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Psychosocial interventions in people with multiple sclerosis

A review

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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Corresponding author

Correspondence to L. Dunwoody.

Additional information

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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Keywords

  • Multiple sclerosis
  • psychosocial interventions
  • systematic review
  • emotional well-being
  • quality of life