Showing papers by "Rona Moss-Morris published in 2016"

A systematic review with meta-analysis of the role of anxiety and depression in irritable bowel syndrome onset.

Abstract: It is well established that people with irritable bowel syndrome (IBS) have higher levels of anxiety and depression compared with controls. However, the role of these as risk factors is less clearly established. The aims of this systematic review were to investigate: (1) whether anxiety and/or depression predict IBS onset; (2) the size of the relative risk (RR) of anxiety versus depression in IBS onset. Subgroup analyses explored if methodological factors affected the overall findings. Prospective cohort or case–control studies were included if they: (1) focused on the development of IBS in population-based or gastroenteritis cohorts; (2) explored the effects of anxiety and/or depression at baseline as predictors of IBS onset at a future point. In all, 11 studies were included of which eight recruited participants with a gastrointestinal infection. Meta-analyses were conducted. The risk of developing IBS was double for anxiety cases at baseline compared with those who were not [RR 2.38, 95% confidence interval (CI) 1.58–3.60]. Similar results were found for depression (RR 2.06, 95% CI 1.44–2.96). Anxiety and depression seemed to play a stronger role in IBS onset in individuals with a gastrointestinal infection although this could be attributed to other differences in methodology, such as use of diagnostic interviews rather than self-report. The findings suggest that self-reported anxiety and depression provide a twofold risk for IBS onset. There is less support for the role of anxiety or depressive disorder diagnosed using clinical interview. These findings may have implications for the development of interventions focused on IBS prevention and treatment.

Can We Identify the Active Ingredients of Behaviour Change Interventions for Coronary Heart Disease Patients? A Systematic Review and Meta-Analysis.

Abstract: Background The main behaviour change intervention available for coronary heart disease (CHD) patients is cardiac rehabilitation. There is little recognition of what the active ingredients of behavioural interventions for CHD might be. Using a behaviour change technique (BCT) framework to code existing interventions may help to identify this. The objectives of this systematic review are to determine the effectiveness of CHD behaviour change interventions and how this may be explained by BCT content and structure.

Improving distress in dialysis (iDiD): a feasibility two-arm parallel randomised controlled trial of an online cognitive behavioural therapy intervention with and without therapist-led telephone support for psychological distress in patients undergoing haemodialysis

Abstract: Introduction: Psychological distress is common in end-stage kidney disease (ESKD) and is associated with poorer health outcomes. Cognitive behavioural therapy (CBT) is recommended in UK clinical guidelines for the management of depression in people with long-term conditions. Access to skilled therapists competent in managing the competing mental and physical health demands of ESKD is limited. Online CBT treatments tailored to the needs of the ESKD population offers a pragmatic solution for underresourced services. This study examines the feasibility and acceptability of implementing a two-arm parallel randomised controlled trial of online CBT with (intervention arm) and without (control arm) therapist support to improve psychological distress in patients undergoing haemodialysis. Methods: Patients will be screened for depression and anxiety while attending for their haemodialysis treatments. We aim to recruit 60 adult patients undergoing haemodialysis who meet criteria for mild to moderately severe symptoms of depression and/or anxiety. Patients will be randomised individually (using a 1:1 computerised sequence ratio) to either online CBT with therapist telephone support (intervention arm), or online CBT with no therapist (control arm). Outcomes include feasibility and acceptability descriptive data on rates of recruitment, randomisation, retention and treatment adherence. Self-report outcomes include measures of depression (Patient Health Questionnaire-9), anxiety (Generalised Anxiety Disorder-7), quality of life (Euro-QoL), service use (client service receipt inventory) and illness cognitions (brief illness perception questionnaire). A qualitative process evaluation will also be conducted. The statistician will be blinded to treatment allocation. Ethics and dissemination: A National Health Service (NHS) research ethics committee approved the study. Data from this study will provide essential information for the design and testing of further interventions to ameliorate distress in patients undergoing dialysis. Any amendments to the protocol will be submitted to the NHS committee and study sponsor. Trial registration number: NCT023528702; Pre-results.

