Wellness Program Improves Self-Efficacy in Multiple Sclerosis

Can an interdisciplinary wellness program improve self-efficacy, quality of life, and physical activity ability for patients with multiple sclerosis? 
 

To find out, my colleagues and I enrolled 129 patients in one of seven 4-day interdisciplinary wellness programs across the country that offered psychological and physiological evaluations, lectures, and workshops.¹ Outcomes were measured at 1, 3, and 6 months after the program.

We found that a short term “portable” educational/wellness program can improve self-efficacy and quality of life measures in these patients. These improvements were stable over time to varying degrees; self-efficacy was stable for at least 6 months after the program. These improvements were independent of a person’s initial disability, as measured by the commonly used expanded disability status scale (EDSS).

This approach to wellness in persons with MS has important implications for those who might not otherwise have opportunity to participate in such programs. This could be especially for patients who live in rural areas or in areas without ready access to an MS center or major clinic. As such, the intervention described could be a model for others who wish to reach out to the more clinically underserved. This approach to health and wellness delivery could also be of benefit not to only those minimally affected but also those with more debilitating MS.

About the lectures and workshops
Lectures were presented about MS, management of its symptoms, the benefits of good nutrition and exercise, and the impact of mental health. Workshops were held in which individual goal setting, motivation, exercise, stress reduction, health care access, and preventive health were stressed. Participants also learned how to improve balance, conserve energy, and to stretch. Clinically relevant individual physiological and psychological assessments were also performed. Optional consultations with specialists were available if needed or desired (eg, physical or occupational therapy, neurology, nutrition, speech pathology, urologic evaluation).

Our intervention also included a parallel program for participants such as a significant-other, caregiver, or other support partner. Although different in content, this latter program was integral to the overall program goals.

Outcomes
The control subscale of the MS self-efficacy scale improved after our health/wellness intervention for at least 6 months. Thus, a person could have gained increased confidence in his or her ability to manage and cope with symptoms and disease-related limitations. Also at 6 months, we found improvements in physical function, vitality, and mental health scales, as measured by the SF-36-which is commonly used to indicate health-related quality of life. 

The workshops did not result in increased physical activity. There are several possible explanations. We believe, however, that participants’ attitudes toward exercise could have positively changed, but we have no data to support this. And although physical activity levels did not increase, they also did not decrease for at least 6 months.

The take-home message
Our study offers encouragement for clinicians and patients. With the proper tools and motivation, health and wellness are attainable goals-even within the constraints of MS.

Reference
1. Ng A, Kennedy P, Hutchinson B, et al. Self-efficacy and health status improve after a wellness program in persons with multiple sclerosis. Disability and Rehabilitation. 2012. (in press)