Multiple Sclerosis Journal - October 2017 - 1437

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9%

19%

19%
ITT
88%

23%
ITT
100%

91%

20%

100%

35%

Aims to promote a positive attitude
towards active decision-making
and the optimum use of the
available energy to fit the unique
needs of individuals. ECM aims to
reduce the impact and severity of
fatigue, to increase patients' use of
energy-conserving strategies and to
improve their confidence in their
ability to manage fatigue.

Cognitive behavioural model of MS
fatigue:disease factors trigger fatigue in
MS, and cognitive, emotional, and
behavioural factors perpetuate the
severity and impact of fatigue.
CBT for MS fatigue aims to
influence cognitions, behaviours
and emotions that perpetuate
fatigue.
Aerobic exercise may result
in improvements through
increased fitness, normalisation
of hormonal functions, and
changes in neuroinflammatory and
neuroprotective biomarkers

Summary of theory/rationale
behind treatment

4× occupational
therapists familiar
with MS and ECM
and qualified
in motivational
interviewing
Training included
programme guideline
and 1 day ECM
refresher course

6 CBT
state-certified healthcare psychologists
Received 3 day
training in this
protocol.
Supervised every
second week by a
supervising CBT
psychologist
Six trained
physiotherapists
Experienced in
treating MS patients.
Specific trial
intervention training
not reported

Who delivered
treatment (level of
training)

12 individually supervised
45-minute outpatient aerobic
interval training sessions on Kettler
X7 home trainer over 16 weeks
Regular prescribed home exercise
over 16 weeks on Kettler X7 home
trainer provided for duration of
study.
12 × 45 minute (face-to-face)
individual sessions over 16 weeks
Patients given an ECM workbook

12 × 45 minute (face-to-face)
individual outpatient sessions over
16 weeks)
Therapy tailored to patients'
individual needs.

Timing and mode of delivery
(week × frequency × minutes
(mode))

CBT: cognitive behavioural therapy; CON: nurse-led control group; EDSS: Expanded Disability Status Scale; EXP: experimental intervention group; RRMS: Relapse-Remitting Multiple Sclerosis; ITT: intention to treat.

Energy
conservation
management
(ECM)
Blikman
et al.3

14%
n = 46
Female: 72%
RRMS:74%
Age: 48 (9.2)
EDSS: 3.0
(2.0-4.0)
MS length
12.0 (2.0-19.0)
14%
n = 44
Female: 68%
RRMS 73%
Age 47 (11.5)
EDSS: 3
(2.8-3.6)
MS length
7.5 (3-14)

n = 43
Female: 74%
RRMS: 73%
Age: 43 (9.8)
EDSS: 2.5
(2.0-3.5)
MS length: 7.0
(2.0-10.0)
n = 42
Female: 81%
RRMS: 76%
Age: 48 (11.0)
EDSS: 2.5 (2-4)
MS length
6.5 (3.7-17.4)

98%

26%

Aerobic
exercise
Hein et al.2

11%
ITT
100%

14%
n = 47
Female: 83%
RRMS: 75%
Age: 46 (11.6)
EDSS: 2.5
(2.3-3.0)
MS length: 5.2
(2.1-11.5)

n = 44
Female: 71%
RRMS: 73%
Age: 51 (8.3)
EDSS: 3
(2.8-3.6)
MS length: 8.2
(2.9-14.2)

Cognitive
behavioural
therapy
(CBT)
Van de
Akker et al.1

22%

Experimental Control Experimental Control

Control

Experimental

Lost to 52-week
follow-up (%)
(dropout +
non-response)
Percent analysed
in ITT

Lost to end-oftreatment
follow-up (%)
(dropout + nonresponse)

N
Demographic and
disease factors
Female (%)
RRMS (%)
Age (years, M (SD))
EDDS level of disability
(median (range))
Time since diagnosis
(median years (range))

Study
reference

Table 1. Summary comparison of the three TREFAMS-ACE randomised controlled trials.

R Moss-Morris and S Norton

1437


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Table of Contents for the Digital Edition of Multiple Sclerosis Journal - October 2017