Improving Distress in Dialysis (iDiD): A tailored CBT self-management treatment for patients undergoing dialysis

Abstract: SummaryBackground There is significant psychological distress in adults with end-stage kidney disease (ESKD). However, psychological treatments tailored to address the unique challenges of kidney failure are absent. We identified psychological correlates of distress in ESKD to develop a cognitive-behavioural therapy (CBT) treatment protocol that integrates the mental health needs of patients alongside their illness self-management demands. Methods Studies which examined relationships between distress and psychological factors that apply in the context of ESKD including: health threats, cognitive illness representations and illness management behaviours were narratively reviewed. Review findings were translated into a CBT formulation model to inform the content of a renal-specific seven session CBT treatment protocol, which was commented on and refined by patient representatives. Results Health threats related to distress were grouped into four themes including: acute ESKD events, loss of role, uncertainty and illness self-management. Having pessimistic illness and treatment perceptions were associated with elevated distress. Non-adherence and avoidance behaviours were related to feelings of distress, whereas cognitive reappraisal, acceptance, social support and assertiveness were associated with less distress. Conclusions The dialysis-specific CBT formulation identifies the importance of targeting ESKD-specific correlates of distress to allow the delivery of integrated mental and physical health care. The ‘Improving Distress in Dialysis (iDiD)’ treatment protocol now requires further evaluation in terms of content, feasibility and potential efficacy.

Potential treatment mechanisms in a mindfulness-based intervention for people with progressive multiple sclerosis.

Abstract: Objectives To explore putative mediators of a mindfulness-based intervention to decrease distress in people with multiple sclerosis (MS) and to explore the patients’ perspectives on this intervention. Design We used an explanatory mixed methods design incorporating quantitative data from a pilot randomized control trial and a qualitative interview study with people who completed the mindfulness intervention. Methods People with MS (n = 40) completed standardized measures of distress (outcome), and acceptance, decentring, self-compassion, and self-efficacy (potential mediators). Semi-structured interviews (n = 15) of patients’ experiences of the mindfulness intervention were analysed deductively and inductively. Results Decentring post-intervention explained 13% of the 3-month change in distress and between 27% and 31% of concurrent changes in distress. Acceptance changed only slightly, and as a result, the indirect effect accounts for only 2% of future distress and between 3% and 11% of concurrent distress. Qualitative data showed that acceptance and self-compassion needed more time to develop, whereas decentring could be implemented readily after being introduced in the sessions. Self-efficacy also had a large mediating effect. Participants in their interviews talked about group dynamics and prior expectations as essential elements that determine their engagement with the course and their level of satisfaction. Conclusions Mindfulness interventions for people with a chronic progressive condition may benefit from focusing on helping them to accept daily challenges and teach them to recognize their thoughts and feelings, allowing time for acceptance and self-compassion to develop. Group dynamics also play a fundamental role in the success of the mindfulness interventions.

The role of psychological factors in fatigue among end-stage kidney disease patients: a critical review.

Abstract: Fatigue is a common and debilitating symptom, affecting 42-89% of end-stage kidney disease patients, persisting even in pre-dialysis care and stable kidney transplantation, with huge repercussions on functioning, quality of life and patient outcomes. This paper presents a critical review of current evidence for the role of psychological factors in renal fatigue. To date, research has concentrated primarily on the contribution of depression, anxiety and subjective sleep quality to the experience of fatigue. These factors display consistent and strong associations with fatigue, above and beyond the role of demographic and clinical factors. Considerably less research is available on other psychological factors, such as social support, stress, self-efficacy, illness and fatigue-specific beliefs and behaviours, and among transplant recipients and patients in pre-dialysis care. Promising evidence is available on the contribution of illness beliefs and behaviours to the experience of fatigue and there is some indication that these factors may vary according to treatment modality, reflecting the differential burdens and coping necessities associated with each treatment modality. However, the use of generic fatigue scales casts doubt on what specifically is being measured among dialysis patients, illness-related fatigue or post-dialysis-specific fatigue. Therefore, it is important to corroborate the available evidence and further explore, qualitatively and quantitatively, the differences in fatigues and fatigue-specific beliefs and behaviours according to renal replacement therapy, to ensure that any model and subsequent intervention is relevant and grounded in the experiences of patients.

Psychosocial and Clinical Correlates of Fatigue in Haemodialysis Patients: the Importance of Patients’ Illness Cognitions and Behaviours

Abstract: We wish to highlight a discrepancy with regards to the reported mean fatigue severity score (mean = 28.3, standard deviation = 6.5). Since publication we have followed this sample up over time and are currently evaluating the longitudinal trajectories of fatigue severity.

