Table 1 Included studies

Barlow et al. [31]

216

N/R

12 years

Chronic Disease Self-Management Course, a lay-led self-management intervention that provides participants with a range of skills and strategies

6 weeks

Waiting-list

CDSMC had an impact on self-management self- efficacy and trends towards improvement on depression and MS self-efficacy were noted. All improvements were maintained at 12-months

CDSMC had an impact on MSIS physical status

Stuifbergen et al.[32]

113

15.65 on the Incapacity Status Scale

10.76 years

45,79

lifestyle-change classes and telephone follow-up

8 weeks

Waiting-list

Improvement of self-efficacy, health-promoting behaviors and mental health (SF36)

Reduction of Bodily Pain as measured with the SF36, no difference on the severity of impairment as measured with the Incapacity Status Scale

Ghafari et al. [33]

66

EDSS <5.5

2 years

31,5

Progressive Muscle Relaxation Technique

63 sessions during two months

No intervention

One and two months after intervention the experimental group reported better QoL

The physical component of QoL (PCS-8) improved as well

Tesar et al. [34]

29

EDSS <5.5 (mean 3.2)

5.1 years

38.2

Psychological program which combines proven cognitive-behavioral strategies for coping with stress with body exercises

7 weeks

Waiting-list

The therapy group showed long-term improvements in depressive stress coping style

The therapy group showed short-term improvement in “vitality and body dynamics”.

Forman & Lincon [35]

40

23 on the Guys Neurological Disability Scale

9.8 years

47.5

The intervention group programme was designed for people with multiple sclerosis and focused on adjustment to illness.

6 weeks

Waiting-list

Patients allocated to the group intervention reported fewer depressive symptoms than those in the control group but there were no significant differences in anxiety symptoms, self-efficacy or quality of life.

No changes on the MS Impact Scale - Physical

O’Hara et al. [36]

183

17 (median) on the Barthel Index

11.8 years

51.5

The intervention comprised discussion of self-care based on client priorities, using an information booklet about self-care.

The discussions lasted between 1 and 2 hours and were conducted on two occasions, over a one month period.

No intervention

At follow-up the intervention group had better SF-36 health scores, in mental health and vitality. Participants in the intervention group had maintained levels of independence at follow-up while the control group showed a signicant decrease in independence

Participants in the intervention group reported that assistance with daily activities was less essential than individuals in the control group at follow-up; However, there were no improvements in independence in daily living, mobility or a reduction in the number of occasions individuals were assisted with activities

Baron et al. [37]

127

22.4 on the Guys Neurological Disability Scale; patients with insomnia

N/R

48.1

telephone administered cognitive behavioral therapy

16 weeks

telephone administered supportive emotion-focused therapy

Improvements in depression and anxiety

Improvement in insomnia

Tompkins et al. [38]

3623

N/R

48.9 RM; 43.5 Control

PREP for participant and partner in workshop sessions or teleconference series; 8 hrs programming (1 or 2 days or 4–6 wks for teleconference)

In person 1–2 days or teleconference 4–6 weeks

No intervention

RM improvement with increased QoL at 3 months

Number of MS symptoms at baseline not signfiicantly different at baseline between groups but comorbidiities did (with control at fewer), controled at analysis stage. Improved communications; willingness to try; better prepared for issues; acquisition of tools to address MS issues with partner

Khan et al. [39]

101

EDSS between 2 and 8; KFS 0-2

10.69 (TR); 9.73 (Control)

49.5 TR; 51.1 Control

Individualised rehabilitation programme

12 months

waiting-list

MSIS and GHQ-28 assessed participation and QoL; no differences between control and treatment on MSIS physical or psychological or GHQ subscales

FIM motor scores improvement at statistically significant levels for 2 groups.

Sutherland et al. [40]

22

EDSS < = 5.0; no prior CB techniques for 6 months prior to study

AT program supervised training

10 weeks

No intervention

HRQOL positively affected;participants in relaxation less limited by physical findings but not for the AT . AT group positively impacted regarding role limitations due to emotional problems.

