COMBAT-MS (group-based cognitive remediation and behavioural approaches to intervention in multiple sclerosis)

Cognitive impairment (CI) and psychological distress are prevalent and interrelated in persons with multiple sclerosis (PwMS). Holistic interventions are needed to support psychosocial adjustment.

To evaluate the effects of a combined group-based cognitive behavioural therapy (CBT) and cognitive training (CT) program on cognitive and psychosocial outcomes in PwMS.

This randomized controlled trial involved 105 PwMS allocated to a 10-week group-based intervention or treatment-as-usual control. Assessments were conducted at baseline (BL), three months post-intervention (3MFU), and 12 months post-intervention (12MFU). Due to the COVID-19 pandemic, the intervention transitioned from in-person to telehealth, enabling comparative analyses of delivery modes. Primary outcomes were quality of life and a memory composite score. Secondary outcomes included measures of processing speed, executive functioning, depression, anxiety, subjective cognitive impairment, coping strategies, and social support. Longitudinal changes were analysed using Linear Mixed Models (LMM).

Face-to-face participants demonstrated significant post-intervention improvements in vitality and positive coping, maintained at 12MFU. At 12MFU, additional gains in general health and emotional support were observed. Fatigue impact improved significantly at 12MFU in the telehealth and control groups but not the face-to-face group. At 12MFU, memory composite scores improved significantly in the face-to-face intervention group but not in the telehealth intervention group. Memory composite scores also improved significantly in the control group at 12MFU. No significant changes were found in other cognitive or psychosocial outcomes.

The COMBAT-MS program, integrating CBT and CT, demonstrates feasibility and potential efficacy in improving cognitive and psychosocial health in PwMS, with outcome variability influenced by the mode of delivery.