A New Zealand pilot randomized controlled trial of a web-based interactive self-management programme (MSInvigor8) with and without email support for the treatment of multiple sclerosis fatigue

Abstract: Objective:To pilot and compare the efficacy of an internet-based cognitive behavioural therapy self-management programme with (MSInvigor8-Plus) and without (MSInvigor8-Only) the use of email support in reducing fatigue severity and impact (primary outcomes), and depressed and anxious mood (secondary outcomes).Design:Randomized controlled trial using an independent randomization system built into the website and intention-to-treat analysis.Setting:Participants were recruited through the local Multiple Sclerosis Society and hospital neurological services in New Zealand.Subjects:A total of 39 people (aged 31–63 years), experiencing multiple sclerosis fatigue, able to walk with and without walking aids, were randomized to MSInvigor8-Only (n = 20) or to MSInvigor8-Plus (n = 19).Interventions:MSInvigor8 is an eight-session programme based on cognitive behaviour therapy principles including psycho-education, self-monitoring, and changing unhelpful activity and thought patterns.Main measures:Outcome measures incl...

The Chalder Fatigue Questionnaire is a valid and reliable measure of perceived fatigue severity in multiple sclerosis.

Abstract: Background:Fatigue is one of the most distressing symptoms of multiple sclerosis (MS). Measuring MS fatigue poses a number of challenges. Many measures confound definitions of severity and impact of fatigue and/or lack psychometric validation in MS.Objective:To evaluate the psychometric properties of an 11-item fatigue severity measure, the Chalder Fatigue Questionnaire (CFQ) in MS including validity of the factor structure, internal reliability, discriminant validity and sensitivity to change.Methods:Data were pooled from four previous studies investigating MS fatigue using the CFQ (n=444). Data analysis included confirmatory factor analysis to determine the factor structure and model fit, correlations to assess discriminant validity and effects sizes to determine sensitivity to change.Results:A bi-factor model with one general fatigue factor, incorporating two smaller group factors (mental and physical fatigue) had good model fit and appeared the most appropriate factor structure underlying the CFQ scal...

Attentional and interpretive bias towards illness-related information in chronic fatigue syndrome: A systematic review.

Abstract: Purpose Chronic fatigue syndrome (CFS) is characterized by severe and debilitating fatigue. Studies based on self-report measures suggest negative illness representations, related symptom interpretations, and heightened symptom focusing are maintaining factors of fatigue. This study reviews studies which have investigated these cognitive biases using experimental methods, to (1) review the evidence for information processing biases in CFS; (2) determine the nature of these biases, that is the stages cognitive biases occur and for what type of stimuli; and (3) provide directions for future methodologies in this area. Methods Studies were included that measured attention and interpretation bias towards negative and illness-related information in people with CFS and in a comparison group of healthy controls. PubMed, Ovid, CINAHL, PsycINFO, Web of Science, and EThOS were searched until December 2014. Results The evidence for cognitive biases was dependent on the methodology employed as well as the type and duration of the stimuli presented. Modified Stroop studies found weak evidence of an attentional bias in CFS populations, whereas visual-probe studies consistently found an attentional bias in CFS groups for health-threatening information presented for 500 ms or longer. Interpretative bias studies which required elaborative processing, as opposed to a spontaneous response, found an illness-related interpretive bias in the CFS group compared to controls. Conclusions Some people with CFS have biases in the way they attend to and interpret somatic information. Such cognitive processing biases may maintain illness beliefs and symptoms in people with CFS. This review highlights methodological issues in experimental design and makes recommendations to aid future research to forge a consistent approach in cognitive processing research. Statement of contribution What is already known on this subject? Studies based on self-report measures suggest negative illness representations, related symptom interpretations, and heightened symptom focusing contribute to the maintenance of chronic fatigue. Experimental studies in other clinical populations, such as patients with anxiety, depression, and chronic pain, have identified illness-specific biases in how information is implicitly attended to and interpreted, which has a causal role in these conditions. What does this study add? This is the first review of implicit cognitive processes in chronic fatigue syndrome (CFS). Sustained attention and negative interpretations of somatic information may reinforce negative illness beliefs. Cognitive processes have a role to play in the cognitive behavioural model of CFS.

