Mindfulness based interventions in multiple sclerosis--a systematic review

Robert Simpson, Jo Booth, Maggie Lawrence, Sharon Byrne, Frances Mair, Stewart Mercer, Robert Simpson, Jo Booth, Maggie Lawrence, Sharon Byrne, Frances Mair, Stewart Mercer

Abstract

Background: Multiple sclerosis (MS) is a stressful condition; depression, anxiety, pain and fatigue are all common problems. Mindfulness based interventions (MBIs) mitigate stress and prevent relapse in depression and are increasingly being used in healthcare. However, there are currently no systematic reviews of MBIs in people with MS. This review aims to evaluate the effectiveness of MBIs in people with MS.

Methods: Systematic searches were carried out in seven major databases, using both subject headings and key words. Papers were screened, data extracted, quality appraised, and analysed by two reviewers independently, using predefined criteria. Study quality was assessed using the Cochrane Collaboration risk of bias tool. Perceived stress was the primary outcome. Secondary outcomes include mental health, physical health, quality of life, and health service utilisation. Statistical meta-analysis was not possible. Disagreements were adjudicated by a third party reviewer.

Results: Three studies (n = 183 participants) were included in the final analysis. The studies were undertaken in Wales (n = 16, randomised controlled trial - (RCT)), Switzerland (n = 150, RCT), and the United States (n = 17, controlled trial). 146 (80%) participants were female; mean age (SD) was 48.6 (9.4) years. Relapsing remitting MS was the main diagnostic category (n = 123, 67%); 43 (26%) had secondary progressive disease; and the remainder were unspecified. MBIs lasted 6-8 weeks; attrition rates were variable (5-43%); all employed pre- post- measures; two had longer follow up; one at 3, and one at 6 months. Socio-economic status of participants was not made explicit; health service utilisation and costs were not reported. No study reported on perceived stress. All studies reported quality of life (QOL), mental health (anxiety and depression), physical (fatigue, standing balance, pain), and psychosocial measures. Statistically significant beneficial effects relating to QOL, mental health, and selected physical health measures were sustained at 3- and 6- month follow up.

Conclusion: From the limited data available, MBIs may benefit some MS patients in terms of QOL, mental health, and some physical health measures. Further studies are needed to clarify how MBIs might best serve the MS population.

Figures

Figure 1
Figure 1
Search results flow diagram.

