title: A New Zealand pilot randomized controlled trial of a web-based interactive self-management programme (MSInvigor8) with and without email support for the treatment of multiple sclerosis fatigue.
abstract: OBJECTIVE
  To pilot and compare the efficacy of an internet-based cognitive behavioural therapy self-management programme with (MSInvigor8-Plus) and without (MSInvigor8-Only) the use of email support in reducing fatigue severity and impact (primary outcomes), and depressed and anxious mood (secondary outcomes).
  
  
  METHODS
  Randomized controlled trial using an independent randomization system built into the website and intention-to-treat analysis.
  
  
  METHODS
  Participants were recruited through the local Multiple Sclerosis Society and hospital neurological services in New Zealand.
  
  
  METHODS
  A total of 39 people (aged 31-63 years), experiencing multiple sclerosis fatigue, able to walk with and without walking aids, were randomized to MSInvigor8-Only (n = 20) or to MSInvigor8-Plus (n = 19).
  
  
  METHODS
  MSInvigor8 is an eight-session programme based on cognitive behaviour therapy principles including psycho-education, self-monitoring, and changing unhelpful activity and thought patterns.
  
  
  METHODS
  Outcome measures included fatigue severity (Chalder Fatigue Scale) and impact (Modified Fatigue Impact Scale), and anxiety and depression (Hospital Anxiety and Depression Scale). Assessments were performed at baseline and at 10 weeks.
  
  
  RESULTS
  The MSInvigor8-Plus condition resulted in significantly greater reductions in fatigue severity (F [1,36] = 9.09, p < 0.01) and impact (F [1,36] = 6.03, p < 0.02) compared with the MSInvigor8-Only condition. Large between-group effect sizes for fatigue severity (d = 0.99) and fatigue impact (d = 0.81) were obtained. No significant differences were found between the groups on changes in anxiety and depression.
  
  
  CONCLUSIONS
  MSInvigor8 delivered with email-based support is a potentially promising, acceptable, and cost-effective approach to treating fatigue in people with multiple sclerosis in New Zealand.
authors.affiliation: Department of Psychology AUT University, Auckland, New Zealand kvankess@aut.ac.nz.
authors.forename: Kirsten
authors.initials: K
authors.lastname: van Kessel
authors.affiliation: Department of Psychological Medicine, University of Auckland, Auckland, New Zealand.
authors.forename: Trecia
authors.initials: T
authors.lastname: Wouldes
authors.affiliation: Section of Health Psychology, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
authors.forename: Rona
authors.initials: R
authors.lastname: Moss-Morris
mesh_terms: D000328:Adult; D001007:Anxiety / Q000209:etiology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000209:etiology / Q000628:therapy*; D034742:Electronic Mail; D005221:Fatigue / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D020407:Internet; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications* / Q000523:psychology; D009520:New Zealand; D010865:Pilot Projects; D012648:Self Care / Q000379:methods*; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D012944:Social Support
keywords: Multiple sclerosis fatigue; cognitive behavioural therapy; self-management; web-based intervention