Establishing how psychological therapies work: the importance of mediation analysis

Abstract: This editorial reviews the literature regarding psychological studies that are designed to address the question of not just whether, psychological interventions effect change, but how. The practicalities and implications of assessing mechanisms of treatments are considered with examples from the fields of Cognitive Behavioural Therapy (CBT) and Mindfulness. The potential for elucidating theoretical mechanisms, developing new theoretical models and modifying treatment approaches are described. In addition an overview of different types of statistical methods available to researchers for assessing mediation is given. Structural Equation Modelling (SEM) is a recommended approach. The review concludes with a summary of optimum study conditions adopted by researchers for establishing mediating effects.

Cost-utility and biological underpinnings of Mindfulness-Based Stress Reduction (MBSR) versus a psychoeducational programme (FibroQoL) for fibromyalgia: a 12-month randomised controlled trial (EUDAIMON study).

Abstract: The EUDAIMON study focuses on fibromyalgia syndrome (FMS), a prevalent chronic condition characterized by pain, fatigue, cognitive problems and distress. According to recent reviews and meta-analyses, Mindfulness-Based Stress Reduction (MBSR) is a promising therapeutic approach for patients with FMS. The measurement of biomarkers as part of the analysis of MBSR effects would help to identify the neurobiological underpinnings of MBSR and increase our knowledge of FMS pathophysiology. The main objectives of this 12-month RCT are: firstly, to examine the effectiveness and cost-utility for FMS patients of MBSR as an add-on to treatment as usual (TAU) versus TAU + the psychoeducational programme FibroQoL, and versus TAU only; secondly, to examine pre-post differences in brain structure and function, as well as levels of specific inflammatory markers in the three study arms and; thirdly, to analyse the role of some psychological variables as mediators of 12-month clinical outcomes. Effectiveness, cost-utility, and neurobiological analyses performed alongside a 12-month RCT. The participants will be 180 adult patients with FMS recruited at the Sant Joan de Deu hospital (St. Boi de Llobregat, Spain), randomly allocated to one of the three study arms: TAU + MBSR vs. TAU + FibroQol vs. TAU. A comprehensive assessment to collect functional, quality of life, distress, costs, and psychological variables will be conducted pre-, post-intervention, and at 12-month post-intervention. Fifty per cent of study participants will be evaluated at pre- and post-treatment using Voxel-Based Morphometry, Diffusion Tensor Imaging, pseudo-continuous Arterial Spin Labeling, and resting state fMRI. A cytokine multiplex kit of high-sensitivity will be applied (cytokines IL-6, IL-8, IL-10 + high-sensitivity CRP test). The findings obtained from this RCT will indicate whether MBSR is potentially cost-effective for FMS and contribute to knowledge of any brain and inflammatory changes associated with MBSR in FMS patients. Specifically, we will determine whether there are morphometric and functional changes associated with participation in MBSR in brain regions related to meta-awareness, body awareness, memory consolidation-reconsolidation, emotion regulation and in networks postulated to underpin the sensory-discriminative, cognitive-evaluative and affective-motivational aspects of the pain experience. NCT02561416 . Registered 23 September 2015.

Understanding fatigue in paediatric multiple sclerosis: a systematic review of clinical and psychosocial factors

Abstract: Aim Fatigue in children and adolescents with multiple sclerosis (caMS) is currently poorly understood. This review aimed to provide greater insight into this area and direction for future research by evaluating evidence of associations between fatigue and clinical, psychological, and social factors in caMS. Method Studies were identified by searching online databases, hand-searching reference lists, and requesting unpublished literature from key authors. Studies that examined fatigue in relation to at least one clinical, psychological, or social factor in caMS were included. Data on design, sample characteristics, measures of fatigue, clinical, psychological, and social variables, and key findings were extracted. Twelve studies were narratively synthesized. Results Clinical factors appeared largely unrelated to fatigue, whereas associations between fatigue and tests of neurocognitive functioning, and fatigue and diagnosable psychiatric disorders, were mixed. However, fatigue and depressed mood consistently correlated. A small number of studies indicated associations between fatigue and reduced quality of life and school performance. Interpretation A sufficient explanatory model of fatigue in caMS is lacking as studies in this area are few and diverse. Future research should endeavour to identify potentially modifiable clinical and psychosocial factors that are associated with fatigue in caMS so that interventions targeting such factors may be developed.

