Randomized trial of a teleconference-delivered fatigue management program for people with multiple sclerosis

Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL 60612-7250, USA.
Multiple Sclerosis (Impact Factor: 4.86). 05/2011; 17(9):1130-40. DOI: 10.1177/1352458511404272
Source: PubMed

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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    • "However, another trial of an education-based management program did not find it to be effective, possibly due to a less interactive approach.[92] A recent study found a teleconference-based multi-disciplinary fatigue management program to be effective,[93] and a large controlled trial of the program is currently underway.[94] 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.[95] "
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    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
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    • "The educational sessions could be offered regardless of geographic location. In a randomized trial using a teleconference platform to deliver a fatigue management program to patients with multiple sclerosis, Finlayson, et al. (2011) found the educational intervention to be effective and efficacious in reducing fatigue impact and fatigue severity. The intervention also improved patients quality of life. "
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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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