Patient education program to enhance decision autonomy in multiple sclerosis relapse management: A randomized-controlled trial

Unit of Health Sciences and Education, University of Hamburg, Hamburg, Germany.
Multiple Sclerosis (Impact Factor: 4.82). 10/2008; 15(1):96-104. DOI: 10.1177/1352458508095921
Source: PubMed


Contrary to strong recommendations for high-dose intravenous corticosteroid treatment for relapses in multiple sclerosis (MS), uncertainty remains about most aspects of relapse management. Oral corticosteroids administered by physicians or patients themselves or no corticosteroids also appear justifiable.
To evaluate an education program that aims to involve patients with MS in decisions on relapse management.
In three German MS centers, 150 patients with relapsing MS were randomly assigned to a single, 4-h group session or a standard information leaflet. The primary outcome measure was the proportion of relapses with oral or no corticosteroid therapy as an indicator of patient autonomy in treatment decision making. Other outcomes included perceived decision autonomy, quality of life, and disability status.
In the intervention group (IG), 108/139 (78%) relapses were treated with oral or no corticosteroids compared with 101/179 (56%) in the control group; P < 0.0001. Patients' perceived autonomy of treatment decision making was significantly higher in the IG; P < 0.0001. Quality of life, disability status, and adverse events of corticosteroid therapies were comparable.
The patient education program led to more autonomous decision making in patients with relapsing MS. Relevant changes in relapse management were observed.

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    • "Because of the variety of intervention goals and strategies it is difficult to compare the programs. Positive outcomes were for example improved coping with symptoms [31] [32] [37], greater autonomy in decision-making [34], improved coping behavior [38]; improved mental quality of life [39] [42]; reduced anxiety [38], reduced depression [39], and higher self-efficacy expectations [30] [42]. A review from Rae-Grant et al. [43] concluded that self-management is relevant to MS and more high-quality research is necessary. "
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    ABSTRACT: Objective To determine the impact of the self-management training program “S.MS” for new multiple sclerosis (MS) patients. Method Multicenter, prospective, quasi-experimental study with 31 MS patients in the intervention group (training program) and 33 participants in the control group (CG) (brochures). Data were collected before, after and 6 months after the interventions. Analysis of change was done by ANCOVA with repeated measurements. Results At baseline, participants in CG were younger at the time of diagnosis, suffered more frequently from relapsing-remitting MS and took more MS-medication on a permanent basis. The intervention had a stable significant effect on each dimension of self-management ability, on total self-management ability (ES = 0.194, p < 0.001), on anxiety (ES = 0.193, p = 0.001), and on disease-specific quality of life (ES = 0.120, p = 0.007). Regarding depression, a significant interaction effect of time and intervention could be observed (ES = 0.106, p = 0.011). No effect was found on disease-specific knowledge. High participant acceptance was reported. Conclusion “S.MS” participation was associated with a significant and sustained improvement of self-management abilities, anxiety and disease-specific quality of life in a quasi-experimental study design. Using RCT or CRT-designs would be desirable to further improve the evidence of treatment effectiveness. Practice implications This study provides substantial evidence that “S.MS” fosters patients’ self-management ability.
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    • "The program was compared to a two-page standard information leaflet. Participants were 150 relapsing MS patients with high disease activity from three German centers [17]. Based on existing guidelines recommending i.v. "
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    • "ity [ Sijens et al . 2008 ] . Since behavioral and pharmacological therapies are comparably effective in MS depres - sion , the effect of psychotherapy on lesion load and atrophy should be explored in future studies . A randomized controlled trial with 150 patients using patient education showed a decreased relapse rate in the intervention group [ Kopke et al . 2009 ] . However , no biological or paraclini - cal markers of disease activity were obtained , so this should be interpreted with caution ."
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