A study funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).

Multiple sclerosis (MS) is a chronic condition that affects the central nervous system. According to the National MS Society, some of the most common and debilitating symptoms people with MS may experience are fatigue, chronic pain, and depression. Living well with these symptoms can be a daily challenge. One NIDILRR-funded study shows that people with MS who receive self-management training can develop the skills and knowledge they need to manage the day-to-day physical, emotional, and social aspects of living with a chronic condition, and they may be able do it from the comfort of home.

Researchers at the Multiple Sclerosis Rehabilitation Research and Training Center tested a telephone-delivered self-management intervention to see whether it could help adults with MS effectively manage and reduce symptoms of fatigue, chronic pain, and depression. Generally, in a self-management program, participants are taught evidence-based cognitive-behavioral strategies, such as problem-solving or relaxation skills, to help them self-manage the symptoms of a chronic condition. Participants in these programs may meet with therapists individually or in group settings and may have some homework such as reading assignments or practicing skills learned in a session.

For this study, one group of participants received a specially-developed self-management intervention teaching strategies to reduce their symptoms. Another group received an educational intervention offering general information on MS along with specific material on pain, fatigue, mood, and other topics. In the self-management intervention, participants were taught self-management skills like self-monitoring, goal setting, identifying strengths and priorities, relaxation techniques, and more. At the end of the program, they worked with the therapist to create a comprehensive, personal self-management plan that included their preferred skills and goals to use after the treatment ended. In the educational intervention, participants received information about fatigue, pain, depression, and other common MS challenges, but were not taught any self-management skills. Participants from both groups met one-on-one with a therapist by phone over eight sessions, plus follow-up calls at four and eight weeks after the treatment ended.

The authors found that, at the end of the treatment, both groups had positive results in the following areas:

• improvements in common symptoms of MS including depression, chronic fatigue, and/or pain, and those benefits were generally maintained up to a year after the study;
• improvements in life areas such as self-efficacy, mental health-related quality of life, resilience, and social role satisfaction.

Participants also reported high satisfaction with the program and its delivery. Most participants said they appreciated the convenience of working with a therapist by phone and would recommend their program to a friend with MS.

The self-management intervention group had better results than the education intervention group in some areas:

• better knowledge, skills, and confidence among participants in managing their own care;
• more positive moods such as joy, interest, and alertness;
• more improvement in their confidence in their ability to manage MS symptoms.

The authors suggested that future studies could include developing and testing the effectiveness of self-management interventions that include online communities and social media as ways to build social support in addition to that achieved through one-on-one phone contacts. Other studies could compare MS-specific self-management programs to generic self-management programs to see whether specially-tailored programs would have advantages over generic ones. The authors also suggested adding a physical activity intervention to a self-management program to see if such a combined program might lead to improved quality of life for people with MS.

According to the authors, this study showed that a single self-management or education program can give people with MS the tools and information they could use to effectively manage multiple symptoms of their condition. It also showed that participants and therapists can establish a good working relationship by phone. The convenience of phone delivery means more people with MS may have access to these effective programs, including people in rural areas and those who may not be able to travel.

To learn more:

The National Multiple Sclerosis Society has a wealth of information about MS, as well as tools and programs for working, playing, and living with the condition. http://www.nationalmssociety.org/

The National Council on Aging offers information about the Chronic Disease Self-Management Program, a generic self-management program, including local providers and an online option. https://www.ncoa.org/healthy-aging/chronic-disease/chronic-disease-self-management-program/

To learn more about this study:

Ehde, D.M., Elzea, J.L., Verrall, A.M., Gibbons, L.E., Smith, A.E., and Amtmann, D. (2015) Efficacy of a telephone-delivered self-management intervention for persons with multiple sclerosis: A randomized controlled trial with a one-year follow-up . Archives of Physical Medicine and Rehabilitation, 96: 1945-1958. This article is available from NARIC under Accession Number J72682

This study was highlighted in the Archives Podcast: http://www.archives-pmr.org/issue/S0003-9993(15)00647-4 (mp3)

Take charge of MS: http://msrrtc.washington.edu/research/takecharge