Efficacy of A Telephone-Delivered Self-Management Intervention For Persons With Multiple Sclerosis: a Randomized Controlled Trial With a One-Year Follow-Up.

TitleEfficacy of A Telephone-Delivered Self-Management Intervention For Persons With Multiple Sclerosis: a Randomized Controlled Trial With a One-Year Follow-Up.
Publication TypeJournal Article
AuthorsEhde DM, Elzea JL, Verrall AM, Gibbons LE, Smith A, Amtmann D
JournalArch Phys Med Rehabil
Start Page1945
Date Published2015 Nov

OBJECTIVE: To evaluate the efficacy of a telephone-delivered self-management intervention for fatigue, pain, and depression in adults with multiple sclerosis (MS). DESIGN: Single-center, randomized (1:1), single blind (outcome assessors) parallel-group trial with a primary end-point of post-treatment (9-11 weeks post-randomization) and long-term follow-ups at 6- and 12-months. SETTING: Telephone-delivered across the United States. PARTICIPANTS: Adults with MS (N=163) with fatigue, chronic pain, and/or moderate depressive symptoms (age range 25-76 years). INTERVENTIONS: Eight-week individual telephone-delivered self-management intervention (T-SM: n=75) versus an eight-week individual telephone-delivered MS education intervention (T-ED: n=88). MAIN OUTCOME MEASURES: The primary outcome was the proportion who achieved a > 50% decrease in one or more symptom - fatigue impact, pain interference, and/or depression severity. Secondary outcomes included continuous measures of pain, fatigue impact, depression, self-efficacy, activation, health-related quality of life, resilience, and affect. RESULTS: For our primary outcome, 58% of those in the T-SM and 46% of those in the T-Ed had a > 50% reduction in one or more symptom; this difference was not statistically significant (OR: 1.50, 95% CI: 0.77 to 2.93, p = 0.238). Participants in both groups significantly improved from baseline to post-treatment in primary and secondary outcome measures (p < 0.05). T-SM participants reported significantly higher treatment satisfaction and therapeutic alliance and greater improvements in activation, positive affect, and social roles. Improvements were generally maintained at 6- and 12-months. CONCLUSIONS: Both interventions resulted in short- and long-term, clinically meaningful benefits. The study demonstrated that the telephone is an effective method for engaging participants in and extending the reach of care for individuals with MS.

Full Text

Self-Management Helps us Take Charge of Our Lives with MS

What is this research about?

Many people with multiple sclerosis (MS) experience frequent pain, fatigue (feeling tired), or depression (feeling sad or down). Counseling can teach us practical skills to deal with these symptoms, known as self-management skills. These skills include setting goals, energy management strategies, relaxation techniques, coping with unhelpful thoughts and feelings, and focusing on strengths and positive feelings.  In this research, we wanted to test out a self-management program to see how well it works when delivered over the telephone. We also compared it with a different program that gave people education about common MS symptoms without the self-management skills.

What did the researchers do?

We had nearly two hundred people with MS from across the United States join our study. About half went through the self-management program and the other half went through the education program. In both programs, a trained therapist called each participant once a week for eight weeks, and each phone session lasted for about an hour. In the self-management program, the therapist guided the participant to set goals related to managing MS symptoms. Then, the therapist and participant worked through lessons and discussions about relaxation, energy management, dealing with unpleasant thoughts and feelings, and focusing on strengths and positive feelings. In the education program, the therapist discussed information about common MS symptoms such as pain and fatigue, as well as health habits like exercising and eating well. In both programs, the participants were sent workbooks and readings to go along with the telephone lessons.

To see how well the programs worked, we asked the participants questions by phone before they started the programs and again a week or two after they finished. Then we repeated the questions six and twelve months after the programs ended to see if benefits lasted over time. We asked about their mood and how much pain and fatigue got in the way of their daily lives. We also asked about general health, how confident they felt about managing their MS symptoms, how happy they were with social activities, and how well they felt they could bounce back from setbacks.

What did the researchers find?

Both programs helped the participants feel better. Participants reported better moods and less bothersome pain and fatigue after they finished the programs, and these benefits continued twelve months later. Both programs also increased participants’ sense of general health, happiness with social activities, and confidence that they could manage MS symptoms well. Although both programs were effective, participants said they were more satisfied with the self-management program than the education program, and they reported stronger relationships with the therapist. Almost everyone in both programs said they would recommend their program to a friend with MS.

How can you use this research?

  • Telephone-based counseling can help people with MS to cope better with their symptoms. Counseling over the phone may be especially helpful for those of us who live in rural areas or who might have trouble visiting a therapist in person.
  • Self-management skills are an important part of living well with MS. To learn more about how to manage specific aspects of MS, check out our [Living Well with MS Fact Sheets].

What you should know:

  • People with MS have a higher risk of feeling depressed. If you think you or a loved one may be experiencing depression, check out our fact sheet on How to Cope with Depression.
  • For more information about managing MS-related pain and fatigue, take a look at our fact sheet on fatigue.
PubMed ID26254948