Pain dimension large effect of MSQOL indicates AT practice may associate with diminished pain perception.; Improved vigor (POMS); decreased perception of fatigue

Maguire [41]

33

N/R

N/R

45.13

Relaxation training and ongoing work with biologically oriented imagery.

6 days

Standard care

Imagery group subjects demonstrated significant reductions in state anxiety and significant alteration in their illness imagery

No significant differences were found between the two groups with regard to decrease in MS symptoms across time

Mathiowetz et al. [42]

169

Multiple Sclerosis Functional Composite score: −.97

15 years

48,8

Energy Conservation course

6 weeks

Waiting-list

increase self-efficacy and some aspects of quality of life

significant effects on reducing the physical and social subscales of Fatigue Impact Scale and on increasing the Vitality subscale of the SF-36 scores

Grossman et al. [43]

150

EDSS =3

8.7 years

47.29

A modified version of the Mindfulness-Based Stress Reduction (MBSR)

8 weeks

Usual Care

improvement on Quality of Life and other measures of well-being, for at least 8 months

Improvement on fatigue

Tavee et al. [44]

17

3,25 (Experimental group); 2,79 (controls)

10,4 (Experiemental group); 19,4 (Controls)

48,7

Meditation

2 months

Standard care

General improvement on mental health

Improvements on pain perception, phisical health, fatigue and vitality

Van Kessel et al. [45]

72

EDSS =3,45

6 years

45

CBT based on a cognitive behavior model of fatigue

8 weeks

relaxation training

A significant time effect was obtained for depression, anxiety and perceived stress, with both groups. CBT performed better, on this regard, at the post-treatment, but not at follow-up evaluations

Both CBT and RT appear to be clinically effective treatments for fatigue in MS patients, although the effects for CBT are greater than those for RT.

Mohr et al. [46]

121

EDSS =3,1

7,05 since diagnosis

42.66

individual stress management program

20–24 weeks

Waiting-list

Participants in the experiemental group reported lower level of distress

Reduction of brain lesions in comparison with the control group (lower number of new gadolinium-enhancing brain lesions on MRI)

Mohr et al. [47]

60

N/R

8.5 years

44,6

individual cognitive behavioral therapy, group psychotherapy

16 weeks

sertraline

Reductions on depression for each group

treatment for depression is associated with reductions in the severity of fatigue symptoms, and that this relationship is due primarily to treatment related changes in mood

Schwartz [48]

132

EDSS =4,7

7,9

43

coping skills group

8 weeks

peer telephone support

coping skills intervention yielded gains in psychosocial role performance, coping behavior, and numerous aspects of well-being. In contrast, the peer support intervention increased external health locus of control but did not influence psychosocial role performance or well-being

No differences between the two groups on physical limitations and fatigue

Wassem & Dudley [49]

27

EDSS =3,36

3,49

44

nursing intervention in promoting adjustment and symptom management

4 weeks

Not specified

Treatment participants had significant improvements in symptom management at the 4-yearfollow up

significant improvements in sleep and fatigue levels

Lincon et al. [50]

240

No intervention

no effect of the interventions on mood, quality of life, subjective cognitive impairment or independence.

No differences among the three groups on perceived health

Mohr et al. [51]

14

EDSS =3,6

11.3

47.4

individual cognitive behavioral therapy, group psychotherapy

16 weeks

Sertraline

Reductions on depression for each group

successful treatment of MS depression (either pharmacologically or with psychotherapy) can reduce IFNg production by OKT3 or MBP-stimulated immune cells

Kopke et al. [52]

150

United Kingdom Neurological Disability Scale =7,9

5,2

38

Patient education program to enhance decision autonomy

4 hours

Standard care

The patient education program led to more autonomous decision making in patients with relapsing MS

The number of relapses reported by subjects in the experimental group was considerably lower than the one from controls