Evaluation of a web-based program for the adoption of wellness behaviors to self-manage fatigue and improve quality of life among people with multiple sclerosis: A randomized waitlist-control trial

• Published in: Multiple sclerosis and related disorders 2023-09, Vol.77, p.104858-104858, Article 104858
• Main Authors: Titcomb, Tyler J, Sherwood, Max, Ehlinger, Mary, Saxby, Solange M, Shemirani, Farnoosh, Eyck, Patrick Ten, Wahls, Terry L, Snetselaar, Linda G
• Format: Article
• Language: English
• Subjects: Fatigue; Fatigue - etiology; Fatigue - psychology; Fatigue - therapy; Humans; Internet; Multiple sclerosis; Multiple Sclerosis - complications; Multiple Sclerosis - therapy; Quality of Life; Self-Management; Web-based program; Wellness
• ISSN: 2211-0348; 2211-0356
• DOI: 10.1016/j.msard.2023.104858

•Compared to a waitlist control, a web-based wellness program consisting of diet, stress reduction, and exercise recommendations, had efficacy for reducing fatigue as assessed by the fatigue severity scale and modified fatigue impact scale.•Overall, 33.3% of participants completed all modules in the course; however, course completion was higher among the immediate intervention group (47.5%) compared to the waitlist control (delayed intervention) group (18.8%).•There were no between-group mean differences for physical or mental QoL; however, a significantly higher proportion of participants had clinically significant improvement in physical QoL in the immediate intervention group (50%) compared to the waitlist control (delayed intervention) group (22.5%) at 12-weeks. Wellness is a promising area of research in multiple sclerosis (MS); however, considerable questions remain regarding the efficacy of behavioral interventions to improve wellness and which delivery methods yield favorable results. To evaluate the efficacy of a wellness intervention consisting of diet, stress reduction techniques, sleep hygiene, and exercise, delivered via a 7-week web-based program with no tailored intervention support (e.g., counseling or resources) from the study team, on quality of life (QoL) and fatigue among people with MS. Individuals (n = 100) with self-reported physician's diagnosis of relapsing-remitting MS or clinically isolated syndrome were recruited to enroll in this randomized waitlist-control trial consisting of three timepoints at 0, 12, and 24 weeks. Participants were randomized to begin the intervention at baseline (INT; n = 51) or to a waitlist to begin the intervention after the 12-week timepoint (WLC; n = 49), and both groups were followed for 24 weeks. At 12-weeks, 95 participants (46 INT and 49 WLC) completed the primary endpoint and 86 (42 INT and 44 WLC) completed the 24-week follow-up. Compared to baseline, the INT group had a significant increase in physical QoL (5.43 ± 1.85; P = 0.003) at 12-weeks which was maintained at 24-weeks. Physical QoL values in the WLC group did not significantly increase between weeks 12 and 24 (3.24 ± 2.03; P = 0.11); however, physical QoL values significantly improved compared to week 0 values (4.00 ± 1.87; P = 0.033). Neither group had significant changes in mental QoL. The INT group had a mean baseline to 12-week change of ‑5.06 ± 1.79 (P = 0.005) for MFIS and -0.68 ± 0.21 (P = 0.002) for FSS, both of which were maintai