Table 1 Results of included studies (n = 57) examining lifestyle management on QOL and disability, characterised according to self-management dimension

Beatus et al. [37](USA)  

Observational study

1 week 

N = 41 

Female 34,

Male 7,

Age 45 (8.54) 

EDSS unknown.

14.8 (8.38)

One-week summer retreat to encourage physical activity, art and social interaction.  

NA      

Physical activity      

QOL (MSQOL-54)

No significant change between pre and post test on the physical component of QOL (P=0.214).A significance difference when comparing pre and post test measures on the mental portion of QOL (P=0.035).

Retreat had no positive effects on physical QOL, however did increase the mental perception of QOL in subjects with MS. 

Carter et al. [38] (UK)               

RCT

12 months

N = 120 (83%) 

InterventionFemale 43, Male 17,

Age 46 (8.4)

EDSS 3.8 (1.5) Control:Female 43,

Male 17,

Age 45.7 (9.1)EDSS 3.8 (1.5)

✓

N = 98

✓

N = 4

✓

N = 18

Intervention: 9.2 (7.9) Control: 8.4 (7.4)

12- week EXMES + usual care including: aerobic, strength, resistance training incorporating self directed exercise at home. 

Usual care only 

Physical activity 

QOL (MSQOL-54) Disability (EDSS)

Difference in mean QOL change at 3, 9 months respectively:Intervention:Physical health component 59.7 (20.6)*, 54.1 (21.7)Mental health component65.5 (20.2)*, 65.9 (21.0)ControlPhysical health component 52.5 (21.4), 53.3 (21.1)Mental health component60.8 (20.0), 63.8 (24.1)*Significant change, P<0.05.There were no significant change in EDSS between in the intervention or control in 3 or 9 months post treatment (P>0.05).

Intervention could be an effective way to implement rehabilitation into a health care setting.

D'Hooghe et al. [39](Belgium) 

Observational cohort study

10 months

N = 9 (100%)

Female 6, Male 3,

Age 42 (23-40)^a EDSS 3 (1-4)^a

✓

üN = 9 

9 (3-24)^a

5 day expedition to Machu Picchu (45.5km walk).(Fitness training 5 months prior + Follow up for 4 months post expedition).

NA

Physical activity

Walking ability (ESES)

ESES increased by 1 (36 – 37) within 8 months (P>0.05).The relapse rate during the study period did not differ from the relapse rate in the year prior.

Fluctuations were observed in self- reported disease steps

Fasczewski et al. [40](USA) 

Mixed methods 

N = 15 

Female 11,

Male 1

Age 43.5 (± 10.03)  

✓

üN = 15

7 ± (± 4.34)

Qualitative interviews lasting 20- 60 mins were used to explore physical activity motivation and benefits. The transcribed interviews were coded into clusters of meaning.

NA

Physical activity

QOL(QOL survey)

QOL measures:

Emotional: 19.56 (± 3.24)

Physical: 20.34 (± 3.52)Two main themes emerged of how PA and QOL relate: (1) Physical fitness/strength (2) QOL/mental wellness/happiness.

Motivation to participate in long term PA reportedly increases QOL. 

Fasczewski et al. [41](US) 

Mixed methods 

6 month 

N = 16 

Female 14,

Male 2,

Age 55.1 (± 9.93)

PDDS 2.9 (± 1.79) 

✓

N = 12

✓

N = 2

✓

N = 1

14.7 (± 11.72)

7x 90min medical therapeutic yoga sessions + education + relaxation therapy. A follow up structured interview used to assess retention of physical activity behaviours.

None 

Physical activity (Medical therapeutic yoga therapy) 

QOL(QOL-3) Disability (PDDS)

Only emotional QOL (P= 0.019) significantly improved between pre- and post-test measures.

Greatest motivator for exercise was an improvement in QOL and functioning.

Intervention only increased emotional QOL.

Feys et al. [42](Belgium) 

Uncontrolled interventional

10 months

N = 57 (74%) 

Group 1:

Female 22,

Male 2,

Age 37 (± 10)

PDDS 0.9 (± 0.3) Group 2:

Female 11

Male 7, Age 50 (± 11) PDDS 3.2 (± 1.3)

✓

N = 33

✓

N = 4

✓

N = 5

Group 1:7 (± 7) 

Group 2:12 (± 8)

Single education day followed by 3x 45 min practical sessions of different sports.Subgroups of disability level (Authors hypothesised that effects on education on physical activity could be greater in persons that have little physical restrictions).

NA

Physical activity 

QOL(SF-36) 

Group 1 change at 6 months for:Physical QOL: 0.21(6)Mental QOL: 0.6(7.7) Group 2 change at 6 months for:

Physical QOL: -0.24(± 7)

Mental QOL: -0.7(± 9.1) 

No significant change in QOL domains; Physical health (P=0.29) and Mental health (P=0.75) were found between groups or over time.

No significant difference was found between groups. 

Flachenecker et al. [43](Germany)  

RCT

6 months 

N = 84 (76%) 

InterventionFemale 22,

Male 9,

Age 47.6 (± 9.2)

EDSS 4.3 (IQR 1.5)^b Control:Female 17,

Male 13,

Age 46.4 (± 12.2)

EDSS 4 (IQR 3)^b

✓

N = 39

Intervention: 13.4 (± 7.9) 

Control: 9 (± 7.5)

Goal-oriented, multimodal inpatient rehabilitation program after discharge that promoted exercise.  

Usual care

Physical activity

QOL (MSIS-29)

Improvements in HRQOL in intervention were sustained for up to 6 months (p < 0.001), whereas HRQOL in the control group returned to baseline scores at 3 months.Similar results for physical and psychological subscales of the MSIS-29.

With the reduction of fatigue, HRQoL increased.

Khan et al. [44](Australia) 

RCT 

12 month 

N = 101 (98%) 

InterventionFemale 40,

Male,

21

Age 49.7 (± 8.96)

EDSS 0-3: 8, 3.5-6: 36, 6.5+: 17 

Control: Female 32,

Male 8,

Age 51.2 (± 9.51)

EDSS 0-3: 11, 3.5-6: 23, 6.5+: 6

✓

N = 31

✓

N = 14

✓

N = 56

Intervention: 10.52 (± 6.61) 

Control: 9.7(± 8.11)

Acute neurological and intensive MD rehabilitation (5 days x 3h therapy sessions a week). Intervention offered education, health promotion, bladder retraining and mobilisation. 

Waitlist 

Physical activity (Exercise) 

QOL

(GHQ-28)

Mean difference between intervention and control for GHQ subscales:

Anxiety: -0.055 (CI: -1.85 – 1.74)

Depression: 0.212 (CI: -1.32 to 1.74)

Somatic: -1.25 (CI: -3.3 to 0.79)

Social: -0.68 (CI: -2.91 to 0.83) 

No significant effect of intervention on QOL. Therefore further exploration is required. 

