Motivational interviewing to increase exercise in multiple sclerosis.
|Title||Motivational interviewing to increase exercise in multiple sclerosis.|
|Publication Type||Journal Article|
|Authors||McMullen KA, Bamer AM, Bombardier CH, Ehde DM, Bowen JD|
Background: People with multiple sclerosis (MS) in the US are at risk for inactivity and the negative effects associated with it. Research indicates that exercise can improve physical function, participation, and pain in other populations. Motivational interviewing (MI) is an evidence-based intervention to promote adoption of health promotion activities. In this study MI was used to assist people with MS initiate and maintain an individually-tailored exercise program. Objective: Evaluate the efficacy of a primarily telephone-based MI intervention for exercise using a randomized controlled trial in improving several MS outcomes. Methods: Participants were recruited through MS clinics in Seattle, WA, USA, advertisements, previous studies, and through word of mouth. In total, 123 people with MS were randomized into a MI exercise intervention (n¼64) or usual care control group (n¼59). Treatment subjects received an in-person MI and physical therapy session and six phone-based short MI follow-up sessions over nine months. Follow-up assessments were conducted at 12, 24, and 36 months by blinded evaluators. Eighty-nine subjects completed the three year follow up, which assessed physical activity, participation, physical function, quality of life, fatigue, and pain. Results: Two tailed t-tests were conducted to determine the difference in outcomes between the intervention and the control group. At three year follow up, intervention participants had significantly lower average pain levels (p<0.01) and significantly lower pain interference (p<0.01) than the control group. At two year follow-up, treated subjects reported significantly better community integration compared to controls (p¼0.05). The other outcomes, including physical activity, participation, physical function, quality of life, and fatigue, were not significantly different between the two groups at any followup point. Conclusions: This low-dose, primarily telephone-based motivational intervention produced modest positive benefits in pain and community integration over a three year period. Since the target variable, physical activity, was not significantly improved in the treatment versus control group, the mechanism behind improvements in pain and community participation remain unclear. Future research should examine the effects of higher doses of the same intervention or different intervention approaches e.g., self-management training to promote health in newly diagnosed persons with MS.