Table 1 MS INFoRm intervention website content and features

1. Initial login page

- Presents introductory video providing user with orientation to website and overview of MS fatigue

2. Basics of fatigue

- Provides definition of fatigue

- Provides facts about MS fatigue including prevalence, association with other disease-related factors, and how MS fatigue is different than regular fatigue

- Provides description of primary and secondary fatigue

- Includes section on tracking fatigue, including description of the benefits of tracking fatigue, how to track fatigue using a printable form, or on the “Rate your Fatigue” section (described below in section 3) of the website

- Provides a link to the introductory video (enables users to review initial login page information)

3. Rate your fatigue

- Allows users to rate fatigue level at each visit (limits to one entry per day) from 0 (lowest fatigue) to 10 (highest fatigue)

- Presents all ratings in a line graph that shows date and time, and rating

4. Track your goals

- After initial login page, users are prompted to set at least one fatigue management goal

- Users are prompted to enter the following for each goal: (a) What do you want to do? (b) When do you want to start doing it? (c) How often do you want to do it? (d) How will you know that you have achieved this goal? (e) How confident are you that you can achieve this goal?

- Users can update the answers to question (e) and are asked to rate the goal completion progress at each subsequent login

- Users can have 3 goals active at a time, any goals that become achieved are put in a “Goals History” page

- Users are prompted to select up to three fatigue management strategies to use to help them accomplish each goal. Strategies are described and can be selected from Sections 5 and 6 (described below) of the website

5. Influencing factors

Each of the following influencing factors, or contributors to secondary fatigue are provided on separate webpages

i. Poor sleep

- Describes the prevalence of poor sleep in persons with MS, causes of poor sleep (e.g. pain, stress, depression), definition and signs and symptoms of poor sleep, and common sleep disorders in persons with MS (insomnia, restless legs syndrome, and sleep apnea)

- Describes when to talk to a healthcare professional regarding poor sleep

- Describes 11 sleep hygiene strategies that can be used to improve sleep quality, and includes a link to a pdf sleep diary that can be used to track sleep and use of sleep hygiene strategies

ii. Medication side effects

- Describes how fatigue can be a side effect of medications

- Describes use of medications for MS fatigue

- Describes strategies for managing medication side effects and includes a link to a pdf medication side effects diary

iii. Deconditioning

- Defines physical activity, exercising, and deconditioning

- Describes how getting enough physical activity can improve fatigue

- Guides users about how to start an exercise program

- Provides strategies for being more physically active, one of which includes working towards meeting the “Canadian Physical Activity Guidelines for People with MS” (description of these guidelines provided)

iv. Cognitive fatigue

- Provides a definition of cognitive fatigue, and contributing factors

- Provides a description and examples of cognitive rehabilitation strategies that can help improve cognitive fatigue

v. Depression

- Provides a definition, and describes signs and symptoms, and prevalence of depression in MS

- Describes when to get help for depression and includes a link to pdf version of the Patient Health Questionnaire-2. Users are encouraged to make an appointment with their health care provider if their score adds up to 3 or more

- Describes how depression is treated in MS (pharmacological and non-pharmacological approaches)

- Describes strategies for managing depression (e.g. participating in therapy, talking to healthcare provider about possibility of taking antidepressant medication)

6. General fatigue

- Describes principles of energy management and provides examples and strategies for how to bank and budget energy. A link to a pdf “Rest Scheduling Worksheet” is provided to help users with banking energy

- Describes strategies for talking to other people about MS fatigue and asking for help, including five audio examples. Section also includes a link to a pdf handout which can be filled out and given to friends, family, or caregivers as a tool to teach others about MS fatigue and ask for help

- Provides examples and strategies for modifying activities in order to use energy more wisely

7. Next steps

- Provides a summary of main points from website and things to remember

- Provides quotes from people with MS who are working to manage their fatigue

- Provides links to additional resources about MS fatigue (e.g. from MS Society of Canada, National MS Society, MS International Federation, etc.)