Physiotherapy informed by Acceptance and Commitment Therapy (PACT): protocol for a randomised controlled trial of PACT versus usual physiotherapy care for adults with chronic low back pain

Abstract: Introduction Chronic low back pain (CLBP) is a common condition and source of significant suffering, disability and healthcare costs Current physiotherapy treatment is moderately effective Combining theory-based psychological methods with physiotherapy could improve outcomes for people with CLBP The primary aim of this randomised controlled trial (RCT) is to evaluate the efficacy of Physiotherapy informed by Acceptance and Commitment Therapy (PACT) on functioning in patients with CLBP Methods and analysis The PACT trial is a two-armed, parallel-group, multicentre RCT to assess the efficacy of PACT in comparison with usual physiotherapy care (UC) 240 patients referred to physiotherapy with CLBP will be recruited from three National Health Service (NHS) hospitals trusts Inclusion criteria are: age ≥18 years, CLBP ≥12-week duration, scoring ≥3 points on the Roland-Morris Disability Questionnaire (RMDQ) and adequate understanding of spoken and written English to participate Patients will be randomised to PACT or UC (120 per arm stratified by centre) by an independent randomisation service and followed up at 3 and 12 months post randomisation The sample size of 240 will provide adequate power to detect a standardised mean difference of 040 in the primary outcome (RMDQ; 5% significance, 80% power) assuming attrition of 20% Analysis will be by intention to treat conducted by the trial statistician, blind to treatment group, following a prespecified analysis plan Estimates of treatment effect at the follow-up assessments will use an intention-to-treat framework, implemented using a linear mixed-effects model Ethics and dissemination This trial has full ethical approval (14/SC/0277) It will be disseminated via peer-reviewed publications and conference presentations The results will enable clinicians, patients and health service managers to make informed decisions regarding the efficacy of PACT for patients with CLBP Trial registration number ISRCTN95392287; Pre-results

Psychological Treatments for Chronic Pain in East and Southeast Asia: A Systematic Review

Abstract: Psychological treatments are recognised as generally effective for chronic pain. However, little is known about the evidence for psychological treatments for chronic pain in Asia. This study aimed (1) to identify all treatment outcome studies in the area of psychological approaches to chronic pain in adult populations of East Asia and Southeast Asia and (2) to evaluate the treatment types, the evidence for treatment outcomes and research design quality with regard to these studies. We identified all psychologically based treatment outcome studies for chronic pain in East and Southeast Asia by searching CENTRAL, EMBASE, PsycINFO, MEDLINE (via Ovid), Global Health and Web of Science from the beginning of each abstracting service until December 2014 (week 4). Seventeen studies met inclusion criteria including a total of N = 1,890 participants. Four were randomised controlled trials (RCTs), five controlled clinical trials (CCTs) and eight cohort studies. Treatment outcomes included pain, disability, depression and anxiety. Overall, the studies included in this review showed small to medium within-group effect sizes for all four outcomes. A majority of the studies were rated as weak in design quality. Three RCTs were found to be of strong quality, one of moderate quality and only one CCT of moderate quality. The current available literature on psychological treatments for chronic pain in East and Southeast Asia is generally small in scale, mostly preliminary and lags behind on some developments occurring in North America and Europe. Further development of treatment methods and research designs is warranted.

Maximizing potential impact of experimental research into cognitive processes in health psychology: A systematic approach to material development