Kjolhede et al. [45](Denmark) 

RCT 

6 months 

N = 35 (83%) 

Age 43 (± 8)

EDSS 2.9 (2-4)^a 

✓

N = 35

7 (± 7)

Progressive resistance training for 24 weeks, completed twice a week. Sessions consisted of four lower and two upper body exercises. 

Habitual lifestyle.  Followed interventiona after 24 weeks.

Physical activity (Resistance training) 

Disability (EDSS, MRI)

Non- significant decrease in EDSS from baseline to T48 (P=0.75).

All participants had a mean increase of 0.40 (CI: 0.001 - 0.558) in the number of lesions from T0 to T48 (p<0.01). No interaction was observed for T2 lesion volume.

Possible restorative effect of resistance training on brain structures, but the interpretation should be cautious. 

Langeskov- Christensen et al. [46](Denmark)   

RCT 

6 months

N = 86 (73%) 

InterventionFemale 26,

Male 17,

Age 44 (± 9.5),

EDSS 2.7 (± 1.4)

Control:Female 26,

Male 17,

Age 45.6 (± 9.3)

EDSS 2.8 (± 1.6)

✓

N= 75

✓

N= 6 

✓

N= 5

Intervention: 10.9 (± 7.9)

Control: 8.6 (± 6.0)

Twice weekly-supervised physical aerobic exercise followed by self guided physical activity.    

Habitual lifestyle followed by supervised physical aerobic exericse.  

Physical activity (aerobic exercise)        

QOL (MSIS-29) Disability(T2 lesion count & load, relapse rate)    

Between- group change after 24 weeks:

Physical QOL: -1.6 (-6.6 to 3.5)

Mental QOL: -3.4 (-9. to 2.9)

T2 lesion count: 0.92 (-1.09 to 2.93)

T2 lesion load: -0.16 (-0.73 to 0.40) 

Relapse rate:

Intervention; 0 (0.0-0.07)

*Control; 0.45 (0.28-0.61)*Significantly different

Intervention failed to affect QOL 

Motl et al. [47] (USA) 

Prospective cross sectional

N = 196 

Female 173,

Male 23,

Age 46.1 (± 9.8)

✓

N = 174

✓

N = 3

✓

N = 19

9 (± 7.1)

Pedometer and accelerometer during waking hours for 7 days + A battery of questionnaires on the 8th day.

NA

Physical activity 

QOL(SWLS)

The direct path between physical activity and QOL was non significant (.

Those with MS who were more physically active had greater self-efficacy and better functional capacity, which, in turn, was associated with greater QOL.

Motl et al. [48](USA)  

Cross sectional

6 months

N = 292 (95%)

Female 245,

Male 47,

Age 48 years (10.3) 

EDSS Unknown

✓

N = 246

✓

N = 12

✓

N = 34

10.3 (± 7.9)

Accelerometer during waking hours for 7 days & repeated at 6 months.

No accelerometer

Physical activity

QOL: (LMSQOL)Disability: (PDDS)

Association between physical activity and QOL (P= 0.73). Indicators of physical activity and QOL (LMSQOL λ = 0.84) were statistically significant. Those who were more physically active reported higher QOL.

Indirect relationship between changes in physical activity and QoL over time, based on fatigue, pain, social support and self-efficacy.

Motl et al. [49] (US)  

Panel study 

6 months 

N = 269 (98%) 

Female 233,

Male 46,

Age 45.9 (9.6)

PDSS 2 (0-6)^a 

✓

N = 233

8.8 (± 7)

Association between changes in physical activity and walking impairment. Frequency and intensity of participants exercise levels were recorded.

NA

Physical activity

Disability (PDDS)

Mean change:PDDS: -0.1 (1.0)

Insignificant Significant path coefficients between baseline physical activity and walking impairment (P=0.0001) and between follow-up physical activity and walking impairment (P=0.01).

Results support change in physical activity as a determinant of walking impairments over time.

Mutluay et al. [50](Turkey) 

RCT 

6 weeks 

N = 40 

InterventionFemale 8,

Male 12,

Age 40.3 (± 6)

EDSS 4.85 (± 1.3) 

Control:

Female 8,

Male 12,

Age 38.1 (± 7)

EDSS 4.18 (± 1.7)

✓

N = 12

✓

N = 8

✓

N = 20

Intervention: 9.8 (± 5.6) 

Control: 9 (± 4.6)

Home training programme, monitored by the physiotherapist by recalls to hospital for checking compliance with the assigned exercise schedule.

No exercises assigned.

Physical activity (breathing enhanced upper extremity exercise)

Disability (EDDS)

Mean change:Intervention: -0.23 (± 0.44)Control: 0.08 (± 0.37)Not significant (P > 0.05).  

Intervention had no effect on EDSS.

Petjan et al. [51](Utah)  

RCT 

15 weeks 

N = 54 (85%) 

InterventionFemale 15,

Male 6,

Age 41.1 (± 2)

EDSS 3.8 (± 0.3) 

Control:Female 16,

Male 9,

Age 39 (± 1.7)

EDSS 2.9 (± 0.3)

Intervention: 9.3 (± 1.6) 

Control: 6.2 (± 1.1)

15-week aerobic training program to improve measures of physical fitness.

No exercise

Physical activity

Disability (EDSS)

Mean change:Intervention: EDSS 3.8 (± 0.3) to 3.7 (± 0.3) Control:EDSS 2.9 (± 0.3) to 2.8 (± 0.3)Insignificant change P < 0.05  

Intervention had no effect on EDSS. 

Pilutti et al. [52](USA) 

RCT

6 months 

N = 82 (92%) 

Intervention:Female 30,

Male 11,

Age 48.4 (IQR 9.1)^bPDDS 2 (IQR 4)^b 

Control:Female 32,

Male 9,

Age 49.5 (IQR 9.2)^bPDDS 3 (IQR 3) ^b

✓

N = 65

✓

N = 7

✓

N = 10

Intervention: 10.6 (IQR 7.1)^b 

Control: 13.0 (IQR 9.1)^b

Behavioural intervention that focused on increasing lifestyle physical activity through coaching sessions + a battery of questionnaires at the 6 month period. 

Did not receive intervention

Physical activity 

QOL(MSIS-29) 

Disability (PDDS)

No significant difference between groups on the physical and psychological QOL domains post intervention (P = 0.06 & P = 0.11 respectively).

Mean difference between pre- post intervention not reported.  

Lifestyle physical activity might be effective in supervised exercise training for improving HRQOL in MS patients. 

