title: Efficacy of a Telephone-Delivered Self-Management Intervention for Persons With Multiple Sclerosis: A Randomized Controlled Trial With a One-Year Follow-Up.
abstract: OBJECTIVE
  To evaluate the efficacy of a telephone-delivered self-management intervention for fatigue, pain, and depression in adults with multiple sclerosis (MS).
  
  
  METHODS
  Single-center, randomized (1:1), single-blind (outcome assessors), parallel-group trial with a primary endpoint of posttreatment (9-11 wk postrandomization) and long-term follow-up at 6 and 12 months.
  
  
  METHODS
  Telephone-delivered across the United States.
  
  
  METHODS
  Adults with MS (N=163) with fatigue, chronic pain, and/or moderate depressive symptoms (age range, 25-76 y).
  
  
  METHODS
  Eight-week individual telephone-delivered self-management intervention (T-SM) (n=75) versus an 8-week individual telephone-delivered MS education intervention (T-ED) (n=88).
  
  
  METHODS
  The primary outcome was the proportion who achieved a ≥50% decrease in 1 or more symptoms-fatigue impact, pain interference, and/or depression severity. Secondary outcomes included continuous measures of pain, fatigue impact, depression, self-efficacy, activation, health-related quality of life, resilience, and affect.
  
  
  RESULTS
  For our primary outcome, 58% of those in the T-SM group and 46% of those in the T-ED group had a ≥50% reduction in 1 or more symptoms; this difference was not statistically significant (odds ratio, 1.50; 95% confidence interval, .77-2.93; P=.238). Participants in both groups significantly improved from baseline to posttreatment in primary and secondary outcome measures (P<.05). T-SM participants reported significantly higher treatment satisfaction and therapeutic alliance and greater improvements in activation, positive affect, and social roles. Improvements were generally maintained at 6 and 12 months.
  
  
  CONCLUSIONS
  Both interventions resulted in short- and long-term, clinically meaningful benefits. The study demonstrated that the telephone is an effective method for engaging participants in care and extending the reach of rehabilitation for individuals with MS.
authors.affiliation: Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, WA. Electronic address: ehde@uw.edu.
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Ehde
authors.affiliation: Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, WA.
authors.forename: Jamie L
authors.initials: JL
authors.lastname: Elzea
authors.affiliation: Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, WA.
authors.forename: Aimee M
authors.initials: AM
authors.lastname: Verrall
authors.affiliation: Department of General Internal Medicine, School of Medicine, University of Washington, Seattle, WA.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Gibbons
authors.affiliation: Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, WA.
authors.forename: Amanda E
authors.initials: AE
authors.lastname: Smith
authors.affiliation: Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, WA.
authors.forename: Dagmar
authors.initials: D
authors.lastname: Amtmann
mesh_terms: D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000453:epidemiology / Q000534:rehabilitation; D003863:Depression / Q000453:epidemiology / Q000534:rehabilitation; D005221:Fatigue / Q000453:epidemiology / Q000534:rehabilitation; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation*; D010147:Pain Measurement; D010353:Patient Education as Topic / Q000458:organization & administration; D011788:Quality of Life; D055500:Resilience, Psychological; D012648:Self Care / Q000379:methods*; D020377:Self Efficacy; D016037:Single-Blind Method; D013689:Telephone; D014481:United States
keywords: Chronic pain; Depression; Fatigue; Multiple sclerosis; Rehabilitation; Self care