Online fatigue management program for patients with multiple sclerosis - a randomized controlled trial
Author(s): ,
J. Poettgen
University Medical Centre Hamburg Eppendorf, Hamburg, Germany
R. Moss-Morris
Health Psychology, King's College, London, United Kingdom
J.-M. Wendebourg
University Medical Centre Hamburg Eppendorf, Hamburg, Germany
L. Feddersen
University Medical Centre Hamburg Eppendorf, Hamburg, Germany
S.M. Gold
Institute of Neuroimmunology and MS, University Medical Centre Hamburg Eppendorf, Hamburg, Germany
I.-K. Penner
Department of Cognitive Psychology and Methodology, University of Basel, Basel, Switzerland
C. Heesen
University Medical Centre Hamburg Eppendorf, Hamburg, Germany
ECTRIMS Online Library. Poettgen J. Oct 8, 2015; 116705; 954
Jana Poettgen
Jana Poettgen
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Abstract: 135

Type: Hot Topic

Abstract Category: Treatment of specific symptoms

Objective: Fatigue is a major disabling symptom in Multiple Sclerosis (MS) but treatment options are limited. A few randomized trials have demonstrated efficacy of face-to-face behavioral interventions or standardized exercise programs. A recent pilot trial provided preliminary evidence that an online intervention based on cognitive behavioral therapy (CBT) combined with telephone support may reduce fatigue in MS. We developed a fully automated, interactive online fatigue management program (ELEVIDA) based on a manualized face-to face CBT intervention and conducted a randomized controlled trial to test its efficacy for reducing fatigue in MS.

Methods: Patients with MS and self-reported fatigue were recruited via the website of the German MS Society. Patients were randomly assigned to the 3 month online intervention (ELEVIDA) or a waitlist control group. Recruitment, randomization, the intervention as well as all outcome assessments were conducted online. The primary outcome was Fatigue as measured by the Chalder Fatigue Scale. Secondary outcomes included the Fatigue Scale for Motor and Cognition (FSMC) and measures of quality of life, anxiety, mood, and self-reported neuropsychological function. Outcomes were assessed at baseline and after the intervention (month 3). The trial was approved by the ethics review committee Hamburg and registered prior to patient enrolment (ISRCTN25692173). Data are reported from the per protocol sample.

Results: 275 patients were randomized to ELEVIDA (n=139) or to the waitlist control group (n=136). At baseline, both groups were comparable with regard to demographic or clinical characteristics (age, sex, education, disease duration, disease course). 224 of the 275 participants completed assessments at month 3. ELEVIDA significantly reduced fatigue as measured by the primary endpoint with a moderate effect size (Chalder Fatigue Scale d=.537). The ELEVIDA group also reported significantly greater improvements in anxiety and subjective cognitive impairment. No significant treatment effects were seen in measures of depression or coping.

Conclusion: Our trial provides first evidence for the efficacy of a fully automated, internet-based CBT intervention to reduce fatigue in MS. Interventions such as ELEVIDA may be a cost effective treatment option for MS fatigue. We are currently exploring whether the effects can be maintained over longer follow-up periods (3 months).


Jana Poettgen: nothing to disclose,

Rona Moss-Morris: nothing to disclose,

Janina-Maria Wendebourg: nothing to disclose,

Lena Feddersen: nothing to disclose,

Björn Meyer: nothing to disclose,

Stefan Gold: nothing to disclose,

Iris-Katharina Penner: nothing to disclose,

Christoph Heesen: nothing to disclose
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