References

    1. Franklin RJM, Ffrench-Constant C, Edgar JM, Smith KJ. Neuroprotection and repair in multiple sclerosis. Nat Rev Neurol. 2012;8(11):624–634. doi: 10.1038/nrneurol.2012.200.
    1. Scalfari A, Neuhaus A, Degenhardt A, Rice GP, Muraro PA, Daumer M. et al.The natural history of multiple sclerosis, a geographically based study 10: relapses and long-term disability. Brain. 2010;133(7):1914–1929. doi: 10.1093/brain/awq118.
    1. Chiaravalloti ND, DeLuca J. Cognitive impairment in multiple sclerosis. The Lancet Neurol. 2008;7(12):1139–1151. doi: 10.1016/S1474-4422(08)70259-X.
    1. Young CA. Factors predisposing to the development of multiple sclerosis. QJM. 2011;104(5):383–386. doi: 10.1093/qjmed/hcr012.
    1. Dennison L, Moss-Morris R, Chalder T. A review of psychological correlates of adjustment in patients with multiple sclerosis. Clin Psychol Rev. 2009;29(2):141–153. doi: 10.1016/j.cpr.2008.12.001.
    1. Damasceno A, Von Glehn F, Brandão CO, Damasceno BP, Cendes F. Prognostic indicators for long-term disability in multiple sclerosis patients. J Neurol Sci. 2012;234(1):29–33.
    1. Boland P, Levack WM, Hudson S, Bell EM. Coping with multiple sclerosis as a couple: ’peaks and troughs’-an interpretative phenomenological exploration. Disabil Rehabil. 2012;34(16):1367–1375. doi: 10.3109/09638288.2011.645115.
    1. McDonald WI, Compston A, Edan G, Goodkin D, Hartung H-P, Lublin FD. et al.Recommended diagnostic criteria for multiple sclerosis: guidelines from the international panel on the diagnosis of multiple sclerosis. Ann Neurol. 2001;50(1):121–127. doi: 10.1002/ana.1032.
    1. Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M. et al.Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol. 2011;69(2):292–302. doi: 10.1002/ana.22366.
    1. McCrone P, Heslin M, Knapp M, Bull P, Thompson A. Multiple Sclerosis in the UK. Pharmacoecon. 2008;26(10):847–860. doi: 10.2165/00019053-200826100-00005.
    1. Marrie R, Horwitz R, Cutter G, Tyry T, Campagnolo D, Vollmer T. Comorbidity, socioeconomic status and multiple sclerosis. Mult Scler. 2008;14(8):1091–1098. doi: 10.1177/1352458508092263.
    1. Dallmeijer AJ, Beckerman H, de Groot V, van de Port IG, Lankhorst GJ, Dekker J. Long-term effect of comorbidity on the course of physical functioning in patients after stroke and with multiple sclerosis. J Rehabil Med. 2009;41(5):322–326. doi: 10.2340/16501977-0335.
    1. Warren SA, Turpin KV, Pohar SL, Jones CA, Warren K. Comorbidity and health-related quality of life in people with multiple sclerosis. Int J of MS Care. 2009;11(1):6–16. doi: 10.7224/1537-2073-11.1.6.
    1. Kang JH, Chen YH, Lin HC. Comorbidities amongst patients with multiple sclerosis: a population‒based controlled study. Eur J Neurol. 2010;17(9):1215–1219. doi: 10.1111/j.1468-1331.2010.02971.x.
    1. Marrie R, Horwitz R, Cutter G, Tyry T, Campagnolo D, Vollmer T. The burden of mental comorbidity in multiple sclerosis: frequent, underdiagnosed, and undertreated. Mult Scler. 2009;15(3):385–392. doi: 10.1177/1352458508099477.
    1. Klevan G, Jacobsen C, Aarseth J, Myhr KM, Nyland H, Glad S. et al.Health related quality of life in patients recently diagnosed with multiple sclerosis. Acta Neurol Scand. 2013;129(1):21–26.
    1. McGuigan C, Hutchinson M. Unrecognised symptoms of depression in a community–based population with multiple sclerosis. J neurol. 2006;253(2):219–223. doi: 10.1007/s00415-005-0963-0.
    1. Chwastiak LA, Ehde DM. Psychiatric issues in multiple sclerosis. Psychiatr Clin N Am. 2007;30(4):803–817. doi: 10.1016/j.psc.2007.07.003.
    1. Trojan DA, Arnold D, Collet J-P, Shapiro S, Bar-Or A, Robinson A. et al.Fatigue in multiple sclerosis: association with disease-related, behavioural and psychosocial factors. Mult Scler. 2007;13(8):985–995. doi: 10.1177/1352458507077175.
    1. Bol Y, Duits AA, Hupperts RM, Vlaeyen JW, Verhey FR. The psychology of fatigue in patients with multiple sclerosis: a review. J Psychosom Res. 2009;66(1):3–11. doi: 10.1016/j.jpsychores.2008.05.003.
    1. Mohr DC, Hart SL, Julian L, Cox D, Pelletier D. Association between stressful life events and exacerbation in multiple sclerosis: a meta-analysis. Bmj. 2004;328(7442):731. doi: 10.1136/bmj.38041.724421.55.
    1. Mohr DC, Lovera J, Brown T, Cohen B, Neylan T, Henry R. et al.A randomized trial of stress management for the prevention of new brain lesions in MS. Neurology. 2012;79(5):412–419. doi: 10.1212/WNL.0b013e3182616ff9.
