Mindfulness based interventions in multiple sclerosis - a systematic review

Abstract

BackgroundMultiple sclerosis (MS) is a stressful condition; depression, anxiety, pain and fatigue are all common problems. Mindfulness based interventions (MBIs) mitigate stress and prevent relapse in depression and are increasingly being used in healthcare. However, there are currently no systematic reviews of MBIs in people with MS. This review aims to evaluate the effectiveness of MBIs in people with MS.MethodsSystematic searches were carried out in seven major databases, using both subject headings and key words. Papers were screened, data extracted, quality appraised, and analysed by two reviewers independently, using predefined criteria. Study quality was assessed using the Cochrane Collaboration risk of bias tool. Perceived stress was the primary outcome. Secondary outcomes include mental health, physical health, quality of life, and health service utilisation. Statistical meta-analysis was not possible. Disagreements were adjudicated by a third party reviewer.ResultsThree studies (n = 183 participants) were included in the final analysis. The studies were undertaken in Wales (n = 16, randomised controlled trial - (RCT)), Switzerland (n = 150, RCT), and the United States (n = 17, controlled trial). 146 (80%) participants were female; mean age (SD) was 48.6 (9.4) years. Relapsing remitting MS was the main diagnostic category (n = 123, 67%); 43 (26%) had secondary progressive disease; and the remainder were unspecified. MBIs lasted 6–8 weeks; attrition rates were variable (5-43%); all employed pre- post- measures; two had longer follow up; one at 3, and one at 6 months. Socio-economic status of participants was not made explicit; health service utilisation and costs were not reported. No study reported on perceived stress. All studies reported quality of life (QOL), mental health (anxiety and depression), physical (fatigue, standing balance, pain), and psychosocial measures. Statistically significant beneficial effects relating to QOL, mental health, and selected physical health measures were sustained at 3- and 6- month follow up.ConclusionFrom the limited data available, MBIs may benefit some MS patients in terms of QOL, mental health, and some physical health measures. Further studies are needed to clarify how MBIs might best serve the MS population.

Distress improves after mindfulness training for progressive MS: A pilot randomised trial

“…Median time since diagnosis was 12.0 years (range=1-38).The mean neurological disability score (EDSS) was 6.5 (SD=1.5), which indicates a transition from being ambulant with an assistive device to requiring a wheelchair. Previous mindfulness studies in MS had all cut-off at EDSS score of 6 [11]. The groups were well matched for gender, age, marital status, education, EDSS scores, distress scores and time since diagnosis.…”

“…Controlled trials on mindfulness in MS [11] showed that after the mindfulness training, patients reported improvements in quality of life, depression, fatigue [12,13], standing and dynamic balance [13,14], and reduced fatigue and pain [15].…”

Short Report: Evaluation of Acceptance and Commitment Therapy Training for Psychologists Working with People with Multiple Sclerosis

“…The workshop concluded with a demonstration role-play with a participant playing the role of a client with MS. Experiential exercises and self-practice of the ACT processes were emphasized. Resources included ACT interventions can enhance quality of life and physical health and can decrease anxiety and depression in people with various chronic illnesses, including MS. [5][6][7][8] ACT incorporates mindfulness, which can improve quality of life and mental health in people with MS. 9 Importantly, ACT is a transdiagnostic treatment model that can provide relief for multiple life difficulties rather than for a particular disorder.…”

Mindfulness-based interventions for people with multiple sclerosis

“…Such factors may serve as a practical barrier to participation in research studies, highlighting the important point that MBIs may need to be adapted to make them more suitable for the wide and varied population of people with MS. For example, the majority of studies thus far have included participants who score at or below 6 on the expanded disability status scale (EDSS) (able to walk up to 100m with a walking aid), and most of these individuals have had relapsing−remitting phenotypes (RRMS). 5 Very little is thus known about if or how MBIs might help people with progressive phenotypes, or with more severe disabilities.…”

“…A recent systematic review demonstrated a relative paucity of high-quality research, with evidence for effectiveness being limited to improvements in measures for anxiety, depression, health-related quality of life, standing balance, and fatigue. 5 The UK National Institute for Clinical Excellence (NICE) now includes the recommendation of MBIs as one potential treatment for fatigue. 6 A major issue concerning the use of MBIs in healthcare settings is that, despite various models, there is no consensus definition on the construct of mindfulness itself, and further, no one is really sure how they work.…”