Oken et al. [53](Portland)  

RCT 

6 months 

N = 69 (83%) 

Exercise:Female 13,

Male 2,

Age 48.8 (± 10.4)

EDSS 2.9(± 1.7) 

Yoga:Female 20

Male 2,

Age 49.8 (± 7.4)

EDSS 3.2 (± 1.7) 

Control:Female 20

Male 0,

Age 48.4 (± 9.8)

EDSS 3.1(± 2.1)

90 min yoga classes once per week. With emphasis on breathing for concentration and relaxationORAerobic exercise + stretching

Waitlist

Physical activity (Yoga)

QOL (SF-36)

Mean change:Exercise:Physical QOL: 76.7 (± 25.8) to 61.7 (± 41.0)

Emotional QOL: 82.2 (± 27.8) to 88.9 (± 30) 

Yoga:Physical QOL: 50 (44) to 48.8 (39.1)Emotional QOL: 72.4 (± 24) to 64.9 (± 17.9) 

Waitlist:Physical QOL: 40.3 (± 37.5) to 52.8 (± 43.6)

Emotional QOL: 72.2 (± 43.2) to 72.2 (± 36.6)

Yoga intervention only improved the energy and Fatigue (Vitality) dimensions.

Sangelaji et al. [54](Iran)  

RCT

14 months 

N = 61 (90%) 

Intervention:Female 24,

Male 15,

Age 33.05 (± 7.68)

Control:Female 15,

Male 7 Age 32.05 (± 6.35) 

10 weeks (3x 60-90 min sessions per week) of combined exercise classes.

Avoided plannedphysical or rehabilitation activity for 10 weeks. 

Physical activity (exercise therapy) 

QOL specific for MS Disability (EDSS)

Mean change at time 1:Mental QOL 16.36 (*Physical QOL 12.17 (*EDSS -0.13 ( Time 2:

Mental QOL 2.82 (Physical QOL -1.27 (EDSS -0.15 ( Time 3:Mental QOL 13.54 (*Physical QOL 10.90(*EDSS -0.28 (*P<0.05.

Rehabilitation can be important in keeping MS patients capable of doing their daily activities. 

Savsek et al. [55](Slovenia)  

Exploratory RCT 

12 weeks 

N = 28

Intervention:Female 11,

Male 3,

Age 39.7 (± 6.7)

EDSS 2.5 (1.0-6.5)^a

Control:Female 12,

Male 2,

Age 42.3 (± 5.7)

EDSS 3 (1.0-6.0)^a

✓

N=28

Intervention: 8.4 (± 6.1) 

Control: 14.8 (± 4.5)

60min aerobic exercise twice weekly.

Participants followed prescribed exercise intensity and exercise. All participants were taking Fingolimod. 

Normal daily routine

Physical activity (Aerobic exercise) 

QOL (MSQOL-54) 

Disability (MRI- T2 lesion, EDSS) 

Mean difference between groups at 3 month follow up:

EDSS: -0.31 (-0.84 to 0.22)

Physical health composite QOL: -2.38 (-10.74 to 5.98)

Mental health composite QOL: 1.47 (-8.13 to 11.07).

Intervention was strongly associated with a decrease in lesion count: (T2 lesion count change: -0.13 (-1.90 to 1.64)).

Positive effect of intervention on the preservation of several regional brain volumes, possibly indicating a slowing of the neurodegenerative process in pwMS 

Sutherland et al. [56] (Australia)  

RCT (

10 weeks 

N = 22 

InterventionFemale 6,

Male 5,

Age 47.18 (± 4.75) 

Control:Female 6

Male 5

Age 45.45 (± 5.05)

Intervention: 7 (± 5.59) 

Control: 6.18 (± 3.63)

Water and land aerobics 3x 45min weekly for 10 weeks.

No special activity

Aerobic exercise

QOL (MSQOL-54)

Mean change:Intervention:Physical: 15.2 (± 4.6) to 17.1 (± 4.4)

Emotional: 19.6 (± 4.2) to 22.4 (± 4.1)

Control:Physical: 15.4 (± 4.0) to 15.9 (± 4.0)

Emotional: 20.7 (5.1) to 20.8 (6.7) 8 out of 11 subscales of QOL, showed a significant improvement (P<0.05)

Aerobic exercise can alter HRQOL for people with MS.

Vasudevan et al. [57] (India)  

Single group pre/ post experimental 

4 months 

N = 10 

Female 7,

Male 3,

Age range 31- 52

12 private customized yoga sessions and three group sessions, conducted by yoga therapists.

Physical activity (Yoga)

QOL (MSQOL-54)

QOL domain: ^bPhysical composite: 72.1 (IQR 57 - 80) – 78.9 (69 - 81)

Mental composite: 73 (65 - 85) to 85.3 (84 - 88)

Overall: 73.4 (64 – 83) to 79.2 (70 – 87)Not significant (P>0.05).

Yoga may be encouraged in addition to medical management for better QOL, which includes social and cognitive function.

Abolghasemi et al. [58](Tehran city)  

Experimental pre test/ post test with control 

N = 32 

InterventionFemale 7,

Male 9,

Age 31.75 ((8.25) Control:Female 9

Male 7,

Age 32.5 (90.58)

12x 75 min supportive-expressive therapy sessions. At the twelfth session, subjects were asked to answer questionnaire’s on quality of life again.

Followed the medicaltreatments

Coping, depression, stress and emotional management

QOL (WHOQOL-B)

Mean QOL pretest VS posttest:Intervention: 35.47 (6.76) VS 54.06 (7.05)

*Control: 40.65 (14.66) VS 42.29 (12.48)**Significant difference between pre and post-intervention scores in both groups (P<0.01). The effect of supportive-expressive therapy on enhancing quality of life was 0.418.

Intervention is effective for enhancing the QOL MS patients.

Besharatet al. [59] (US)  

RCT

3 months

N = 24

InterventionFemale 12,

Male 0,

Age 35 (7.45)

EDSS 2.3 

Control:Female 12,

Male 0,

Age 30 (± 4.1)

EDSS 2.7

Intervention: 2.8 

Control: 3.25

Mindfulness based stress reduction program. Training sessions involved mindfulness awareness during yoga/ stressful situations/ social interactions, body scan meditation.

Standard medical care for MS

Coping, depression, stress and emotional management (Stress management)

QOL(SF- 36)Disability (EDSS)

Mean QOL:Intervention -3.1 (± 4.74)*Control 2.51 (± 2.28)*Significant increment in quality of life.

Training in mindfulness may offer MS patients a self-management of symptoms that enhances QOL.