Abstract: Background There is an abundance of research into cognitive processing biases in clinical psychology including the potential for applying cognitive bias modification techniques to assess the causal role of biases in maintaining anxiety and depression. Within the health psychology field, there is burgeoning interest in applying these experimental methods to assess potential cognitive biases in relation to physical health conditions and health-related behaviours. Experimental research in these areas could inform theoretical development by enabling measurement of implicit cognitive processes that may underlie unhelpful illness beliefs and help drive health-related behaviours. However, to date, there has been no systematic approach to adapting existing experimental paradigms for use within physical health research. Many studies fail to report how materials were developed for the population of interest or have used untested materials developed ad hoc. The lack of protocol for developing stimuli specificity has contributed to large heterogeneity in methodologies and findings. Purpose In this article, we emphasize the need for standardized methods for stimuli development and replication in experimental work, particularly as it extends beyond its original anxiety and depression scope to other physical conditions. Method We briefly describe the paradigms commonly used to assess cognitive biases in attention and interpretation and then describe the steps involved in comprehensive/robust stimuli development for attention and interpretation paradigms using illustrative examples from two conditions: chronic fatigue syndrome and breast cancer. Conclusions This article highlights the value of preforming rigorous stimuli development and provides tools to aid researchers engage in this process. We believe this work is worthwhile to establish a body of high-quality and replicable experimental research within the health psychology literature. Statement of contribution What is already known on this subject? Cognitive biases (e.g., tendencies to attend to negative information and/or interpret ambiguous information in negative ways) have a causal role in maintaining anxiety and depression. There is mixed evidence of cognitive biases in physical health conditions and chronic illness; one reason for this may be the heterogeneous stimuli used to assess attention and interpretation biases in these conditions. What does this study add? Steps for comprehensive/robust stimuli development for attention and interpretation paradigms are presented. Illustrative examples are provided from two conditions: chronic fatigue syndrome and breast cancer. We provide tools to help researchers develop condition-specific materials for experimental studies.

Protocol for a pilot randomised controlled trial of an online intervention for post-treatment cancer survivors with persistent fatigue

Abstract: Introduction Many post-treatment cancer survivors experience persistent fatigue that can disrupt attempts to resume normal everyday activities after treatment. Theoretical models that aim to explain contributory factors that initiate and sustain fatigue symptoms, or that influence the efficacy of interventions for cancer-related fatigue (CrF) require testing. Adjustment to fatigue is likely to be influenced by coping behaviours that are guided by the representations of the symptom. Objectives This paper describes the protocol for a pilot trial of a systematically and theoretically designed online intervention to enable self-management of CrF after cancer treatment. Methods and analysis This 2-armed randomised controlled pilot trial will study the feasibility and potential effectiveness of an online intervention. Participants will be allocated to either the online intervention (REFRESH (Recovery from Cancer-Related Fatigue)), or a leaflet comparator. Participants 80 post-treatment cancer survivors will be recruited for the study. Interventions An 8-week online intervention based on cognitive–behavioural therapy. Primary and secondary outcome measures The primary outcome is a change in fatigue as measured by the Piper Fatigue Scale (revised). Quality of life will be measured using the Quality of Life in Adult Survivors of Cancer Scale. Outcome measures will be collected at baseline, and at completion of intervention. Results The feasibility of trial procedures will be tested, as well as the effect of the intervention on the outcomes. Conclusions This study may lead to the development of a supportive resource to target representations and coping strategies of cancer survivors with CrF post-treatment. Setting Recruitment from general public in Ireland. Ethics and dissemination This trial was approved by the Research Ethics Committee at National University of Ireland Galway in January 2013. Trial results will be communicated in a peer-reviewed journal. Trial registration number ISRCTN55763085; Pre-results.

Parents’ expressed emotion and mood, rather than their physical disability are associated with adolescent adjustment: A longitudinal study of families with a parent with multiple sclerosis

Abstract: Objective:This study investigated the impact of the severity of parental multiple sclerosis, parents’ expressed emotion and psychological well-being on offspring’s psychological difficulties.Design:A longitudinal study including baseline and 6-month follow-up data collected from parents and children.Subjects:Adolescents (n=75), their parents with multiple sclerosis (n=56) and the partner without multiple sclerosis (n=40).Main measures:Parents completed the Hospital Anxiety and Depression Scale and the Five Minutes Speech Sample, a standardised interview of expressed emotion towards their child. Parents with multiple sclerosis also completed the Expanded Disability Status Scale, a measure of illness severity. Adolescents completed the Strength and Difficulties Questionnaire, a self-report measure of psychological difficulties.Results:Higher depression scores of the parents with multiple sclerosis at baseline correlated with increased adolescents’ internalising symptoms at 6-month follow-up (γdep=0.31, P=.0...