    1. Kern S, Ziemssen T. Review: Brain—immune communication psychoneuroimmunology of multiple sclerosis. Mult Scler. 2008;14(1):6–21. doi: 10.1177/1352458507079657.
    1. Thomas P, Thomas S, Hillier C, Galvin K, Baker R. Psychological interventions for multiple sclerosis. Cochrane Database Syst Rev. 2006;1:1–53.
    1. Kabat-Zinn J. Wherever you go, there you are: Mindfulness meditation in everyday life: Hyperion. 1994.
    1. Miller JJ, Fletcher K, Kabat-Zinn J. Three-year follow-up and clinical implications of a mindfulness meditation-based stress reduction intervention in the treatment of anxiety disorders. Gen Hosp Psychiatry. 1995;17(3):192–200. doi: 10.1016/0163-8343(95)00025-M.
    1. Kabat-Zinn J, Lipworth L, Burncy R, Sellers W. Four-year follow-up of a meditation-based program for the self-regulation of chronic pain: treatment outcomes and compliance. The Clinical Journal of Pain. 1986;2(3):159–774. doi: 10.1097/00002508-198602030-00004.
    1. Piet J, Hougaard E. The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: a systematic review and meta-analysis. Clin Psychol Rev. 2011;31(6):1032–1040. doi: 10.1016/j.cpr.2011.05.002.
    1. Lawrence M, Booth J, Mercer S, Crawford E. A systematic review of the benefits of mindfulness‒based interventions following transient ischemic attack and stroke. Int J Stroke. 2013;8(6):465–474. doi: 10.1111/ijs.12135.
    1. Robinson FP, Mathews HL, Witek-Janusek L. Psycho-endocrine-immune response to mindfulness-based stress reduction in individuals infected with the human immunodeficiency virus: a quasiexperimental study. The JAltern & Complement Med. 2003;9(5):683–694. doi: 10.1089/107555303322524535.
    1. Davidson RJ, Kabat-Zinn J, Schumacher J, Rosenkranz M, Muller D, Santorelli SF. et al.Alterations in brain and immune function produced by mindfulness meditation. Psychosom Med. 2003;65(4):564–570. doi: 10.1097/01.PSY.0000077505.67574.E3.
    1. Carlson LE, Speca M, Patel KD, Goodey E. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress and levels of cortisol, dehydroepiandrosterone sulfate (DHEAS) and melatonin in breast and prostate cancer outpatients. Psychoneuroendocrinology. 2004;29(4):448–474. doi: 10.1016/S0306-4530(03)00054-4.
    1. Hölzel BK, Lazar SW, Gard T, Schuman-Olivier Z, Vago DR, Ott U. How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspect Psychol Sci. 2011;6(6):537–559. doi: 10.1177/1745691611419671.
    1. Kabat-Zinn J. Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness: Delta. 2009.
    1. Teasdale JD, Segal ZV, Williams JMG, Ridgeway VA, Soulsby JM, Lau MA. Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. J Consult Clin Psychol. 2000;68(4):615.
    1. Kahl KG, Winter L, Schweiger U. The third wave of cognitive behavioural therapies: what is new and what is effective? Curr Opin Psychiatry. 2012;25(6):522–528. doi: 10.1097/YCO.0b013e328358e531. 10.1097/YCO.0b013e328358e531.
    1. Richardson WS, Wilson MC, Nishikawa J, Hayward RS. The well-built clinical question: a key to evidence-based decisions. ACP J Club. 1995;123(3):A12–A13.
    1. Reviews UoYCf D, Akers J. Systematic reviews: CRD’s guidance for undertaking reviews in health care: Centre for Reviews and Dissemination. 2009.
    1. Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD. et al.The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ: British Medical Journal. 2011;343:d5928. doi: 10.1136/bmj.d5928.
    1. Grossman P, Kappos L, Gensicke H, D’Souza M, Mohr DC, Penner IK. et quality of life, depression, and fatigue improve after mindfulness training: a randomized trial. Neurology. 2010;75(13):1141–1149. doi: 10.1212/WNL.0b013e3181f4d80d.
    1. Mills N, Allen J. Mindfulness of movement as a coping strategy in multiple sclerosis: a pilot study. Gen Hosp Psychiatry. 2000;22(6):425–431. doi: 10.1016/S0163-8343(00)00100-6.
    1. Tavee J, Rensel M, Pope Planchon S, Stone L. Effects of meditation on pain and quality of life in multiple sclerosis and polyneuropathy: a controlled study. Int J MS Care. 2011;13(S2):163–168.
    1. Mills N, Allen J, Carey-Morgan S. Does Tai Chi/Qi Gong help patients with multiple sclerosis? J Bodyw Mov Ther. 2000;4(1):39–48. doi: 10.1054/jbmt.1999.0139.

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