Abstract
Background: Multiple Sclerosis (MS) affects quality of life (QoL). Pharmacological treatments demonstrated benefits on clinical endpoints without improving QoL. We evaluated the effects of a group Cognitive Behavioural Therapy (CBT) on QoL disease progression. Methods: One-year multi-centre controlled multivariate-matched study was organised on Relapsing-Remitting MS (RRMS) patients with Expanded Disability Status Scale (EDSS) < 4, MS duration < 2 years, treated by interferon I? in 11 French centres. For each new patient, the two best-matching patients for age, gender, EDSS, mood, illness duration baseline variables were selected in the other centres. The self-filled Two Lives Scale (TLS)-QoL10 was used at months (M) 0-3-6-9-12-15; the post-baseline mean QoL was the endpoint. We compared CBT + I? to I? alone. The effect of disease progression on QoL was evaluated by modelling, for each visit, the effect of EDSS on QoL at later visits.Results: 19 + 32 patients were recruited. Compared to placebo, improvements of 1.10 (95%CI [0.31-1.89], p = 0.009) and 1.43*** [0.72, 2.15] were observed in the CBT group on QoL and coping scales, respectively. Coping explained 81%*** [57, 100] of the effect of CBT on QoL. QoL was negatively affected by disease progression (0.95*** [-1.21; 0.63]), whereas EDSS was influenced by QoL values (-0.10*** [-0.14; -0.06]).Conclusions: We observed a clinically significant beneficial effect of CBT on QoL, the effect of CBT essentially explained by an increase of coping, a positive influence of QoL on disease progression. QoL is both the most important target for patients and a factor of slowing disease progression.
Highlights
Multiple Sclerosis (MS) severely affects Quality of Life (QoL) [1,2,3]
19 patients were recruited in the tested centre and were matched to one or two patients among the control centres
The mean improvement effect in the Cognitive Behavioural Therapy (CBT) group adjusted for baseline was 1.10 on Two Lives Scale (TLS)-quality of life (QoL) 10
Summary
Multiple Sclerosis (MS) severely affects Quality of Life (QoL) [1,2,3]. Interferon β1a and β1b provide evidence of benefits in reducing the number of exacerbations or delaying disease progression [4,5,6,7,8], without Annal Behav Neurosci, 1(1): 77-84 (2018)proving a significant effect on QoL [1]. Pioneer studies provided first evidence that a group Cognitive Behavioural Therapy (CBT) used as add-on treatment to standard therapy may have beneficial effect on QoL [917], by improving the adaptation or coping of patients towards the illness [18,19,20,21,22,23,24,25]. We evaluated the effects of a group Cognitive Behavioural Therapy (CBT) on QoL disease progression. Conclusions: We observed a clinically significant beneficial effect of CBT on QoL, the effect of CBT essentially explained by an increase of coping, a positive influence of QoL on disease progression. QoL is both the most important target for patients and a factor of slowing disease progression
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