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Effects of Mindfulness-based interventions on physical symptoms in people with multiple sclerosis - a systematic
Robert Simpson1, Sharon Simpson2, Nitish Ramparsad3
1Physical Medicine & Rehabilitation, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Room H390 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada; General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.
Background:
Physical wellbeing is commonly impaired in people with multiple sclerosis (PwMS). This study aims to update our previous systematic review (2014) and conduct a meta-analysis on the efficacy of Mindfulness-based interventions (MBIs) for improving physical symptoms in PwMS.
Methods:
In November 2017 we carried out systematic searches for eligible randomised controlled trials (RCTs) in seven major databases, updating our search in July 2018. We used medical subject headings and key words. Two independent reviewers used pre-defined criteria to screen, data extract, quality appraise, and analyse studies. The Cochrane Collaboration risk of bias tool was used to determine study quality. Physical wellbeing was the main outcome of interest. We used the random effects model for meta-analysis, reporting effect sizes as Standardised Mean Difference (SMD). This study is registered with PROSPERO: CRD42018093171.
Results:
We identified 10 RCTs as eligible for inclusion in the systematic review (including 678 PwMS), whilst seven RCTs (555 PwMS) had data that could be used in our meta-analyses. In general, comorbidity, disability, ethnicity and socio-economic status were poorly reported. MBIs included manualised and tailored interventions, treatment duration 6-9 weeks, delivered face-to-face and online in groups and also individually. For fatigue, against any comparator SMD was 0.24 (0.08 - 0.41), I2=0%; against active comparators only, SMD was 0.10 (-0.14 - 0.34), I2=0%. For pain SMD was 0.16 (-0.46 - 0.79), I2=77%. Three adverse events occurred across all studies.
Conclusions:
MBIs appear to be an effective treatment for fatigue in PwMS. The optimal MBI in this context remains unclear. Further research into MBI optimisation, cost- and comparative-effectiveness is required.
Insights
Mindfulness-Based Interventions (MBIs) effectively reduce fatigue in people with multiple sclerosis (PwMS). Further research is needed to optimize MBIs for this population.
Area of Science:
- Neurology
- Rehabilitation Medicine
- Psychiatry
Background:
- Physical wellbeing is frequently compromised in people with multiple sclerosis (PwMS).
- Existing systematic reviews on interventions for PwMS require updates.
- Mindfulness-Based Interventions (MBIs) show potential for improving physical symptoms.
Purpose of the Study:
- To systematically review and meta-analyze the efficacy of MBIs for improving physical symptoms in PwMS.
- To update previous systematic reviews on MBIs for PwMS.
- To provide evidence-based recommendations for MBI application in multiple sclerosis care.
Main Methods:
- Systematic searches of seven databases were conducted (November 2017, updated July 2018).
- Ten randomized controlled trials (RCTs) involving 678 PwMS were included.
- Meta-analysis used a random effects model, reporting Standardised Mean Difference (SMD).
Main Results:
- MBIs demonstrated a significant effect on reducing fatigue (SMD=0.24).
- The effect of MBIs on pain was not statistically significant (SMD=0.16).
- Comorbidity, disability, and socioeconomic status were often poorly reported in the included studies.
Conclusions:
- MBIs are a promising intervention for managing fatigue in people with multiple sclerosis.
- The optimal MBI protocol for PwMS requires further investigation.
- Future research should focus on MBI optimization, cost-effectiveness, and comparative effectiveness.
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