A systematic review of the effects of modifiable risk factor interventions on the progression of multiple sclerosis

Hempel, Susanne; Graham, Glenn D.; Fu, Ning; Estrada, Elena; Chen, Annie Y.; Miake-Lye, Isomi M; Miles, Jeremy N. V.; Shanman, Roberta; Shekelle, Paul G; Beroes, Jessica M; Wallin, Mitchell T.

doi:10.1177/1352458517690271

Cited by 39 publications

(26 citation statements)

References 14 publications

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“…In Australia, vitamin D tests were the fastest growing Medicare item in recent times and testing has increased rapidly over the past 15-20 years, prompting concerns of over-testing [38]. Despite considerable research in MS suggesting that high normal vitamin D serum levels may be beneficial [39], a recent meta-analysis found no significant benefit for disease progression compared to placebo [19], potentially due to a paucity of suitably robust clinical trials. There are numerous large randomized trials investigating the efficacy of high dose vitamin D supplementation in people with MS due to release results soon, which may assist in elucidating the potential benefits of vitamin D supplementation for people with MS.…”

Section: Vitamin D and Sun Exposurementioning

confidence: 99%

“…By contrast, multimodal intervention studies are scarce, even though they may be most effective [18], and effects may be multiplicative. In addition, as many trials lack longitudinal follow-up [19], an international multidisciplinary working group has called for more research in this area [20]. Lifestyle intervention trials can be difficult to design and conduct [21], but such evidence is needed to enable a shift in MS management towards a more holistic approach [22].…”

Section: Introductionmentioning

confidence: 99%

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Understanding barriers, enablers, and long-term adherence to a health behavior intervention in people with multiple sclerosis

Barnard

Brown

Weiland

et al. 2018

Disability and Rehabilitation

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Background: The optimal management strategy for multiple sclerosis (MS), and many other chronic diseases, likely involves health behavior modification. Multimodal behavioral interventions may be most effective, but little is known about long-term adherence in people with MS. Methods: This qualitative study assessed barriers and enablers to long-term adherence by people with MS who self-selected for a 5-day health behavior intervention 3-5 years prior. Thirteen women and five men participated in semi-structured phone interviews, which were transcribed and thematically analyzed. Results: The experience was described as useful for information gathering, decision making, and practical strategies regarding health behaviors. The majority still followed supplementation and dietary recommendations most of the time, although consuming non-recommended food while eating out was common. Support at home, ability and enjoyment in food preparation, and ability to resist unhealthy foods were both barriers and enablers. Adherence to "time-consuming" exercise and meditation recommendations were less common and episodic. Many reported competing interests on time from work and family; and barriers including injuries and symptoms, weather, financial or geographical barriers, and lack of personcentred support and motivation. Increased fitness and mobility, weight loss, and a sense of accomplishment and control were advantages and motivators. Practical and attitudinal strategies employed included planning, tailoring activities to ability and preference, and self-monitoring. Conclusion: While most people attempted to engage with all components of the intervention initially, only some still engaged with all components, and none to the recommended levels. These data can inform future quantitative studies and health behavior interventions. ä IMPLICATIONS FOR REHABILITATION A multimodal group lifestyle intervention may be useful to assist people with multiple sclerosis in information gathering, decision making, attitudinal changes, and practical strategies regarding health behaviors; as well as providing a sense of hope for the future and control over wellbeing. While participants are unlikely to engage with all components of a multimodal intervention to the recommended level, they are likely to make improvements to one or more health behaviors. Experiential learning, including going through recipes and ingredient lists, and practicing meditation and physical exercises, is helpful to instigate behavior change. The initiation and maintenance of behavior change was assisted by support from family, friends, and health practitioners; and practical strategies employed by participants, including planning, self-monitoring, and tailoring activities to ability and preference ARTICLE HISTORY

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Section: Vitamin D and Sun Exposurementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Understanding barriers, enablers, and long-term adherence to a health behavior intervention in people with multiple sclerosis

Barnard

Brown

Weiland

et al. 2018

Disability and Rehabilitation

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“…For the other eleven risk factors, which included diet, alcohol, exercise and trauma there was insufficient evidence to determine a compelling relationship with progression. In their companion paper, 37 trials of the effect of modifiable risk factor interventions on progression were reviewed and no clear beneficial effect from any risk factor was identified 23 . The evidence base for rehabilitation and symptomatic management in progressive MS is also quite limited 24 .…”

