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Table 1 Included studies

From: Symptom changes in multiple sclerosis following psychological interventions: a systematic review

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