Development and Feasibility of an Evidence-Based Patient Education Program for Managing Fatigue in Multiple Sclerosis: The "Fatigue Management in MS" Program (FatiMa)

Abstract: Background: Multiple sclerosis (MS) is an inflammatory and neurodegenerative disease of the central nervous system. Fatigue is a common and disabling symptom, often causing decreased quality of life, social withdrawal, and unemployment. We developed and studied the feasibility of a cognitive-behavioral group intervention to manage fatigue in MS. We aimed to integrate the concepts of cognitive-behavioral therapy and evidence-based patient information. Methods: We conducted patient interviews and a focus group to assess patients' interest in and need for fatigue self-management training and developed the program accordingly. The program consists of six 90-minute modules, which were structured with the use of moderation cards, helping to guarantee treatment fidelity. The program was tested on three pilot groups (N = 16) in a rehabilitation center. Fatigue, depression, and coping self-efficacy were assessed at baseline and after the intervention. Acceptance and general satisfaction with the program were also ...

Psychological Treatment Needs for Chronic Pain in Singapore and the Relevance of the Psychological Flexibility Model.

Abstract: Objective. The goals of the present study were (a) to assess the psychological treatment needs and treatment delivery preferences in people attending services or contacting a hospital website for chronic pain in Singapore, and (b) to explore potential relevance of the psychological flexibility (PF) model for this group by investigating associations between PF and pain-related outcomes. Design and Setting. This was a cross-sectional questionnaire study of people with chronic pain in Singapore. Subjects. Current users of treatment services at a tertiary pain management clinic (PMC), users of pain treatment services elsewhere, and non-treatment users. Methods. Participants were either recruited face-to-face at a pain clinic or via an online portal. All participants completed a questionnaire, including a survey of treatment barriers and needs, treatment delivery preferences for chronic pain, and standardized measures of PF, pain interference, emotional functioning, and health care use. Results. A total of 200 participants completed the study. Cost of treatment was identified as a main deterrent, while proof of treatment success was identified as a main facilitator for treatment uptake. A majority of participants (88.5%) indicated a preference for face-to-face treatment. In multiple regression analyses, after controlling for relevant demographic variables and pain intensity, PF explained 14% of the variance for pain interference and impact of depressive symptoms and 22% of the variance for depressive symptoms. Conclusion. A focus on meeting patients’ needs at low cost, and providing proof of treatment success may increase psychological treatment uptake. Increasing PF for pain in people from Singapore may also contribute to better patient functioning.*

Healthcare professionals’ perceptions of psychological treatment for chronic pain in Singapore: challenges, barriers, and the way forward

Abstract: Purpose: There are very few studies on healthcare providers’ experiences of delivering treatment for chronic pain in a Southeast Asian setting. The aims of this study are to understand the experiences of professionals delivering treatment for people with chronic pain in Singapore and identify possible barriers to psychological treatment for this condition within the broader experiences of these professionals. Method: Healthcare professionals with at least 1-year experience treating chronic pain were recruited and purposefully sampled. Fifteen inductive semi-structured interviews were conducted to explore healthcare professionals’ experiences of treating people with chronic pain. Interviews were transcribed verbatim and analysed using thematic analysis. Results: Four main themes were identified: ‘System Barriers’, ‘Core Beliefs and management of Chronic Pain’, ‘Engaging Patients in treatment’ and ‘Creating Awareness for Chronic Pain Management’. Professionals trained in a multidisciplinary approach...

Which exercise or behavioural fatigue interventions are effective for people with multiple sclerosis (MS)? A systematic review with detailed intervention breakdown and meta-analysis

Abstract: Review question(s) The overall aim of this review is to provide guidance as to which of the existing exercise and behavioural interventions appear most promising for the treatment of MS fatigue. The specific objectives are to: (1) Provide a narrative synthesis of all the interventions including a breakdown of the key contextual and treatment components of each of the interventions, the acceptability of the interventions (uptake and adherence), and the study quality (risk of bias) alongside the standardized intervention effect sizes. (2) Conduct meta-analyses of effect sizes across interventions with similar key intervention components. (3) Compare the overall effect sizes of the exercise and behavioral interventions followed by subgroup analysis within each of these groups (e.g. behavioral interventions: energy conservation, CBT, combined; exercise interventions: aerobic endurance, strength, balance and combined). (4) Conduct exploratory moderator and sensitivity analyses to explore how treatment effects vary according to whether interventions were guided by theory or not, different levels of health care professional contact (e.g. email support, telephone, face-to-face), types of MS, comparators used, and study quality.