Section: Clinical Trials In Progressive Msmentioning

confidence: 99%

Challenge of progressive multiple sclerosis therapy

Thompson¹

2017

Current Opinion in Neurology

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“…Hempel et al [52] konnten keinen Einfluss einer Vit.-D-Supplementation auf den EDSS-Score nachweisen, jedoch zeigen die Überzahl an Studien in verschiedenen Parametern einen positiven Effekt. Niedrige 25(OH)-D-Spiegel wurden 2 -3 Jahre vor klinischer Manifestation der MS bei Epstein-Barr-Virus-Infektion gesehen [53].…”

Section: Vitamin-d-supplementation -Pragmatismus Gefragt?unclassified

Die Post-Alemtuzumab-Therapie-induzierte Schilddrüsendysfunktion bei schubförmig-remittierender MS (RRMS) – ein variantenreiches Krankheitsbild auf einem interdisziplinären Terrain

Goischke¹

2017

Akt Neurol

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ZusammenfassungAlemtuzumab-induzierte Schilddrüsendysfunktionen (engl.: Alemtuzumab-induced thyroid dysfunction; AITD) können die Lebensqualität von MS-Patienten wesentlich beeinträchtigen, wenn diese Nebenwirkung nicht rechtzeitig erkannt und adäquat von allen Fachrichtungen reagiert wird. Vor Alemtuzumab-Therapie sollten der TSH-Spiegel und die Schilddrüsen-AK untersucht werden. Bei Nachweis von TPO-AK vor Beginn der Behandlung betrug das Risiko 69 %, eine AITD zu entwickeln im Vergleich zu TPO-negativen Patienten mit nur 31 %.Trotzdem waren 85 %, die eine AITD später entwickelten, vor Therapie TPO-AK-negativ, sodass AK-Negativität basal kein Schutz vor AITD darstellt. Deshalb müssen die periodischen Tests streng durchgeführt werden. Eine interdisziplinäre Zusammenarbeit von Neurologen, Internisten (Endokrinologen) und Gynäkologen führt zum rechtzeitigen Erkennen des variantenreichen klinischen Verlaufes bei wechselnden biochemischen Befunden mit entsprechenden diagnostischen und therapeutischen Konsequenzen. Da die klinischen Symptome der Hypothyreose/Hyperthyreose sich mit denen der MS überschneiden können, ist die Bestimmung von laborchemischen Parametern auch im Verlauf rechtzeitig unerlässlich, insbesondere bei graviden Patientinnen. Durch die kostengünstige und gut verträgliche Add-on-Therapie mit Vitamin D mit multiplen Zielwirkungen – 1. auf die AITD, 2. auf die Reduktion der Krankheitsaktivität und 3. auf die positive Beeinflussung einer Gravidität (Verringerung einer niedrigen Geburtsgewichts-, Eklampsie- und Frühgeburtenrate, Reduktion der Übertragung der MS auf die Nachkommenschaft) – sollte trotz noch offener Fragen den Betroffenen die Chance zur Minderung der Progression nicht verwehrt werden. Der Arzt spielt eine wichtige Rolle in der Stärkung der Fähigkeit der Patienten, ihre eigene Krankheit zu managen, um die Krankheitsprogression zu vermindern. Im Arzt-Patienten-Gespräch sollte die Reduzierung von Risikofaktoren (z.B. Vit.-D-Mangel) thematisiert werden. Ein Engagement für ein optimales interdisziplinäres Management mit Therapieindividualisierung und Reduzierung von Arzneimittelnebenwirkungen verbessert die Lebensqualität von MS-Patienten.

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A systematic review of the effects of modifiable risk factor interventions on the progression of multiple sclerosis

Abstract: We did not identify any risk factor interventions with significant effects on MS progression, but the overall QoE was limited. More adequately powered trials are needed on vitamin D supplementation, long-term exercise, and smoking cessation.

Cited by 39 publications

References 14 publications

Understanding barriers, enablers, and long-term adherence to a health behavior intervention in people with multiple sclerosis

Understanding barriers, enablers, and long-term adherence to a health behavior intervention in people with multiple sclerosis

Challenge of progressive multiple sclerosis therapy

Die Post-Alemtuzumab-Therapie-induzierte Schilddrüsendysfunktion bei schubförmig-remittierender MS (RRMS) – ein variantenreiches Krankheitsbild auf einem interdisziplinären Terrain

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