A systematic review and meta-analysis of the effects of non-pharmacological interventions on quality of life in adults with multiple sclerosis

Abstract

Background Multiple Sclerosis (MS) is a chronic debilitating disease that targets the central nervous system. Globally it is estimated that 2.8 million people live with MS (2018) and as there is no known cure; therefore, identifying methods to increase a patient’s quality of life (QoL) is of considerable importance. Non-pharmacological interventions are a viable and effective option to increase QoL in patients with MS, however, to date, the literature lacks a complete systematic review of these interventions. Methods A literature search was conducted for studies published up until March 4th 2022 in Scopus, Web of Science, CINAHL Plus, The Cochrane Library, Medline, and Embase. Studies were included if they were randomized control trials (RCTs) assessing a non-pharmacological intervention in adults with MS and measured QoL using the MSQOL-54, SF-36 or MSQLI tools for at least two time points. Quality assessment of each study was completed as well as a review of publication bias. Where possible, meta-analysis was conducted using a random effects model and for other studies a qualitative synthesis was presented. Results Thirty studies were included in the meta-analysis and eleven studies were summarized qualitatively. The pooled effects across all non-pharmacological interventions showed a modest improvement in both the physical and mental components of QoL, with a standardized mean difference (SMD) of 0.44 (95% CI 0.26–0.61) and 0.42 (95% CI 0.24–0.60), respectively. Non-pharmacological interventions based around a physical activity were found to be particularly effective in improving both the physical composite score (PCS) and mental composite score (MCS), with an SMD of 0.40 (95% CI 0.14–0.66) and 0.31 (95% CI 0.08–0.55), respectively. Interventions incorporating balance exercises presented a significant advantageous solution for improving QoL, with an SMD of 1.71 (95% CI 1.22, 2.20) and 1.63(95% CI 1.15–2.12) for PCS and MCS respectively. Conclusions This systematic review and meta-analysis identified that non-pharmacological interventions can be an effective method of improving QoL in patients with MS, especially modalities with a physical activity component and balance interventions.

Impact of Anxious and/or Depressive Reactive State on the Effectiveness of Rehabilitation of Patients with Multiple Sclerosis

“…The last test was the assessment of the QoL of patients with a standardized SF36 test. It is a widely validated and used tool for measuring QoL in MS that uses eight subscales that can be summarized into two results, a physical health component score (PSC) and a mental health component score (MSC) [ 25 ]. Higher scores indicate better QoL.…”

Impact of Cognitive Impairment on Quality of Life in Multiple Sclerosis Patients—A Comprehensive Review

“…Globally, the average age of diagnosis is 32 years and there is no curative treatment, so it is a chronic disease that can affect a person’s life in many ways, especially during their peak years of productivity. For this reason, one of the aims of treatment is to optimize as far as possible the quality of life (QoL) of patients and to maintain functionality in aspects important to them [ 17 ]. The gradual increase in physical and cognitive disability among people with MS has substantial effects that negatively impact their social, economic, and individual well-being [ 1 ], and the aim of this review is to compile the available scientific literature on the impact of MS-specific cognitive impairment on QoL.…”

Editorial: Trends in neuroimmunology: cross-talk between brain-resident and peripheral immune cells in both health and disease

“…However, drugs have low efficacy, several side effects, and high costs. Alternative MS-modifying interventions, such as physical exercise, have gained attention as a new therapy to alleviate patients’ symptoms ( 41 , 42 ). In summary, the authors present morphological, cellular, and molecular evidence from animal models (e.g., EAE and toxin and/or virus-induced demyelination models) and human studies of how this type of adjunctive intervention regulates innate and adaptive immune cells, reducing peripheral immune cell infiltration, and eventually leading to a reduction of the autoimmune responses and their concomitant negative effects in the CNS.…”