Author: Simpson R1, Simpson S2, Ramparsad N3, Lawrence M4, Booth J4, Mercer SW5
1Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK Robert.Simpson@glasgow.ac.uk.
2Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
3Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK.
4School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
5General Practice and Primary Care, University of Glasgow, Glasgow, UK.
Conference/Journal: J Neurol Neurosurg Psychiatry.
Date published: 2019 Jun 13
Other: Pages: jnnp-2018-320165 , Special Notes: doi: 10.1136/jnnp-2018-320165. [Epub ahead of print] , Word Count: 257
OBJECTIVE: Impairment of mental well-being (anxiety, depression, stress) is common among people with multiple sclerosis (PwMS). Treatment options are limited, particularly for anxiety. The aim of this study was to update our previous systematic review (2014) and evaluate via meta-analysis the efficacy of mindfulness-based interventions (MBIs) for improving mental well-being in PwMS.
METHODS: Systematic searches for eligible randomised controlled trials (RCTs) were carried out in seven major databases (November 2017, July 2018), using medical subject headings and key words. Studies were screened, data extracted, quality appraised and analysed by two independent reviewers, using predefined criteria. Study quality was assessed using the Cochrane Collaboration risk of bias tool. Mental well-being was the primary outcome. Random effects model meta-analysis was performed, with effect size reported as standardised mean difference (SMD).
RESULTS: Twelve RCTs including 744 PwMS were eligible for inclusion in the systematic review, eight had data extractable for meta-analysis; n=635. Ethnicity, socioeconomic status, comorbidity and disability were inconsistently reported. MBIs varied from manualised to tailored versions, lasting 6-9 weeks, delivered individually and via groups, both in person and online. Overall SMD for mental well-being (eight studies) was 0.40 (0.28-0.53), p<0.01, I2=28%; against active comparators only (three studies) SMD was 0.17 (0.01-0.32), p<0.05, I2 =0%. Only three adverse events were reported.
CONCLUSIONS: MBIs are effective at improving mental well-being in PwMS. More research is needed regarding optimal delivery method, cost-effectiveness and comparative-effectiveness.
PROSPERO REGISTRATION NUMBER: CRD42018093171.
© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
KEYWORDS: depression; meta-analysis; multiple sclerosis; randomised trials; stress
PMID: 31196913 DOI: 10.1136/jnnp-2018-320165