Ehde et al. [60](USA)    

RCT 

12 months 

N = 163 

InterventionFemale 67,

Male 8,

Age 51 (± 10.1)

EDSS <4: 194.5 – 6.5: 46>7: 10

Control:

Female 75,

Male 13,

Age 53.2 (± 10)

EDSS <4: 234.5 – 6.5: 55>7: 10

✓

N = 91

✓

N = 72

Intervention:<5: 215-9: 1710-19: 29>20: 8 

Control:<5: 215-9: 2510-19: 26>20:16

Individual telephone delivered self management intervention including evidenced based cognitive behavioural and positive psychology strategies

Education in MS care

Coping, depression, stress and emotional management

QOL (SF-8)  

Physical HRQOL significantly improved (CI:-5.51 to -1.45) post treatment, favouring the self management intervention.This was maintained 6 months post intervention (-5.1o to -0.75, however not 12 months post. P<0.05.Mental HRQOL significantly improved post treatment, at 6 and 12 months in both intervention and control (P<0.05).

Validates telephone as a simple but effective method for improving aspects of QOL in the short term.

Grossman et al. [61](Switzerland)  

RCT

8 months

N = 150

InterventionFemale 59,

Male 19,

Age 45.93 (± 10)

EDSS 3.03 (± 1.12) 

Control:Female 60,

Male 14,

Age 48.68 (± 10.58)

EDSS 2.98 (± 0.83)

✓

N = 123

✓

N = 27

Intervention: 7.74 (± 0.9) 

Control: 9.71 (± 0.88)

Mindfulness based intervention (8-week 2.5h class program), based on: perception, acceptance of health changes, sense of control.

Regular medical care

Coping, depression, stress and emotional management (Mindfulness)

QOL (HAQUAMS)

Mean change QOL:InterventionPre/ post intervention: 0.18 (0.09 to 0.27)*6 month f/ u: 0.13 (0.00 to 0.25)* 

Control:Pre/ post intervention: -0.09 (-0.20 to 0.01)6 month f/ u: -0.05 (-0.16 to 0.07) *Significant difference in HAQUAMS QOL, P<0.05.

MBI may improve HRQOL for at least 8 months among mild to moderately severely impaired patients with MS.

Graziano 2014 [62] (Italy)   

RCT 

6 months 

N = 82 (66%) 

InterventionFemale 27,

Male 14,

Age 42.3 (8.5) 

Control:Female 24,

Male 17, Age 38.3 (10.1) 

EDSS Unknown

✓

N= 77

✓

N= 2

✓

N= 3

Intervention: 8.6 (5.2) Control: 7.2 (5.3)

Four group based cognitive behavioural therapy sessions (2hr) over two months + a 6-month follow up + home relaxation tasks and self-practice of exercise. 

Informative sessions about stem cells, CAM and nourishment.

Coping, depression, stress and emotional management (Depression) 

QOL(MSQOL-54)  

QOLIntervention VS controlPretreatment: 13.39 (4.39) VS 12.43 (4.54)Posttreatment: 14.24 (3.62) VS 13.71 (4.00)6- months post: 14.96 (4.28)* VS  11.95 (5.40)*  

*Mean difference between groups at 6-month follow-up was significant (P = 0.034).

QOL increased over time in the intervention and decreased in control, which was found to be significant (P = 0.042). 

Hart et al. [63](USA)  

RCT 

16 weeks 

N = 60 (82.2%) 

Female 44,

Male 16,

Age 44.8 (± 10.3)

✓

N = 60 

8.3 (3 months – 31.2 years)^c

Individual, weekly cognitive behavioural therapyOR Supportive expressive group psychotherapyOR

Sertraline (medication).

Coping, depression, stress and emotional management

QOL (MSQOL-54) 

Disability(T25FW)

Mean QOL pre and post treatment:Physical 45.3 (15.6) VS 52.8 (16.0)*Mental 39.7 (14.9) VS 60.0 (21.1)**Significant improvements over time in the physical health composite scale, P<0.001.Change in depression scores significantly predicted post-treatment scores for the MSQOL total score, physical health composite scale, and the mental health composite scale (P<0.001).

Treatment for depression was related to better QOL in MS patients.

Jongen et al. [64](Netherlands)  

Observational cohort study 

6 months 

N = 94 (47 PwMS + support partners (93%) 

RRMS group 1:Female 16,

Male 4,

Age 42.7 (± 10.1)

EDSS 3.1 (± 1.2) 

PPMS group 1:Female 19,

Male 5,

Age 48.7 (± 7.6)

EDSS 5.5 (± 1.4)

✓

N = 20

✓

N = 2

✓

N = 22

Group 1:8.4 (6.9) Group 2:17.5 (8.6)

Social Cognitive Can Do Program (SCDP) with participants and partners involved group sessions, consultations, theatre evening and joint activities.

NA

Coping, depression, stress and emotional management (stress management) 

QOL (MSQOL-54) 

Disability (EDSS)

Mean (SEM) % QOL change:RRMS group 1:Physical 1 month: 6.0% (5)Physical 3 months: 6.3% (5.9)Physical 6 months: 12.7% (4.8)* 

Mental 1 month: 21.4% (8.8)*Mental 3 months: 22.3% (10.7)*Mental 6 months: 22.3% (8.7)* 

PPMS group 2:Physical 1 month: 5.3% (8.2)Physical 3 months: 8.4% (10.7)Physical 6 months: 7.8% (8.0)

PPMS group 2: Mental 1 month: 11.5% (5.4)Mental 3 months: 5.5% (5.4)Mental 6 months: 3.2% (7.9) 

*Significant result, P<0.05.

6 months post SCDP; PwMS with a RR course or low disability may experience an improved mental and physical HRQoL. 

Jongen et al. [65](Netherlands)   

Exploratory, uncontrolled 

12 months 

N = 60 (66.7%) 

Female 25,

Male 13

EDSS unknown

✓

N = 22

✓

N = 14

As above.

NA 

Coping, depression, stress and emotional management (stress management)

QOL (MSQOL-54) 

Twelve months post treatment, physical QOL improved by almost 15%, reaching significance (P=0.032). Mental QOL increased by 17%, however this change was not significant (P=0.087).

12 months post treatment, persons with RRMS showed improved physical HRQoL.

Jongen et al. [66](Netherlands)   

RCT

3.5 years 

N = 158 (76%) 

InterventionFemale 69,

Male 10,

Age 40 (± 8.7)

EDSS 2.3 (± 1.03) Control:

Female 70,

Male 9,

Age 40 (± 9.4)

EDSS 2.3 (.13)

✓

N = 158

Intervention: 6.5 (± 5.6) 

Control: 6.5 (± 5.3)

As above.

Any care or treatments that were deemed necessary by caregivers. 

