Systematic literature review of self-management interventions in multiple sclerosis.

Background: Self-management interventions are increasingly used to help those with chronic conditions including multiple sclerosis (MS) manage their condition and improve health, well-being, and quality of life. However, little is known about their effectiveness in MS. We conducted a systematic review of MS self-management intervention literature to examine characteristics of and evidence-base for self-management interventions in MS. A critical review of study quality, including evidence grading, was done to inform future research. Methods: Search criteria included peer-reviewed articles: (1) investigating self-management interventions; (2) in adults with a diagnosis of MS; (3) published since 1966; and (4) written in English. Identification of articles began with electronic searches of English-language databases PubMed, CINAHL, PsychINFO, MEDLINE, Web of Science, Cochrane, and Embase. Inclusion criteria included studies in which an intervention was delivered and the outcomes of the study were related to self-management of MS. Results: The 59 studies had considerable heterogeneity in interventions, control conditions, intervention targets, delivery methods, and outcomes. Few studies (n=13) identified interventions as “self-management”. Higher quality studies suggest that various self-management interventions may be effective in helping people manage the effects of MS, particularly depression and fatigue. Inconsistency in reporting study quality indicators was also found, as many studies did not provide sufficient information about the intervention(s), control conditions, or randomization procedures. Conclusions: This review highlights the need for more well-designed intervention studies evaluating self-management in MS and provides direction for improvements in methodological rigor.