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Efficacy of a Telephone-Delivered Self-Management Intervention for Persons With Multiple Sclerosis: A Randomized Controlled Trial With a One-Year Follow-Up

Published:August 05, 2015DOI:https://doi.org/10.1016/j.apmr.2015.07.015

      Abstract

      Objective

      To evaluate the efficacy of a telephone-delivered self-management intervention for fatigue, pain, and depression in adults with multiple sclerosis (MS).

      Design

      Single-center, randomized (1:1), single-blind (outcome assessors), parallel-group trial with a primary endpoint of posttreatment (9–11wk postrandomization) and long-term follow-up at 6 and 12 months.

      Setting

      Telephone-delivered across the United States.

      Participants

      Adults with MS (N=163) with fatigue, chronic pain, and/or moderate depressive symptoms (age range, 25–76y).

      Interventions

      Eight-week individual telephone-delivered self-management intervention (T-SM) (n=75) versus an 8-week individual telephone-delivered MS education intervention (T-ED) (n=88).

      Main Outcome Measures

      The primary outcome was the proportion who achieved a ≥50% decrease in 1 or more symptoms—fatigue impact, pain interference, and/or depression severity. Secondary outcomes included continuous measures of pain, fatigue impact, depression, self-efficacy, activation, health-related quality of life, resilience, and affect.

      Results

      For our primary outcome, 58% of those in the T-SM group and 46% of those in the T-ED group had a ≥50% reduction in 1 or more symptoms; this difference was not statistically significant (odds ratio, 1.50; 95% confidence interval, .77–2.93; P=.238). Participants in both groups significantly improved from baseline to posttreatment in primary and secondary outcome measures (P<.05). T-SM participants reported significantly higher treatment satisfaction and therapeutic alliance and greater improvements in activation, positive affect, and social roles. Improvements were generally maintained at 6 and 12 months.

      Conclusions

      Both interventions resulted in short- and long-term, clinically meaningful benefits. The study demonstrated that the telephone is an effective method for engaging participants in care and extending the reach of rehabilitation for individuals with MS.

      Keywords

      List of abbreviations:

      BPI (Brief Pain Inventory), HRQoL (health-related quality of life), MFIS (Modified Fatigue Impact Scale), MS (multiple sclerosis), PHQ-9 (Patient Health Questionnaire 9), RCT (randomized controlled trial), SMI (self-management intervention), T-ED (telephone education intervention), T-SM (telephone self-management intervention)
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