Coping, depression, stress and emotional management (stress management) 

QOL (MSQOL-54) 

Mean QOL change:Intervention VS controlPhysical baseline: 53.2 (13.6) VS 54.7 (15.3)Physical 1 month: 55.3 (15.1) VS 64.1 (14.6)*Physical 3 months: 56.4 (14.3) VS 60.7 (17.1)Physical 6 months: 58.1 (14.0) VS 59.2 (17.2) 

Mental baseline: 63.4 (20.1) VS  60.9 (17.6)Mental 1 month: 64.1 (19.2) VS 69.1 (15.7)*Mental 3 months: 66.2 (20.2) VS  67.0 (16.2)Mental 6 months: 67.3 (18.2) VS 65.9 (17.8) 

*Significant result, P<0.05.

Intervention favoured CDT group at one month. 

Lincoln et al. [67](UK)   

RCT 

8 months 

N = 151 (85%) 

InterventionFemale , Male,

Age 44.5 (± 11.1) Control:Female ,

Male,Age 47.5 (± 10.5)

✓

N = 103

✓

N = 15

✓

N = 30

Intervention: 9.2 (7.8) Control: 10.5 (8.0)

6x 2h group treatment sessions over 12 weeks. Sessionscovered topics including problem-solving,realistic goal setting and mental health and were taught strategies to reduce distress.

Received all otherrehabilitation routinely provided.

Coping, depression, stress and emotional management (stress management)

QOL(MSIS-29) Disability (Guy’s Neurological Disability Scale)

QOL difference (95% CI)Physical 4 months: 0.14 (12.3 to 0.8)*Physical 8 months: 0.20 (15.1 to 4.4.)* Psychological 4 months: 0.12 (11.8 to -0.6)

Psychological 8 months: 0.20 (15.1 to 4.4)*Significant difference, P<0.05. 

There was a significant difference between intervention and control for psychological QOL (P=0.037), but not for physical QOL (p-0.149).

Significant difference in psychological impact of MS QOL.

Aivo et al. [68](Finland)  

RCT           

12 month 

N = 30 (90%) 

InterventionFemale 9,

Male 6,

Age 37 (25-53)^a

EDSS 2 (0-3.5)^a 

Control:

Female 9,

Male 6,

Age 32 (22-47)^aEDSS 2 (0-4)^a

Intervention: 3 (0.6-15.2)^a 

Control: 1.5 (0.3-4.7)^a

20mg of cholecalciferol / 20000 IU of vitamin D3 , administered as one capsule once a week

Placebo

Diet (Vitamin D supplementation)

Disability (EDSS, MRI)

Mean difference in EDSS pre/ post intervention:Intervention: -0.3 (0.6)Control: -0.1 (0.7)No significant change (P=0.27). Number of T1 lesions decreased in both groups (control; P = 0.018,  vitamin D-treated group;P = 0.027).

Number of new or enlarging T2 weighted lesions was greater in the placebo group (P = 0.132).

Intervention reduced T1 enhancing lesions and lesion volume growth.

Ashtari et al. [69](Iran)  

RCT 

3 months 

N = 94 

InterventionFemale 37,

Male 10,

Age 31.4 (± 7.6)

EDSS 1.7 (± 0.6) Control:Female 41,

Male 6,

Age 34.6 (± 10.1)

EDSS 2 (± 0.9)

✓

N = 94 

Intervention: 4.1(± 3.73) Control: 4.4 (± 3.9)

50,000 IU vitamin D3 every five days for 3 months+ Interferon-β (IFN-β) as main treatment.

Placebo + Interferon-β (IFN-β)

Diet (Vitamin D supplementation)

QOL (MSQOL-54) Disability (EDSS)

Mean difference in QOL components after 3 months:Intervention:Physical: 71.74 (Mental: 62.41 (*ControlPhysical: 69.55 (Mental: 60.99 (* *Significant difference after adjustment for age, sex, disease duration, and EDSS.

A positive change in mental QOL was reported by patients in intervention.  

Bitarafanet al. [70](Iran)  

RCT 

12 month 

N = 101 (92%) 

InterventionFemale 35,

Male 12,

Age 30.4 (6.9)

EDSS 1.3 (± 0.97) 

Control:Female 34,

Male 12,

Age 32.3 (± 5.9)

EDSS 1.4 (± 1.05)

✓

N = 101 

Intervention: 4.3 

Control: 5.3

25000IU Vit. A for six months followed by 10000IU/d Vit. A for another six months.

Placebo

Diet (Vitamin A supplementation)

Disability (Relapse rate, MRI brain scan)

Mean difference in EDSS pre/post intervention:Intervention: 0.07 (0.23)Control: 0.08 (0.23) No significant difference between groups for relapse rate, number of enhanced lesions, volume of T2 hyper intensive lesions, new T2 lesions (P>0.05).

Vitamin A supplementation does not affect disease activity, but may inhibit disease progression in MS patients.

Kampan et al.[71](Norway)  

RCT 

96 weeks 

N = 71 (96%) 

InterventionFemale 24,

Male 11,

Age 40 (21-50)^c

EDSS 2.5 (0-4.5)^c 

Control:

Female 24,

Male 9,

Age 41 (26-50)^a

EDSS 2 (0-4.5)^a

✓

N=68

Intervention: 11 (1-27)^c 

Control: 10 (2-26)^c

20,000IU vitamin D3 + 500 mg elemental calcium daily.

Placebo + calcium tablet

Diet (Vitamin D supplementation)

Disability (EDSS, ARR)

Mean difference in EDSS pre/ post intervention:Intervention: 0.16 (0.73)Control: 0.15 (0.71)No significant change (P=0.97).No significant change in ARR between groups after the intervention period (P=0.25). 

ARR was not reduced and EDSS was unchanged in intervention group. 

Kouchaki, E. et al. [72](Iran)   

RCT

12 weeks

N = 60 (100%) 

InterventionFemale 25,

Male 5,

Age 33.8 (8.9)

EDSS 2 (0-4.5)^a 

Control:

Female 25,

Male 5,

Age 34.4 (9.2)

EDSS 2.5 (0-4)^a

✓

N = 60 

Intervention: 4.3 (2.8) 

Control: 4.3 (2.9)

Probiotic capsule containing Lactoba- cillus acidophilus, Lactobacillus casei, Bifidobacterium bifidum and Lactobacillus fermentum.

Placebo

Diet (Probiotic supplementation)

QOL(GHQ-28) Disability (EDSS, relapse rate)

Mean difference in EDSS pre/ post intervention:Intervention: -0.3 (0.6)Control: 0.1 (0.3)Probiotic intake significantly improved EDSS (P= 0.003) and GHQ-28 scores (P=0.002).

