A randomized controlled trial of a web-based mindfulness programme for people with MS with and without a history of recurrent depression

Abstract

Background: Evidence shows small positive effects associated with psychological treatments for people with multiple sclerosis (PwMS). In a recent meta-analysis, the treatment with the largest effect size was a mindfulness-based intervention (MBI). Objectives: We aimed to determine whether an Internet-delivered MBI was beneficial for PwMS. Furthermore, we aimed to investigate history of recurrent depression as a moderator of treatment outcome. Methods: Participants ( N = 132) were assessed based on whether they had a history of recurrent depression, then stratified and randomized to MBI or waitlist. Outcomes were assessed at baseline, post-intervention, and 3 and 6 months. Results: The MBI group reported significantly improved depressive symptoms (primary outcome) compared with the waitlist ( p = 0.046, Cohen’s d = 0.39). Those with a history of recurrent depression benefitted significantly more than those without ( p = 0.034, d = 0.66). There were benefits for health-related quality of life (HRQoL) in the MBI, irrespective of depression history ( p = 0.009, d = 0.5). Pain interference was less overall in the MBI group ( p < 0.001, d = 0.2), but change over time did not differ from waitlist. There were no treatment effects for anxiety, pain severity or fatigue. Conclusion: The Internet-delivered MBI significantly improved depressive symptoms and HRQoL in PwMS. For depression, the benefits were greater for those with a history of recurrent depression. Trial Registration: ACTRN12618001260213, available at: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375598

A systematic review and meta-analysis exploring the efficacy of mindfulness-based interventions on quality of life in people with multiple sclerosis

“…Following deduplication and the addition of four further studies identified via reference list searching there were 1,312 potential studies for inclusion. After title and abstract screening, 30 full text studies were reviewed, of which 14 were included in the final analyses [50][51][52][53][54][55][56][57][58][59][60][61][62][63] (Fig. 1).…”

“…Eight of the 14 studies reported carrying out power calculations to determine necessary sample size [52, 55, 56, 58-60, 62, 63]; of the remaining, five did not [51,53,57,58,61] and one provided insufficient detail [54]. Studies took place across four continents, in eight different countries: three from Iran [54,57,63], two from Italy [55,56], the UK [51,53], Australia [59,61], the USA [50,60], and one each from Switzerland [52], Canada [62], and France [58]. Sample size ranged from 21-150.…”

“…Sample size ranged from 21-150. Six studies [50,55,56,58,60,61] compared MBI against an active treatment (psychoeducation, physical activity, adaptive cognitive training, chair yoga), five usual care [51-53, 62, 63], one waitlist control [59], and in two the control condition was unclear [54,57]. Most studies collected outcome measures thrice (pre-, post-, follow-up), but three studies were pre-post design [54,57,58] (Table 1).…”

“…Across the 14 RCTs there were 937 participants. Five studies reported on ethnicity, which was 87.8% "white" or "anglo-saxon/anglo-celtic" [50,51,53,59,60]. One study did not report the percentage of women [59], but most studies predominantly recruited women (total women = 621; 78%).…”

Nursing Implications of Mindfulness-Informed Interventions for Stroke Survivors and Their Families

“…Preliminary findings demonstrated that online MBIs can reduce anxiety and stress in healthy adults, adults with posttraumatic stress disorder symptoms, and adults with multiple sclerosis. 52 A recent review of RCTs concluded that web-based MBIs are as effective as in-person MBIs at reducing sleep disturbance and improving sleep quality. To our knowledge, the effectiveness of a web-based MBI has not been examined in poststroke patients, but several studies have addressed the feasibility and efficacy of web-based MBI for those who are undergoing treatment in a clinical setting.…”