A multimodal intervention for patients with secondary progressive multiple sclerosis: feasibility and effect on fatigue.
BACKGROUND
Multiple sclerosis is an autoimmune disease influenced by environmental factors.


OBJECTIVE
The feasibility of a multimodal intervention and its effect on perceived fatigue in patients with secondary progressive multiple sclerosis were assessed.


METHODS
This was a single-arm, open-label intervention study in an outpatient setting.


METHODS
A multimodal intervention including a modified paleolithic diet with supplements, stretching, strengthening exercises with electrical stimulation of trunk and lower limb muscles, meditation, and massage was used.


METHODS
Adherence to each component of the intervention was calculated using daily logs. Side-effects were assessed from a monthly questionnaire and blood analyses. Fatigue was assessed using the Fatigue Severity Scale (FSS). Data were collected at baseline and months 1, 2, 3, 6, 9, and 12.


RESULTS
Ten (10) of 13 subjects who were enrolled in a 2-week run-in phase were eligible to continue in the 12-month main study. Of those 10 subjects, 8 completed the study and 6 subjects fully adhered to the study intervention for 12 months. Over a 12-month period, average adherence to diet exceeded 90% of days, and to exercise/muscle stimulation exceeded 75% of days. Nutritional supplements intake varied among and within subjects. Group daily average duration of meditation was 13.3 minutes and of massage was 7.2 minutes. No adverse side-effects were reported. Group average FSS scores decreased from 5.7 at baseline to 3.32 (p=0.0008) at 12 months.


CONCLUSIONS
In this small, uncontrolled pilot study, there was a significant improvement in fatigue in those who completed the study. Given the small sample size and completer rate, further evaluation of this multimodal therapy is warranted.
1 Department of Health and Human Physiology, University of Iowa College of Liberal Arts and Sciences , University of Iowa, Iowa City, IA.
Babita
B
Bisht
Warren G
WG
Darling
Ruth E
RE
Grossmann
E Torage
ET
Shivapour
Susan K
SK
Lutgendorf
Linda G
LG
Snetselaar
Michael J
MJ
Hall
M Bridget
MB
Zimmerman
Terry L
TL
Wahls
D001835:Body Weight; D003131:Combined Modality Therapy; D066046:Diet, Paleolithic / Q000009:adverse effects; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000379:methods*; D005081:Exercise Therapy / Q000009:adverse effects / Q000379:methods*; D005221:Fatigue / Q000523:psychology / Q000628:therapy*; D005240:Feasibility Studies; D006801:Humans; D008405:Massage / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D020528:Multiple Sclerosis, Chronic Progressive / Q000523:psychology / Q000628:therapy*; D010045:Outpatients; D010349:Patient Compliance; D010865:Pilot Projects