Probiotic intake had favourable effects on EDSS.

Torkildsen et al. [73](Norway)   

RCT

24 months

N = 92 (99%)

InterventionFemale 30,

Male 16,

Age 38.8 (± 8.4)

EDSS 1.94 (± 0.78) 

Control:

Female 29,

Male 16,

Age 38.3 (± 8.4)

EDSS 1.86 (± 0.86)

üN = 92

Intervention: 5.4  (5.4) 

Control: 5.8 years (5.9)

Oral omega- 3 fatty acid supplementcontaining EPA & DHA + 4iu/ gram tocopherol were added for antioxidative protection.After 6 months, all participants (intervention + control) received 44 μg of interferon beta-1a (Rebif ) 3 times per week for another 18 months.

Placebo 

Diet (Omega- 3 supplementation)

Disability (MRI brain scans, relapse rate, EDSS)

No significant effect of intervention on number of new T1 weighted Gd enhanced lesions, at 6, 9 or 24 months (P = .09, P=0.10, P=0.17, respectively).No significant difference between the treatment groups regarding new T1-weighted hypointense lesions after 24 months of treatment (P = 0.40).No difference in EDSS scores between the treatment groups after 24 months (P=0.63).

No beneficial effects of omega-3 fatty acid supplementation on disease activity in MS.

Weinstock-Guttman et al. [74](NY)   

RCT 

12 months 

N = 31 (87%) 

InterventionFemale 12,

Male 2,

Age 45.1 (± 7.7)

EDSS 1.9 (± 0.6) Control:Female 11,

Male 2,

Age 39.9 (± 10)

EDSS 2 (± 1.3)

✓

N = 31

Intervention: 6.9 (5.9) 

Control: 4.6 (3.5)

6x fish oil capsules per day containing 1 g FO (65% o-3; EPA 1.98 g and DHA 1.32 g/day)+ Very low fat diet intake, (<15%).+ 400 units of Vit. E+ 1x multivitamin tablet+ 500mg calcium per day.

Olive Oil group+ Low cholesterol diet (<30% TF)+ Vit E, multivitamin+ 500mg calcium supplement. 

Diet(Fish oil supplementation + low fat diet)

QOL(SF-36) 

Disability (EDSS, relapse rate)

Significant change in physical composite scale (P=0.05) observed between intervention and control at 6 months.Worsening in EDSS scoers in the olive oil group (+0.0.35 EDSS points)Decrease in EDSS in the fish oil group (-0.07 EDSS points).Significant decrease in relapse rate when compared to 1 year prior to the study in both groups (P= 0.021, P=0.044).

Low fat diets have potential to improve the physical and emotional disease burden.Low fat diet + fish oil was more efficient at doing so. 

Zandi- Esfahan, S. et al. [75](Iran)  

RCT 

12 months 

N = 50 (82%) 

InterventionFemale 13,

Male 12,

Age 35.19 (± 9.97) 

Control:

Female 16,

Male 9,

Age 31.4 (8.41)

✓

N = 50

Fingolimod + Fish oil (180 mg (EPA), 120 mg (DHA), and excipient (glycerin, purified water, tocopherol, sunflower oil, and tita- nium dioxide)

Fingolimod + Placebo - capsules

Diet(Fish oil supplementation)

Disability (EDSS)

Mean difference in EDSS pre/ post intervention:Intervention: 0.786 (1.04)Control: 0.875 (0.67)Changes between two groups showed no significant difference (P= 0.747).

Fish oil had no role in improving patients’ disability progression. Decreased EDSS can be attributed to taking Fingolimod. 

Ennis et al. [76](UK)  

Single blinded RCT (II) 

8 weeks

N = 62(32 intervention, 30 control) (98%) 

InterventionFemale 20,

Male 11,

Age 45(± 9)

Control:

Female 19,

Male 11,

Age 46 (± 8) 

✓

N = 28

✓

N = 11

✓

N = 20

Intervention:7 (5) 

Control: 8 (6)

OPTIMISE program (3h weekly sessions) to provide people with the knowledge, skill and confidence to undertake health promoting activities.

Present level of care 

Lifestyle & wellbeing  (Exercise and physical activity, fatigue management, stress management, diet) 

QOL(SF-36)

Mean change in SF-36 domains pre/ post intervention:Intervention:Role Physical: 23.29 (± 53.98) (Role Emotional: 15.0 (± 88.91) (Control:Role Physical: -3.33 (± 36.98) (Role Emotional: 8.87 (± 40.07) 

Physical domain, mental health and general health domain were statistically significant in the intervention compared to the control group P=0.03, P<0.01, P<0.01 respectively.

Increase in health promotion has a significant effect on QOL. 

Feicke et al. [77](Germany)  

Prospective quasi- experimental evaluation study 

6 months 

N = 81 (73%) 

Intervention: Female 27,

Male 4,

Age 41.94 (± 11.7)

Control:

Female 23,

Male 10,

Age 37.12  (± 7.83) 

EDSS unknown

✓

N = 32

✓

N = 2

✓

N = 2

Intervention: 0.97 (1.11) 

Control: 1.64 (1.45)

S.MS program which involved physical and emotional management strategies and support. 

Received brochurewhich covered the same content as the training program. 

Lifestyle & wellbeing  (Disease management, support strategies, coping strategies)

QOL (HAQUAMS)        

Mean changes in HAQUAMS from pre intervention to six month follow up:Intervention: 1.86 (± 0.55) to 1.84 (0.56)Control: 1.80 (± 0.52) to 2.00 (± 0.67) 

MS specific QOL decreased in control group and increased in the intervention from post intervention to 6 months follow up. 

Compared to the control group, ‘‘S.MS’’ participation was associated with a significant, sustained improvement of self-management and disease-specific quality of life. 

Hadgkiss et al. [78](Australia)   

Longitudinal cohortstudy 

5 year follow up

N = 387 attended retreat over 8 years (71%) 

Female 227

Male 47,

Age Unknown 

EDSS Unknown

Five day live in educational programme to assess the impact of modifiable lifestyle factors on MS outcomes.

NA

Lifestyle & wellbeing  (Diet, exercise, stress management) 

QOL (MSQOL-54)

One year follow changes were significant in:(P<0.001): role limitations- physical, emotional well- being, energy, health perceptions, cognitive function, health distress, overall QOL, change in health, physical and mental health composite), role limitations- emotional,(P=0.002): pain(P=0.001): social function

Five year follow up changes were significant in:(P<0.001): Role limitations- physical, role limitations- emotional, emotional well- being, energy, health perceptions, health distress, overall QOL(P=0.004): Physical and mental health composite,(P=0.043), social function cognitive function(P=0.009): Change in health

Overall QOL improved by 11.3% (p<0.001).Overall improvement in quality of life of 19.5% (p<0.001). 