Contents
Multiple Sclerosis Journal - October 2017 - Cover1
Multiple Sclerosis Journal - October 2017 - Cover2
Multiple Sclerosis Journal - October 2017 - Contents
Multiple Sclerosis Journal - October 2017 - ii
Multiple Sclerosis Journal - October 2017 - iii
Multiple Sclerosis Journal - October 2017 - 1436
Multiple Sclerosis Journal - October 2017 - 1437
Multiple Sclerosis Journal - October 2017 - 1438
Multiple Sclerosis Journal - October 2017 - 1439
Multiple Sclerosis Journal - October 2017 - 1440
Multiple Sclerosis Journal - October 2017 - 1441
Multiple Sclerosis Journal - October 2017 - 1442
Multiple Sclerosis Journal - October 2017 - 1443
Multiple Sclerosis Journal - October 2017 - 1444
Multiple Sclerosis Journal - October 2017 - 1445
Multiple Sclerosis Journal - October 2017 - 1446
Multiple Sclerosis Journal - October 2017 - 1447
Multiple Sclerosis Journal - October 2017 - 1448
Multiple Sclerosis Journal - October 2017 - 1449
Multiple Sclerosis Journal - October 2017 - 1450
Multiple Sclerosis Journal - October 2017 - 1451
Multiple Sclerosis Journal - October 2017 - 1452
Multiple Sclerosis Journal - October 2017 - 1453
Multiple Sclerosis Journal - October 2017 - 1454
Multiple Sclerosis Journal - October 2017 - 1455
Multiple Sclerosis Journal - October 2017 - 1456
Multiple Sclerosis Journal - October 2017 - 1457
Multiple Sclerosis Journal - October 2017 - 1458
Multiple Sclerosis Journal - October 2017 - 1459
Multiple Sclerosis Journal - October 2017 - 1460
Multiple Sclerosis Journal - October 2017 - 1461
Multiple Sclerosis Journal - October 2017 - 1462
Multiple Sclerosis Journal - October 2017 - 1463
Multiple Sclerosis Journal - October 2017 - 1464
Multiple Sclerosis Journal - October 2017 - 1465
Multiple Sclerosis Journal - October 2017 - 1466
Multiple Sclerosis Journal - October 2017 - 1467
Multiple Sclerosis Journal - October 2017 - 1468
Multiple Sclerosis Journal - October 2017 - 1469
Multiple Sclerosis Journal - October 2017 - 1470
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Multiple Sclerosis Journal - October 2017 - 1500
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Multiple Sclerosis Journal - October 2017 - 1507
Multiple Sclerosis Journal - October 2017 - 1508
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Multiple Sclerosis Journal - October 2017 - 1510
Multiple Sclerosis Journal - October 2017 - 1511
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Multiple Sclerosis Journal - October 2017 - 1514
Multiple Sclerosis Journal - October 2017 - 1515
Multiple Sclerosis Journal - October 2017 - 1516
Multiple Sclerosis Journal - October 2017 - 1517
Multiple Sclerosis Journal - October 2017 - 1518
Multiple Sclerosis Journal - October 2017 - 1519
Multiple Sclerosis Journal - October 2017 - 1520
Multiple Sclerosis Journal - October 2017 - 1521
Multiple Sclerosis Journal - October 2017 - 1522
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Multiple Sclerosis Journal - October 2017 - 1526
Multiple Sclerosis Journal - October 2017 - 1527
Multiple Sclerosis Journal - October 2017 - 1528
Multiple Sclerosis Journal - October 2017 - 1529
Multiple Sclerosis Journal - October 2017 - 1530
Multiple Sclerosis Journal - October 2017 - 1531
Multiple Sclerosis Journal - October 2017 - 1532
Multiple Sclerosis Journal - October 2017 - 1533
Multiple Sclerosis Journal - October 2017 - 1534
Multiple Sclerosis Journal - October 2017 - 1535
Multiple Sclerosis Journal - October 2017 - 1536
Multiple Sclerosis Journal - October 2017 - 1537
Multiple Sclerosis Journal - October 2017 - 1538
Multiple Sclerosis Journal - October 2017 - 1539
Multiple Sclerosis Journal - October 2017 - 1540
Multiple Sclerosis Journal - October 2017 - 1541
Multiple Sclerosis Journal - October 2017 - 1542
Multiple Sclerosis Journal - October 2017 - 1543
Multiple Sclerosis Journal - October 2017 - 1544
Multiple Sclerosis Journal - October 2017 - 1545
Multiple Sclerosis Journal - October 2017 - 1546
Multiple Sclerosis Journal - October 2017 - 1547
Multiple Sclerosis Journal - October 2017 - 1548
Multiple Sclerosis Journal - October 2017 - 1549
Multiple Sclerosis Journal - October 2017 - 1550
Multiple Sclerosis Journal - October 2017 - 1551
Multiple Sclerosis Journal - October 2017 - 1552
Multiple Sclerosis Journal - October 2017 - 1553
Multiple Sclerosis Journal - October 2017 - 1554
Multiple Sclerosis Journal - October 2017 - 1555
Multiple Sclerosis Journal - October 2017 - 1556
Multiple Sclerosis Journal - October 2017 - 1557
Multiple Sclerosis Journal - October 2017 - 1558
Multiple Sclerosis Journal - October 2017 - 1559
Multiple Sclerosis Journal - October 2017 - 1560
Multiple Sclerosis Journal - October 2017 - 1561
Multiple Sclerosis Journal - October 2017 - 1562
Multiple Sclerosis Journal - October 2017 - 1563
Multiple Sclerosis Journal - October 2017 - 1564
Multiple Sclerosis Journal - October 2017 - 1565
Multiple Sclerosis Journal - October 2017 - 1566
Multiple Sclerosis Journal - October 2017 - Cover3
Multiple Sclerosis Journal - October 2017 - Cover4
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