Randomized trial of a teleconference-delivered fatigue management program for people with multiple sclerosis
ABSTRACT Previous studies support the efficacy and effectiveness of face-to-face group-based fatigue management education for people with multiple sclerosis (MS). Nevertheless, many people are unable to access these programs due to environmental barriers.
To test the efficacy and effectiveness of a group-based, teleconference-delivered fatigue management program for people with MS.
A randomly allocated two-group time series design with a wait-list control group was used. In total 190 participants were allocated (94 intervention, 96 wait-list control). Primary outcomes (fatigue impact, fatigue severity, health-related quality of life (HRQOL)) were measured before, immediately after, at 6 weeks, 3 months, and 6 months post. Secondary outcome (self-efficacy) was measured at the same points. Effectiveness (intent-to-treat) and efficacy (per protocol) analyses were conducted.
The program was more effective and efficacious than control for reducing fatigue impact but not fatigue severity. Before and after comparisons with the pooled sample demonstrated efficacy and effectiveness for fatigue impact, fatigue severity, and 6 of 8 HRQOL dimensions. Changes were maintained for 6 months with small to moderate effect sizes.
The results offer strong support for the viability of teleconference-delivered fatigue management education for enabling people with MS to manage this disabling symptom.
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- "We are also seeing the delivery of self management social learning groups offered in nonmedical, community settings such as Senior Centers and Centers for Independent Living. Several U IC researchers are focusing on creating and testing innovative self management interventions in which peer mentors partner with occupational therapists to work on development of key health, community living, emergency preparedness, and social participation skills and self-efficacy (Finlayson, Peterson, & Cho, 2009; Finlayson et al., 2011; G arcia et al., 2008; Hammel et al., 2013; H ammel, Finlayson, & Lee, 2014; Minkler et al., 2008; Tennstedt et al., 1998). A nother important policy change that we need to recognize that has tremendous implications for occupational therapists is the A ffordable Care A ct (A CA ) of 2010, which is introducing remarkable transformations to the U S healthcare system. "
ABSTRACT: Trends in policy, practice, and research point to the need for a community-engaged Scholarship of Practice (SOP) model that can be used to inform the development of occupational therapy practitioners, educators, and researchers. This article describes a community-engaged SOP model, the evidence justifying the need for such a model, and strategies to effectively create community-engaged practitioners, educators and career scientists within occupational therapy. We highlight several examples of community-based participatory research to further inform this model, and in turn, translate this knowledge back to communities for action and systems change that can affect the lives of people with disabilities and the communities in which they seek to live and participate long term.Occupational Therapy in Health Care 08/2015;
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- "Eighteen rehabilitation intervention trials (ten exercise intervention trials [25–34] and eight educational intervention trials [35–42]) and seven pharmacological intervention trials [43–49] targeting fatigue were selected. A wide range of exercise interventions were prescribed (e.g., aerobic, aquatic, and inspiratory muscle exercise; vestibular rehabilitation program; progressive resistance training; climbing; and yoga). "
ABSTRACT: Fatigue is a common symptom of multiple sclerosis (MS) with negative impacts extending from general functioning to quality of life. Both the cause and consequences of MS fatigue are considered multidimensional and necessitate multidisciplinary treatment for successful symptom management. Clinical practice guidelines suggest medication and rehabilitation for managing fatigue. This review summarized available research literature about three types of fatigue management interventions (exercise, education, and medication) to provide comprehensive perspective on treatment options and facilitate a comparison of their effectiveness. We researched PubMed, Embase, and CINAHL (August 2013). Search terms included multiple sclerosis, fatigue, energy conservation, Amantadine, Modafinil, and randomized controlled trial. The search identified 230 citations. After the full-text review, 18 rehabilitation and 7 pharmacological trials targeting fatigue were selected. Rehabilitation interventions appeared to have stronger and more significant effects on reducing the impact or severity of patient-reported fatigue compared to medication. Pharmacological agents, including fatigue medication, are important but often do not enable people with MS to cope with their existing disabilities. MS fatigue affects various components of one's health and wellbeing. People with MS experiencing fatigue and their healthcare providers should consider a full spectrum of effective fatigue management interventions, from exercise to educational strategies in conjunction with medication.05/2014; 2014(3):798285. DOI:10.1155/2014/798285
- "However, another trial of an education-based management program did not find it to be effective, possibly due to a less interactive approach. A recent study found a teleconference-based multi-disciplinary fatigue management program to be effective, and a large controlled trial of the program is currently underway. Finally, a randomized trial comparing exposure to low frequency magnetic fields to a sham treatment in 40 MS patients with fatigue found no significant benefit. "
Article: Fatigue in multiple sclerosis[Show abstract] [Hide abstract]
ABSTRACT: Background: Fatigue is the most commonly reported symptom in multiple sclerosis (MS). Purpose: This brief narrative review addresses the clinical features, pathophysiology, and management of MS fatigue, as well as the varied approaches to its definition and measurement. Methods: A literature search was conducted through Medline of studies published since 1984, with a focus on findings reported since 2008. Results: Studies of MS fatigue have primarily relied on the definition of fatigue as a subjective sense of tiredness measured through self-report. Additional studies have measured fatigability in MS, as demonstrated by a decline in cognitive or motor performance over time. The pathogenesis of fatigue remains poorly understood but disease characteristics, including structural and physiologic cerebral alterations as well as immune, endocrine, and psychological factors, may all contribute to its expression. Fatigue therapy has included pharmacologic approaches which have had either methodological limitations (e.g., small sample sizes) or inconclusive results and non-pharmacologic interventions, some of which have been effective in reducing fatigue. Conclusions: Fatigue remains a challenging symptom in MS. The most effective measurement approaches will likely be multidimensional and include both subjective and objective indicators, whereas therapy will likely require more than one type of intervention.11/2013; 2(1):3-13. DOI:10.1080/21641846.2013.843812