title: Dietary Interventions in Multiple Sclerosis: Development and Pilot-Testing of an Evidence Based Patient Education Program.
abstract: BACKGROUND
  Dietary factors have been discussed to influence risk or disease course of multiple sclerosis (MS). Specific diets are widely used among patients with MS.
  
  
  OBJECTIVE
  To design and pilot-test an evidence based patient education program on dietary factors in MS.
  
  
  METHODS
  We performed a systematic literature search on the effectiveness of dietary interventions in MS. A web-based survey among 337 patients with MS and 136 healthy controls assessed knowledge, dietary habits and information needs. An interactive group education program was developed and pilot-tested.
  
  
  RESULTS
  Fifteen randomised-controlled trials (RCTs) were included in the systematic review. Quality of evidence was low and no clear benefit could be seen. Patients with MS significantly more often adhered to a `Mediterranean Diet`(29.7% versus 14.0%, p<0.001) compared to controls. 143 (42%) of the patients with MS had tried special MS diets. Important information needs addressed effectiveness of MS diets (44%) and relation between nutrition and MS (43%). A pilot test of our newly developed patient education program with 13 participants showed excellent comprehensibility and the MS-specific content was judged as very important. However, the poor evidence base for dietary approaches in MS was perceived disappointing.
  
  
  CONCLUSIONS
  Development and pilot-testing of an evidence-based patient education program on nutrition and MS is feasible. Patient satisfaction with the program suffers from the lack of evidence. Further research should focus on generating evidence for the potential influence of lifestyle habits (diet, physical activity) on MS disease course thus meeting the needs of patients with MS.
authors.affiliation: Department of Neurology, Institute for Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.|Institute of Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Lübeck, Germany.
authors.forename: Karin
authors.initials: K
authors.lastname: Riemann-Lorenz
authors.affiliation: Department of Neurology, Institute for Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Marlene
authors.initials: M
authors.lastname: Eilers
authors.affiliation: Department of Neurology, University of Washington, Seattle, Washington, United States of America.
authors.forename: Gloria
authors.initials: G
authors.lastname: von Geldern
authors.affiliation: Department of Psychosocial Medicine, Institute of Medical Psychology and Athleticum-Competence Center for Sports- and Exercise Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Schulz
authors.affiliation: Institute of Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Lübeck, Germany.
authors.forename: Sascha
authors.initials: S
authors.lastname: Köpke
authors.affiliation: Department of Neurology, MS Day Hospital and Outpatient Unit and Institute for Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Heesen
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D038441:Diet, Mediterranean; D055317:Evidence-Based Practice; D005260:Female; D006801:Humans; D020407:Internet; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000178:diet therapy / Q000523:psychology*; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D010865:Pilot Projects; D015397:Program Evaluation; D011795:Surveys and Questionnaires