Moderators Of Treatment Outcomes Following Telehealth Self-Management And Education In Adults With Multiple Sclerosis: A Secondary Analysis Of A Randomized Controlled Trial

Publication date: Available online 11 January 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Dawn M. Ehde, Anne Arewasikporn, Kevin N. Alschuler, Abbey J. Hughes, Aaron P. Turner
ObjectiveTo examine moderators of treatment effects in a randomized controlled trial comparing a telehealth self-management intervention to a telehealth MS education intervention for fatigue, pain, and mood in adults with multiple sclerosis (MS).DesignSecondary analysis of a single-blind randomized controlled trial.Setting: community.ParticipantsAdults with MS and chronic fatigue, chronic pain, and/or moderate depressive symptoms (N=163) recruited from across the United States.InterventionsTwo 8-week, telephone-delivered symptom interventions delivered 1:1: a self-management intervention (n=75) and an MS education intervention (n=88).Main Outcome MeasuresOutcome measures were fatigue impact, pain interference, and depressive symptom severity assessed at baseline and post-treatment. Potential moderators of treatment effects assessed at baseline were: demographics (age, sex, and education), clinical characteristics (disease duration and disability severity), symptoms (perceived cognitive impairment, pain intensity), baseline levels of the treatment outcomes (pain interference, fatigue impact, and depressive symptom severity), and cognitive-behavioral factors (pain catastrophizing, fatigue catastrophizing, self-efficacy, and patient activation).ResultsModeration analyses found significant moderation for fatigue impact but not for pain intensity or depressive symptom severity. Baseline patient activation interacted with treatment group to predict fatigue impact at post-treatment (p = .049). Among participants with high baseline patient activation, the self-management group reported significantly less fatigue at post-treatment compared to the education group. No other variables moderated the study outcomes.ConclusionsAt the group level, participants responded to both interventions, regardless of disease characteristics, demographics, symptom levels, and cognitive-behavioral factors. Self-management and education are both potentially beneficial symptom treatments that may be recommended to individuals with MS and chronic pain, fatigue, and/or depressive symptoms.



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