Moderators of Treatment Outcomes After Telehealth Self-Management and Education in Adults With Multiple Sclerosis: A Secondary Analysis of a Randomized Controlled Trial

  • Dawn M. Ehde
    Corresponding author Dawn M. Ehde, PhD, Department of Rehabilitation Medicine, University of Washington, Box 359612, Seattle, WA 98104.
    Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington
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  • Anne Arewasikporn
    Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington

    Multiple Sclerosis Center of Excellence – West, VA Puget Sound Health Care System, Seattle Division, Seattle, Washington
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  • Kevin N. Alschuler
    Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington

    Department of Neurology, School of Medicine, University of Washington, Seattle, Washington
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  • Abbey J. Hughes
    Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland
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  • Aaron P. Turner
    Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington

    Multiple Sclerosis Center of Excellence – West, VA Puget Sound Health Care System, Seattle Division, Seattle, Washington
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Published:January 11, 2018DOI:



      To examine moderators of treatment effects in a randomized controlled trial comparing a telehealth self-management intervention with a telehealth multiple sclerosis (MS) education intervention for fatigue, pain, and mood in adults with MS.


      Secondary analysis of a single-blind randomized controlled trial.




      Adults with MS and chronic fatigue, chronic pain, and/or moderate depressive symptoms (N=163) recruited from across the United States.


      Two 8-week, telephone-delivered symptom interventions delivered 1:1: a self-management intervention (n=75) and an MS education intervention (n=88).

      Main Outcome Measures

      Outcome measures were fatigue impact pain interference, and depressive symptom severity assessed at baseline and posttreatment. Potential moderators of treatment effects assessed at baseline were demographics (age, sex, and education), clinical characteristics (disease duration and disability severity), symptoms (perceived cognitive impairment and pain intensity), baseline levels of the treatment outcomes (pain interference, fatigue impact and depressive symptom severity), and cognitive behavioral factors (pain catastrophizing, fatigue catastrophizing, self-efficacy, and patient activation).


      Moderation analyses found significant moderation for fatigue impact but not for pain intensity or depressive symptom severity. Baseline patient activation interacted with treatment group to predict fatigue impact at posttreatment (P=.049). Among participants with high baseline patient activation, the self-management group reported significantly less fatigue at posttreatment than the education group. No other variables moderated the study outcomes.


      At the group level, participants responded to both interventions, regardless of disease characteristics, demographics, symptom levels, and cognitive behavioral factors. Self-management and education are both potentially beneficial symptom treatments that may be recommended to individuals with MS and chronic pain, fatigue, and/or depressive symptoms.


      List of abbreviations:

      BPI (Brief Pain Inventory), MFIS (Modified Fatigue Impact Scale), MS (multiple sclerosis), NRS (numerical rating scale), PHQ-9 (Patient Health Questionnaire-9), RCT (randomized controlled trial)
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