Li, et al. [79](Australia)   

Longitudinal cohortstudy 

2.5 year follow up

N = 188 (58%) 

Female 94,

Male 15,

Age Unknown 

EDSS Unknown 

As above

NA

Lifestyle & wellbeing  (Diet, exercise, stress management) 

QOL (MSQOL-54)

One year follow changes were significant in:(P<0.001): role limitations- physical, health distress, overall QOL and mental health composite score. P=0.001: emotional wellbeing, energy, physical health composite score. P=0.019: health perceptions, P=0.04: cognitive function, P=0.012: sexual function, P=0.008: role limitations- emotional, P=0.002: pain, P=0.001: social function 

At 2.5 year follow up changes were significant in:P=0.015: emotional wellbeingP=0.044: energy,P=0.013: health perceptions,P=0.001: health distress,P=0.035: sexual function,P=0.031: Overall QOL,P=0.014: physical health composite, P=0.008: mental health composite

A significant improvement in short- and medium-term HRQOL for people with MS, 1 and 2.5 years after intervention.   

Marck et al. [80](Australia)  

Observational study 

3 years 

N=95 (82%) 

Female 69,

Male 26,

Age 44 (± 10.5)EDSS unknown 

✓

N = 68

✓

N = 9

✓

N = 18 (Benign/ other)

49.5% = <2yr19%= 2-5yr17.9%=6-10yr13.7%= >11

5 day group workshop delivered by health care professionals to develop self- management skills. 

NA

Lifestyle & wellbeing (Diet, exercise, stress management) 

QOL (MSQOL-54)

Mean (95% CI) change:Mental health QOL:1 year: 9.2 (5.8 to 12.6)*3 years: 8.0 (4.2 to 11.8)* 

Physical health QOL:1 year: 8.0 (5.2 to 10.8)*3 years: 8.7 (5.3 to 12.2)* 

Significant improvement P<0.05.

QOL maintained up to 3 years post intervention.

Ng et al. [81](Canada)  

6 months 

N = 129  (64%)

Female 99,

Male 30,

Age 49 (11)

EDSS 3.5 (-9.5)^a 

4 (± 2)

Interdisciplinaryeducational wellness program, consisting of physical and psychological evaluations, lectures and workshops.

NA

Lifestyle & wellbeing  (Symptom management, diet, exercise and physical activity, emotional management, goal setting, stress management, energy conservation)

QOL(SF-36)

Significant improvements in:Physical function at 1 month (p < 0.01) and 3 months (p = 0.04).Role physical subscale at 6 months (p = 0.02).Mental Health at 1 (p = 0.004) and 6 months (p = 0.01).No change after program participation in the remaining SF-36 categories; bodily pain, social function or role emotional (P>0.05).

Short-term wellness-program can result in significant positive changes in QOL for plwMS. These changes are stable up to at least 6 months.

Sahebalzamani et al. [82](Iran)  

Quasi experimental 

3 months 

N = 53 (94%) 

1-5 years: 25>5 years: 25

3- month self- care training program involving 6 x 50minute training sessions.

NA

Lifestyle & wellbeing (Symptom management, emotional management) 

QOL (MSQOL-54)

Mean difference pre VS post intervention:Physical health: 12.86 (± 2.39) VS 12.9 (± 2.39)*Mental health: 10.06 (± 1.88) VS 10.08 (1.88)* 

*Significant improvement (P<0.05)

+ * For pain, fatigue, perceived health, overall health, marital satisfaction, psychological health, feeling of wellbeing.

Self-care training to be effective on physical, emotional and psychological domains of quality of life in patients with MS. 

Stuifbergen et al. [83](USA)  

RCT

8 months

N = 121 (93%)

Female 113

Male 0,

Age 45.97 (± 10.09)

EDSSUnknown

✓

N=62

10.76 (± 6.62)

8- week life style program (8x 90 min sessions)+ Bimonthly telephone calls for up to 3 months post program.

No intervention

Lifestyle & wellbeing (physical activity, diet, stress management, women's health) 

QOL(SF-36)

Mean QOL domain at baseline VS T4:Intervention:Role- physical: 42.9 (40.7) VS 46.9 (43.8)Role- emotional: 63.1 (40.5) VS 76.2 (36.0)Control:Role- physical: 38.2 (38.1) VS 41.4 (42.0)Role- emotional: 67.8 (42.2) VS 65.5 (42.5)

Bodily pain and mental health (P<0.05) were higher for the intervention group.Physical function, role- emotional, role-physical, bodily pain, social functioning, general health, mental health, vitality was significant (P<0.01).Stability in scores achieved by month 2

Intervention improved QOL domains: pain & mental health.

Finlayson et al. [84](USA)  

RCT

6 months 

N = 181 (80%) 

Female 143,

Male 38,

Age 56 (9)PDDS 4 (2) 

✓

N=95

✓

N=16

✓

N=39

15 (± 9)

6 -week, group based intervention. 70 min teleconference calls facilitated by an OT. 

Waitlist

Fatigue management

QOL(SF-36) Disability (PDDS)

Mean (95% CI) difference between intervention and control pre/post intervention in QOL domains:Vitality: 6.99 (4.29 to 9.69)*Role emotion: 10.08 (4.13 to 16.04)*Mental health: 5.78 (3.89 to 7.67)*Social function: 7.95 (4.09, 11.82)*Role physical: 11.12 (6.22 to 16.02)*Physical function: 2.62 (0.52 to 4.71)*Significant difference P<0.05/8

Intervention was more effective than control for reducing fatigue impact and improving role- physical domain of QOL. 

Mathiowetz et al. [85](USA)  

Repeated measures clinical trial 

19 weeks 

N = 54 

Female 36,

Male 18,

Age 50 (31-74)^c 

✓

N = 20

9.5 (1-34)^c

6x 2h weekly sessions incorporating lectures, discussions, long- and short-term goal setting, activity stations, and homework activities to teach energy conservation principles.

6 weeks symptom management course followed by 6 week intervention course.

Fatigue management (energy conservation)

QOL(SF- 36)

Mean difference week 1 VS week 19:Role physical: 26.9 (29) VS 26.9 (34)*Role emotional: 49.4 (41) VS 60.9 (42)Vitality: 34.1 (18) VS 43.3 (20)*Social: 59.1 (24) VS 67.5 (22)*Mental health: 65.9 (17) VS 71.2 (16)**Significant improvement post intervention, P<0.001.

Intervention is effective in improving some aspects of QOL for individuals with MS.

