Online psychological interventions to improve symptoms in multiple sclerosis: A systematic review

Abstract

The aim of this systematic review was to assess the effectiveness of Internet‐based psychological interventions in the treatment of physical, socio‐affective and cognitive symptoms and quality of life (QoL) in people with multiple sclerosis (pwMS) to provide currently available evidence. Systematic searches for eligible studies were carried out in four databases (August 2021) using key words. Studies were screened, data extracted, quality appraised and analysed by three independent reviewers, using predefined criteria and following the PRISMA rules. Study quality was assessed using Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields QUALSYST tool. Physical, socio‐affective and cognitive symptoms and QoL were the primary outcomes. Thirteen studies were included. Two principal approaches were reported: Cognitive behavioural therapy (CBT) and mindfulness‐based interventions (MBI). Interventions varied from tailored versions to videoconference by a clinician, duration mean 8 weeks, delivered via individually and groups, all online. The review found that iCBT interventions were effective for improve depression, anxiety, fatigue and QoL, and slightly in cognitive functioning in pwMS, whereas MBI interventions reported benefits in depression, anxiety, stress and QoL, and less evidence in fatigue. Generally, study quality was acceptable in most studies; eleven of the studies scored a low risk of bias on all items in the Qualsyst Tool, whereas only two studies were considered unacceptable. Psychological online interventions may improve physical, socio‐affective and cognitive symptoms as well as QoL in pwMS, overcoming the face‐to‐face barriers (i.e. disability). Contact with the therapist and groups sessions have been identified as enablers of the online interventions. Nevertheless, the limited number of studies and the heterogeneity of health outcomes reported made difficult to afford robust conclusions on psychological intervention effects in pwMS.

Interventions to Improve Quality of Life in Multiple Sclerosis: New Opportunities and Key Talking Points

“… Moderate level of evidence (NICE- Quality appraisal checklist for qualitative study) Qualitative Study Cognition Harand, C., Defer, G (2020) 27 Cognitive rehabilitation Moderate level of evidence demonstrating effectiveness at improving cognitive functioning, quality of life, and self-esteem Extended Review Ozkul C, Guclu-Gunduz A, et al (2020) 41 Combined exercise training (aerobic and pilates) 3x week for eight weeks. Demonstrated significant improvement in verbal memory, walking capacity, cognitive fatigue, and quality of life High level of evidence RCT (PEDRO) Montanes-Masisa B, Bort-Roig J et al (2022) 42 Cognitive behavioral therapy (CBT) and mindfulness interventions (MBI) Psychological online interventions may improve socio-affective and cognitive symptoms and improve quality of life for pwMS. Low level of evidence Systematic Review (PRISMA) Nauta I. M., Speckens, AEM, et al (2017) 26 Cognitive rehabilitation therapy (CRT) and mindfulness-based cognitive therapy (MBCT) CRT and MBCT are effective at improving the quality of life for pwMS Narrative Review Physical Health Grazioli, E., Nigro, E., C, et al (2020) 43 Four months of moderate-intensity training exercises Resulted in a statically significant improvement in perceived quality of life.…”

“…For this review, four articles meeting the inclusion criteria are about cognition and quality of life. 26 , 27 , 41 , 42 One extended review examined the effectiveness of psychosocial interventions for improving health-related quality of life and fatigue for pwMS. 27 After a comprehensive review of evidence published in 2020, the authors concluded that CBT, mindfulness, and physical exercise were effective and appropriate cognitive strategies to improve the quality of life for pwMS.…”

“…In this review, two articles specifically explored mindfulness as a strategy to improve cognitive function and quality of life. 26 , 42 Montanes-Masisa et al published a systematic review on cognitive behavioral therapy and mindfulness as interventions for cognitive impairments and quality of life. The systematic review had a relatively low amount and quality of available evidence.…”

eHealth für MS-Betroffene mit Fatigue

“…Zugelassene Medikamente zur Behandlung von MS-Fatigue gibt es in Deutschland derzeit nicht. KVT ist bei der Behandlung von MS-Fatigue auch Achtsamkeitsbasierten Interventionen überlegen [15].…”

People with newly diagnosed multiple sclerosis benefit from a complex preventative intervention—a single group prospective study with follow up

“…Preventative programmes for newly diagnosed pwMS are frequently recommended ( 4 , 8 , 9 ) and their effectiveness have been documented by several studies ( 10–16 ). Some emphasise the need for appropriate information giving ( 10–12 ), others utilise different psychotherapeutic interventions such as cognitive behavioural strategies ( 13 ) or self-management ( 14 ) as well as online psychological interventions ( 15 , 16 ). Unfortunately, the limited number of studies and the heterogeneity of health outcomes cause difficulties in making clear conclusions for daily practise.…”