MS and empowerment
Multiple Sclerosis/MS and exercise
Multiple Sclerosis/MS and focus group
Multiple Sclerosis/MS and group therapy
Multiple Sclerosis/MS and illness cognition
Multiple Sclerosis/MS and mindfulness
Multiple Sclerosis/MS and mood
Multiple Sclerosis/MS and problem solving
Multiple Sclerosis/MS and psychological education
Multiple Sclerosis/MS and psychological/psychological intervention
Multiple Sclerosis/MS and psychosocial/psychosocial intervention
Multiple Sclerosis/MS and psychotherapy
Multiple Sclerosis/MS and quality of life/QoL/health related quality of life/HRQOL
Multiple Sclerosis/MS and rehabilitation
Multiple Sclerosis/MS and relaxation
Multiple Sclerosis/MS and self control
Multiple Sclerosis/MS and self-efficacy
Multiple Sclerosis/MS and self help/self help strategy
Multiple Sclerosis/MS and self management
Multiple Sclerosis/MS and self monitoring
Multiple Sclerosis/MS and social support
Multiple Sclerosis/MS and social well-being
Multiple Sclerosis/MS and stress
Multiple Sclerosis/MS and stress control
Multiple Sclerosis/MS and support
Multiple Sclerosis/MS and support groups
Multiple Sclerosis/MS and supportive therapy
Multiple Sclerosis/MS and symptom management
Multiple Sclerosis/MS and well-being
Multiple Sclerosis/MS and yoga
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Malcomson, K., Dunwoody, L. & Lowe-Strong, A. Psychosocial interventions in people with multiple sclerosis. J Neurol 254, 1–13 (2007). https://doi.org/10.1007/s00415-006-0349-y
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DOI: https://doi.org/10.1007/s00415-006-0349-y