Mathiowetz et al. [86](USA)  

RCT

6 weeks 

N = 169(77%) 

Female 140,

Male 29,

Age 48.34 (8.44)  

✓

N = 104

✓

N = 10

✓

N = 32

9.47 (± 7.44) 

Energy conservation course. 2h classes that covered rest, communication techniques, body mechanics and prioritisation.

6 week delayed intervention. 

Fatigue management 

QOL(SF-36)

Mean (95% CI) difference between intervention and control in QOL domains:Role- Physical: 15.18 (0.78 to 29.57)*Role- emotional: 13.23 (-6.77 to 33.24)Vitality: 11.64 (5.48 to 17.79)*Mental health: 6.12 (0.01 to 12.24)** Significant improvement, P<0.05.

Intervention increased some aspects of quality of life (vitality, mental health, physical health). 

Mulligan et al. [87] (NZ)  

Observational cohort study 

3 months

N = 23 (88%) 

Female 23,

Male 0,

Age 48.96 (± 8.13) 

EDSS unknown

✓

N = 14

✓

N = 2

✓

N = 3

11.52 (± 9.95)

Minimise fatigue, maximise life program: 6 weeks, 2hr sessions/ wk.

NA

Fatigue management

QOL(SF-12)

Themes:(1) Achieving behaviour change to manage fatigue(2) Whole life effects

Minimise fatigue, maximise life positively affected lives of participants.

Plow et al. [88](Ohio)    

RCT 

6 months 

N = 208 (78.4%) 

Female 176,

Male 32,

Age 52.1 (± 8.4) 

PDDS:Mild: 34

Moderate: 41

Gait: 62

Early cane: 45

Late cane: 26

✓

N = 176 

✓

N = 6

✓

N = 11

12.7 (± 8.6)

3 teleconference sessions+ 4 individually tailored phone calls + Fatigue course for energy conservation. 

(1) PA only(2) CC Health information 

Fatigue management  

QOL(MSIS)

Mean (95% CI) difference post test:PA- only VS CC:Physical function: -6.03 (-12.90 to 0.85)Mental function: -3.27 (-10.18 to 3.63)FM VS CC:Physical function: -5.60 (-12.18 to 0.99)Mental function: -3.40 (-9.96 to 3.17)FM VS PA- only:Physical function: 0.43 (-6.26 to 7.12)Mental function: -0.12 (-6.82 to 6.58)

Intervention had no effect on improving QOL.Future studies can experiment with number of teleconference sessions.

Thomas et al. [89](UK)  

RCT 

18 months 

N = 164 (89%) 

InterventionFemale 61,

Male 23,

Age 48 (10.2) 

Control:

Female 58,

Male 22,

Age 50.1(± 9.1)

✓

N = 75

✓

N = 13

✓

N = 39

<1 year: 6, 1-5 years: 53,6-10 years: 32,11-15 years: 33, >16 years: 34

6x 90min sessions of the FACETS intervention plus current practice to assist 

Current local practice alone

Fatigue management

QOL(MSIS-29 V.1, SF-36)

Mean (95% CI) difference between intervention and control:MSIS-29: 1 year: 1.44 (-2.36 to 5.24)2 years: -1.56 (-6.45 to 3.34)No significant differences between the intervention and control for the MSIS-29 at follow up 1: P=0.46 OR follow up 2: P=0.53.

It may take longer for the intervention to impact on QOL. Therefore longer term follow up may be required.

Thomas et al. [90](UK)  

RCT 

1 year 

N = 164 (80%) 

InterventionFemale 61,

Male 23,

Age 48 (± 10.2)

PDDS <3: 184-5: 376>: 26 

Control:Female 58,

Male 22,

Age 50.1 (± 9.1)

PDDS <3: 154-5: 426>: 21

✓

N = 75

✓

N = 13

✓

N = 39

Intervention:<1: 61-5: 536-10: 3211-15: 33>16: 34  

FACETS programme (6x 90 min sessions, weekly) for fatigue managmenet.

Received current local practice.

Fatigue management

QOL(MSIS-29, SF-36) 

Mean (95% CI) difference between intervention and control:Physical:1 year: 1.39 (-2.87 to 5.65)2 years: -0.81 (-5.91 to 4.28)3 years: -4.74 (-9.4 to -0.08)* Vitality:1 year: 4.42 (-1.22 to 10.06)2 years: 6.38 (0.45 to 12.32)*3 years: 6.64 (0.84 to 12.44)*

Improvements in QOL at 3 years f/u for physical QOL and vitality. 

Miller et al. [91](Ohio) 

RCT

12 months

N = 206 (81%) 

InterventionFemale 88,

Male 16

Age 48.1 (9.7) 

Control:Female 73,

Male 29,

Age 48.1 (9.1)

Access to a secure electronic messaging system between clinicians and plwMS.

Usual care

Symptom and medical management (symptom)

QOL(Euro- Quality of Life)

Mean difference between intervention and control at end of study:EQ-QOL: 76.3 (± 2.6)**Significant difference, P=0.04.No other between-group differences were found.

Access to messaging system did not lead to the expected improvements in patient outcomes.

Seifi et al. [92](Iran)  

Longitudinal cohortstudy 

N = 28 

Female 18,

Male 10,

Mean age 38 (24 - 55)^c 

2x 45 min self- care sessions for controlling symptoms.

None

Symptom and medical management (Continence management, diet, exercise, energy preservation)

QOL (WHOQOL)

Mean difference (standard error) before and after self- care program:Physical health: -15.02 (2.72)*Psychological: 23.36 (2.42)*Social: -13.54 (2.78)*Living: -8.37 (1.70)**Significant difference (P < 0.001).

Self-care program leads to improved QOL. 

Stockl et al. [93](USA)   

Observational cohort study 

7 months 

N = 468 

InterventionFemale 131,

Male 25,

Age 53.3 (± 10.2)

Specialty pharmacy:Female 133,

Male 23,

Age 53.5 (± 10.1)

Retail pharmacy:Female 127,

Male 29,

Age 52.9 (± 10.5)

✓

N = 195      

11.7 (± 8.8)      

DMT program (combined disease self management and medication therapy management) to improve knowledge and maximise therapeutic outcomes. 

(1) Retail pharmacyOR(2) speciality pharmacy 

Symptom and disease management (Medication) 

QOL(SF-12) Disability(MS relapse) 

Mean QOL domains at baseline VS 6 months:Physical: 37.7 (± 10.1) VS 37.9 (± 10.0)Mental: 48.4 (± 10.4) VS 49.9 (11.1)No significant change, (P>0.05). Relapse: 14% VS 9.3%** Significant change, P=0.03. 

DTM program decreased MS relapse rate, but there were no significant changes in QOL.