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September 27, 2010

MS quality of life, depression, and fatigue improve after mindfulness training
A randomized trial

September 28, 2010 issue
75 (13) 1141-1149

Abstract

Objective: Health-related quality of life (HRQOL) is often much reduced among individuals with multiple sclerosis (MS), and incidences of depression, fatigue, and anxiety are high. We examined effects of a mindfulness-based intervention (MBI) compared to usual care (UC) upon HRQOL, depression, and fatigue among adults with relapsing-remitting or secondary progressive MS.
Methods: A total of 150 patients were randomly assigned to the intervention (n = 76) or to UC (n = 74). MBI consisted of a structured 8-week program of mindfulness training. Assessments were made at baseline, postintervention, and 6 months follow-up. Primary outcomes included disease-specific and disease-aspecific HRQOL, depression, and fatigue. Anxiety, personal goal attainment, and adherence to homework were secondary outcomes.
Results: Attrition was low in the intervention group (5%) and attendance rate high (92%). Employing intention-to-treat analysis, MBI, compared with UC, improved nonphysical dimensions of primary outcomes at postintervention and follow-up (p < 0.002); effect sizes, 0.4–0.9 posttreatment and 0.3–0.5 at follow-up. When analyses were repeated among subgroups with clinically relevant levels of preintervention depression, fatigue, or anxiety, postintervention and follow-up effects remained significant and effect sizes were larger than for the total sample.
Conclusions: In addition to evidence of improved HRQOL and well-being, these findings demonstrate broad feasibility and acceptance of, as well as satisfaction and adherence with, a program of mindfulness training for patients with MS. The results may also have treatment implications for other chronic disorders that diminish HRQOL.
Classification of evidence: This trial provides Class III evidence that MBI compared with UC improved HRQOL, fatigue, and depression up to 6 months postintervention.

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Information & Authors

Information

Published In

Neurology®
Volume 75Number 13September 28, 2010
Pages: 1141-1149
PubMed: 20876468

Publication History

Published online: September 27, 2010
Published in print: September 28, 2010

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Keyword

  1. ANCOVA = analysis of covariance; CES-D = Center for Epidemiologic Studies Depression Scale; CI = confidence interval; EDSS = Expanded Disability Status Scale; ES = effect size; HAQUAMS = Hamburg Quality of Life Questionnaire in Multiple Sclerosis; HRQOL = health-related quality of life; MBI = mindfulness-based intervention; MFIS = Modified Fatigue Impact Scale; MS = multiple sclerosis; NNT = number needed to treat; PQOLC = Profile of Health-Related Quality of Life in Chronic Disorders; PRO = patient-reported outcome; STAI = Spielberger Trait Anxiety Inventory; UC = usual care.

Notes

Authors

Affiliations & Disclosures

P. Grossman, PhD
From the Department of Psychosomatic Medicine (P.G., C.S.), Division of Internal Medicine, University Hospital Basel, Basel; Department of Neurology (L.K., H.G., M.D.), University Hospital Basel, Basel; Department of Preventive Medicine (D.C.M.), Feinberg School of Medicine, Northwestern University, Evanston, IL; and Department of Psychology (I.K.P.), University of Basel, Basel, Switzerland.
L. Kappos, MD
From the Department of Psychosomatic Medicine (P.G., C.S.), Division of Internal Medicine, University Hospital Basel, Basel; Department of Neurology (L.K., H.G., M.D.), University Hospital Basel, Basel; Department of Preventive Medicine (D.C.M.), Feinberg School of Medicine, Northwestern University, Evanston, IL; and Department of Psychology (I.K.P.), University of Basel, Basel, Switzerland.
H. Gensicke, MD
From the Department of Psychosomatic Medicine (P.G., C.S.), Division of Internal Medicine, University Hospital Basel, Basel; Department of Neurology (L.K., H.G., M.D.), University Hospital Basel, Basel; Department of Preventive Medicine (D.C.M.), Feinberg School of Medicine, Northwestern University, Evanston, IL; and Department of Psychology (I.K.P.), University of Basel, Basel, Switzerland.
M. D'Souza, MD
From the Department of Psychosomatic Medicine (P.G., C.S.), Division of Internal Medicine, University Hospital Basel, Basel; Department of Neurology (L.K., H.G., M.D.), University Hospital Basel, Basel; Department of Preventive Medicine (D.C.M.), Feinberg School of Medicine, Northwestern University, Evanston, IL; and Department of Psychology (I.K.P.), University of Basel, Basel, Switzerland.
D.C. Mohr, PhD
From the Department of Psychosomatic Medicine (P.G., C.S.), Division of Internal Medicine, University Hospital Basel, Basel; Department of Neurology (L.K., H.G., M.D.), University Hospital Basel, Basel; Department of Preventive Medicine (D.C.M.), Feinberg School of Medicine, Northwestern University, Evanston, IL; and Department of Psychology (I.K.P.), University of Basel, Basel, Switzerland.
I.K. Penner, PhD
From the Department of Psychosomatic Medicine (P.G., C.S.), Division of Internal Medicine, University Hospital Basel, Basel; Department of Neurology (L.K., H.G., M.D.), University Hospital Basel, Basel; Department of Preventive Medicine (D.C.M.), Feinberg School of Medicine, Northwestern University, Evanston, IL; and Department of Psychology (I.K.P.), University of Basel, Basel, Switzerland.
C. Steiner, MS
From the Department of Psychosomatic Medicine (P.G., C.S.), Division of Internal Medicine, University Hospital Basel, Basel; Department of Neurology (L.K., H.G., M.D.), University Hospital Basel, Basel; Department of Preventive Medicine (D.C.M.), Feinberg School of Medicine, Northwestern University, Evanston, IL; and Department of Psychology (I.K.P.), University of Basel, Basel, Switzerland.

Notes

Address correspondence and reprint requests to Dr. Paul Grossman, Department of Psychosomatic Medicine, Division of Internal Medicine, University Hospital Basel, Hebelstrasse 2, CH-3041 Basel, Switzerland [email protected]

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