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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ABSTRACT: Background Fatigue, depression, and physical inactivity are common in multiple sclerosis (MS), but there is limited information on the bi-directional associations among those variables over a long period of time.Objective This study examined the hypothesis that fatigue and depression would predict change in physical activity and that physical activity would predict changes in fatigue and depression over an 18-month period of time in persons with MS, even after controlling for disability status, disease duration, sex, and age.Methods This longitudinal study collected data on fatigue, depression, physical activity, and confounding variables from the same sample of persons with relapsing-remitting MS on two occasions that were separated by 18 months.ResultsThe cross-lagged path coefficient between baseline fatigue and follow-up physical activity was statistically significant (path coefficient=−.26, p<.0001) as was the cross-lagged path coefficient between baseline physical activity and follow-up fatigue (path coefficient=−.11, p<.05). Those bi-directional associations were independent of depression, disability status, disease duration, sex, and age. There were no statistically significant cross-lagged path coefficients between depression and physical activity.Conclusions This study identified bi-directional associations between fatigue and physical activity over an 18-month period of time. The nature of such associations opens the door for research on fatigue management as an approach for sustaining or promoting physical activity over time.01/2012; 1(1):43–48. DOI:10.1016/j.msard.2011.08.003
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ABSTRACT: OBJECTIVE. We determined whether age, gender, work status, or impairment moderated fatigue management program outcomes for people with multiple sclerosis (MS). METHOD. We conducted a secondary analysis of longitudinal data from a randomized controlled trial using mixed-effects models (N = 181) and examined outcomes of fatigue impact, mental health, physical health, and self-efficacy. Measures were collected before and immediately after intervention and at 6 wk, 3 mo, and 6 mo postintervention. RESULTS. Younger participants experienced greater reductions in fatigue impact and greater improvements in self-efficacy over time than did older participants, but we found no age differences in physical or mental health. Participants with less impairment experienced greater mental health gains and were more likely to retain these gains over time than were participants with greater impairment. Although women experienced greater fatigue impact benefits, men experienced greater mental health benefits. Work status did not moderate outcomes. CONCLUSION. Fatigue management program outcomes for people with MS are moderated by age, gender, and impairment.The American journal of occupational therapy.: official publication of the American Occupational Therapy Association 02/2012; 66(2):187-97. DOI:10.5014/ajot.2012.003160 · 1.70 Impact Factor