How Useful is Self-Management Intervention for MS?

Tara Kidd, PhD

A systematic review examined the evidence for people with multiple sclerosis (MS) to use self-management interventions to relieve symptoms of depression and anxiety, and improve quality of life.

Tara Kidd, PhD, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, United Kingdom discussed the potential benefit of self-management interventions with MD Magazine.

"The results of our review suggest that self-management interventions can empower people with MS to make informed decisions about their health and improve their psychosocial well-being," Kidd said.

Kidd emphasized the importance of identifying and validating any means with potential to improve the circumstances faced by those with MS, "as this is a patient population who have been largely neglected in the research literature, and for whom symptom management is integral to their survival and well-being."

Self-management interventions have been found beneficial in several long-term conditions, including diabetes, arthritis and heart disease. While the researchers encountered some evidence of relevance for people with MS, particularly in promoting skills for managing fatigue and medication adherence, they found relatively little investigation of the possible benefit on anxiety and depression symptoms.

Despite the few assessments of the efficacy of self-management intervention for these symptoms, Kidd and colleagues cited several studies of the high prevalence and impact of the symptoms in people MS. The 12-month prevalence of depression in this population is estimated in one study to be 25.7%, compared to 8.9% in the general population. The lifetime prevalence of anxiety is estimated at 37%, and depression as high as 50% in people with MS.

"Importantly, studies have increasing demonstrated that depression symptoms independently predict MS specific health-related quality of life (MS-QOL) and general health-related QOL (HRQOL)," researchers wrote.

The reviewers identified 10 randomized controlled trials with some assessment of the interventions which fulfilled their inclusion criteria, comprising 1,286 people. Five trials evaluated the impact of the intervention on depression, 3 on anxiety, and 7 on QOL. The studies were relatively heterogeneous in the specific interventions and outcome measures.

The reviewers compared end-point rather than interim outcomes, with the assumption that behavior change may require longer durations before psychological benefits are realized.

In the 3 studies of effects on anxiety symptoms, only 1 measured clinically significant symptoms at baseline, and this study found an improvement relative to a comparator group.

The other 2 did not find significant difference in anxiety symptoms compared to control. Three of the 5 studies measuring depression symptoms reported improvement over time, but only 1 documented statistically significant improvement relative to a control group.

The impact on quality of life was more apparent, with 6 of 7 studies reporting significant improvement relative to control groups. The reviewers noted, however, that these studies had generally excluded patients with severe disability, pain or fatigue; and so the results were applicable to those with mild to moderate symptoms.

"We must remember that this is not a homogenous group when developing interventions," Kidd said. "Tailored interventions that incorporate different treatment approaches including remote technology, face-to-face therapy, and/or group programs seem the next logical step forward if we are to meet the needs of all people with MS."

The study, "A systematic review of the effectiveness of self-management interventions in people with multiple sclerosis at improving depression, anxiety and quality of life," was published online in PLOSone last month.

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