title: A systematic review of stress-management interventions for multiple sclerosis patients.
abstract: BACKGROUND
  The objective of this study was to identify stress-management interventions used for people with multiple sclerosis (MS) and systematically evaluate the efficacy of these interventions.
  
  
  METHODS
  Several strategies were used to search for studies reported in articles published up to 2013.
  
  
  RESULTS
  Our initial search retrieved 117 publications, of which 8 met our criteria for review. Of the eight studies, one provided Class I evidence, five provided Class III evidence, and two provided Class IV evidence for the efficacy of stress-management interventions according to the evidence classification established by the American Academy of Neurology. Most studies showed positive changes in outcomes assessed; however, the range of methodological quality among the published studies made it difficult to draw conclusions.
  
  
  CONCLUSIONS
  The promising findings for stress-management interventions highlight the need for future studies. Additional large, prospective, multicenter studies will help to define the role of stress-management interventions in the treatment and course of MS. Furthermore, including outcome measures based on biological and clinical markers of disease will prove useful in understanding potential underlying mechanisms.
authors.affiliation: Psychiatry and Psychology (AKR, ABS) and the Mellen Center for Multiple Sclerosis Treatment and Research (ABS, ARG), Cleveland Clinic, Cleveland, OH, USA. Dr. Reynard is now with NorthShore University HealthSystem, Evanston, IL, USA.
authors.forename: Alison K
authors.initials: AK
authors.lastname: Reynard
authors.affiliation: Psychiatry and Psychology (AKR, ABS) and the Mellen Center for Multiple Sclerosis Treatment and Research (ABS, ARG), Cleveland Clinic, Cleveland, OH, USA. Dr. Reynard is now with NorthShore University HealthSystem, Evanston, IL, USA.
authors.forename: Amy Burleson
authors.initials: AB
authors.lastname: Sullivan
authors.affiliation: Psychiatry and Psychology (AKR, ABS) and the Mellen Center for Multiple Sclerosis Treatment and Research (ABS, ARG), Cleveland Clinic, Cleveland, OH, USA. Dr. Reynard is now with NorthShore University HealthSystem, Evanston, IL, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Rae-Grant