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Efficacy of A Telephone-Delivered Self-Management Intervention For Persons With Multiple Sclerosis: a Randomized Controlled Trial With a One-Year Follow-Up

Dawn M. Ehde, Jamie L. Elzea, Aimee M. Verrall, Laura E. Gibbons, Amanda Smith, Dagmar Amtmann

Archives of Physical Medicine and Rehabilitation, In Press, Accepted Manuscript, Available online 6 August 2015

Abstract

Objective

To evaluate the efficacy of a telephone-delivered self-management intervention for fatigue, pain, and depression in adults with multiple sclerosis (MS).

Design

Single-center, randomized (1:1), single blind (outcome assessors) parallel-group trial with a primary end-point of post-treatment (9-11 weeks post-randomization) and long-term follow-ups at 6- and 12-months.

Setting

Telephone-delivered across the United States.

Participants

Adults with MS (N=163) with fatigue, chronic pain, and/or moderate depressive symptoms (age range 25-76 years).

Interventions

Eight-week individual telephone-delivered self-management intervention (T-SM: n=75) versus an eight-week individual telephone-delivered MS education intervention (T-ED: n=88).

Main Outcome Measures

The primary outcome was the proportion who achieved a > 50% decrease in one or more symptom - fatigue impact, pain interference, and/or depression severity. Secondary outcomes included continuous measures of pain, fatigue impact, depression, self-efficacy, activation, health-related quality of life, resilience, and affect.

Results

For our primary outcome, 58% of those in the T-SM and 46% of those in the T-Ed had a > 50% reduction in one or more symptom; this difference was not statistically significant (OR: 1.50, 95% CI: 0.77 to 2.93, p = 0.238). Participants in both groups significantly improved from baseline to post-treatment in primary and secondary outcome measures (p < 0.05). T-SM participants reported significantly higher treatment satisfaction and therapeutic alliance and greater improvements in activation, positive affect, and social roles. Improvements were generally maintained at 6- and 12-months.

Conclusions

Both interventions resulted in short- and long-term, clinically meaningful benefits. The study demonstrated that the telephone is an effective method for engaging participants in and extending the reach of care for individuals with MS.