Self-guided, online, therapy-based interventions may be effective in improving symptoms of fatigue in patients with multiple sclerosis (MS), according to the results of a study reported in the Journal of Neurology, Neurosurgery, and Psychiatry.
Fatigue is significantly disabling in patients with MS. Therapy may be used in management; however, patients are often limited from participation in one-on-one, office-based appointments due to their symptoms, costs, and the availability of qualified professionals.
Investigators designed a parallel-group, 2-arm, randomized controlled trial to evaluate ELEVIDA, an online fatigue management program based on cognitive behavioral therapy and other therapy-based strategies.
Patients were recruited online through the German MS society website and randomly assigned (1:1) to one of two groups: ELEVIDA (n=139, 82% female, median patient determined disease steps (PDDS) 3.0) or waitlist control group (n=136, 79% female, median PDDS 3.0). Outcomes were measured at baseline, post-intervention (week 12), and follow-up (week 24).
The primary end point of this study was performance on the Chalder Fatigue Scale. Patients in the ELEVIDA group demonstrated significantly decreased scores by week 12 (intention-to-treat analysis: between-group mean difference 2.74 points; 95% CI, 1.16-4.32; P =.0007; effect size d=0.53), which were sustained through week 24 (intention-to-treat analysis; between-group mean difference 2.19 points; 95% CI, 0.57-3.82; P =.0080).
Several secondary end points were also assessed. Those that reached thresholds of significance by week 12 included decrease in anxiety (P =.0406), and increases in quality of life in domains such as fatigue (P <.0001), thinking (P =.0458), and mobility of lower extremities (P =.0397).
“To our knowledge, this trial is the largest of any published behavioral or pharmacological fatigue treatment trial in MS to date,” the investigators wrote. Although the study had multiple limitations, including a dropout rate of 19% and the lack of an active control group, the result “provides evidence for the effectiveness of a self-guided, internet-based intervention to reduce fatigue in MS. Interventions such as ELEVIDA may be a suitable low barrier, cost-effective treatment option for MS fatigue.”
Pottgen J, Moss-Morris R, Wendebourg JM, et al. Randomised controlled trial of a self-guided online fatigue intervention in multiple sclerosis [published online March 16, 2018]. J Neurol Neurosurg Psychiatry. doi:10.1136/jnnp-2017-317463