“It feels like wearing a giant sandbag.” Understanding fatigue in paediatric multiple sclerosis

Abstract: Background: Fatigue is one of the most common and disabling symptoms of multiple sclerosis (MS), associated with depressed mood, impaired school performance and lower quality of life in children and adolescents with MS (caMS). Fatigue in caMS is poorly understood, and effective treatments for fatigue are currently lacking. This is the first qualitative study to explore experiences of fatigue in paediatric MS. The aim was to gain insight into how caMS and their parents respond to and manage fatigue. Methods: In-depth semi-structured qualitative interviews were conducted with 15 caMS and 13 parents, either face-to-face or via telephone. Inductive thematic analysis was primarily used, incorporating elements of grounded theory. Findings: Five key themes were identified in the data. The Lived Experience of Fatigue & Impact on Daily Activities, Uncertainty and Uncontrollability of Fatigue and Balancing Activities were themes common to caMS and parents, whilst parents uniquely expressed Concern about children’s well-being and future, and caMS solely discussed their experiences of Social Support and Disclosure. An additional overarching theme addressed participants’ Emotional Responses to Fatigue & its Impact. Discussion: This study provides a unique insight into the experience and management of fatigue in paediatric MS from the perspective of both caMS and parents. Although some findings echoed experiences of fatigue in other populations, such as perceiving fatigue to be uncontrollable, this study also highlighted new factors in paediatric MS, such as issues about disclosure. These factors should be addressed in clinical practice by developing interventions for fatigue involving caMS, parents and teachers.

Measuring fatigue in haemodialysis patients: psychometric properties of the Chalder Fatigue Questionnaire (CFQ)

Abstract: Background: Fatigue is common in haemodialysis (HD) patients, leading to poorer quality of life and patient outcomes. Given the complex and subjective nature of fatigue, and its overlap with sleep disturbances and depression, its measurement represents a challenge. Great variability exists in fatigue instruments used in this patient population, with little informed agreement on what scale would be optimal. Our aim was to evaluate the psychometric properties of the 11-item Chalder Fatigue Questionnaire (CFQ) in HD patients, including an assessment of the validity of the factor structure, internal-reliability, and discriminant validity with respect to psychological distress and comorbidity. Methods: Data were evaluated for psychometric analysis from a published study investigating clinical and psychosocial correlates of fatigue among 174 HD patients. Confirmatory factor analysis was used to determine the factor structure using Weighted Least-Squares with Mean and Variance adjustment (WLSMV) estimation. Findings: Mental and physical fatigue factors correlated highly (r=.70, p .95; TLI>.95). The CFQ had high internal consistency and showed a moderate correlation with distress and a small association with comorbidity. Discussion: The CFQ can be summed to a total fatigue severity score, representing a composite of physical and mental fatigue, and has good psychometric properties. Taking into consideration its good psychometric properties and brief length, the CFQ should be used in future studies interested in measuring fatigue in HD patients.

Efficacy of targeted versus non-targeted exercise and behavioural interventions onfatigue in multiple sclerosis: systematic review and meta-analysis

Abstract: Review question(s) The specific objectives are to: (1) Provide a narrative synthesis of all the interventions, including a summary of the nature of the intervention using the Template for intervention Description and Replication (TiDieR), and assessment of study quality (risk of bias), alongside the standardised intervention effect sizes. As a detailed synthesis already includes studies evaluating interventions specifically targeting MS fatigue (ref: CRD42016033763), the narrative synthesis will focus on studies evaluating interventions that (a) do not specifically target fatigue, or (b) measured fatigue as a secondary outcome. (2) Conduct (pair-wise) meta-analyses to pool effect sizes across intervention types (exercise, behavioural, mixed) and estimate statistical heterogeneity. (3) Directly compare specific types of targeted versus non-targeted exercise, behavioural and combined interventions on fatigue in multiple sclerosis, using network meta-analyses. (4) Conduct exploratory moderator and sensitivity analyses to explore how treatment effects vary according to health care professional (HCP) contact, type of MS, and study quality (i.e. risk of bias).