Web-based wellness program improves life quality, lowers fatigue

A web-based wellness intervention program that educated multiple sclerosis (MS) patients on dietary plans, stress management, sleep, and exercise recommendations significantly improved their fatigue and quality of life, according to data from a clinical study.

The study, “Evaluation of a web-based program for the adoption of wellness behaviors to self-manage fatigue and improve quality of life among people with multiple sclerosis: A randomized waitlist-control trial,” also showed that web-based programs can be efficient and feasible in providing wellness information to patients. It was published in Multiple Sclerosis and Related Disorders.

MS occurs when the immune system mistakenly attacks the myelin, a sheath around nerve fibers that helps cells communicate with each other. This leads to a wide range of symptoms, including mobility problems, cognitive impairment, fatigue, and mood disturbances, which negatively affect a patient’s quality of life.

In addition to therapies that ease symptoms and slow progression, nonpharmacological interventions, such as physical therapy and exercise, a healthier diet, and emotional support, may help manage the disease and improve life quality.

Individual strategies have been shown to improve quality of life and disease symptoms, but there’s been little data on the effect of combined interventions, leading researchers at the University of Iowa to develop a web-based program that focused on multiple areas and assess if it could improve quality of life and reduce fatigue with MS.

A web-based program may be more accessible and cost-effective, particularly for those with high healthcare costs and limited access to care, the researchers said.

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MS wellness with immediate, delayed intervention

A total of 100 adults with clinically isolated syndrome or relapsing-remitting MS in the U.S. were recruited from social media and research registries between November 2021 and May 2022. Most (94%) were women with a mean age of 44.

The participants were randomly assigned to receive immediate intervention with a seven-week web-based program (51 patients), which they could complete at their own pace during the first 12 weeks, or to a waitlist group (49 patients) that gained access to the intervention after 12 weeks and could complete the program until week 24.

Both groups were followed for 24 weeks (around six months), corresponding to an intervention period of 12 weeks and a nonintervention period of another 12 weeks for each.

The program consisted of an orientation and five self-study modules, with no support from the study team. Each module included videos, documents, and worksheets with information about diets shown to reduce fatigue and improve quality of life in MS, supplements, strategies for stress reduction and better sleep, and physical exercise recommendations.

Results from the trial (NCT05057676) showed that patients in the immediate intervention group saw significant improvements in physical quality of life after 12 weeks, which they maintained at 24 weeks. For those on the waitlist, physical quality of life didn’t change in the first 12 weeks, when they weren’t receiving the intervention, but improved significantly at 24 weeks.

Neither group had significant changes in mental quality of life.

The patients in the immediate intervention group also had significant reductions in fatigue at 12 weeks, which were maintained until week 24. Fatigue scores didn’t change in the first 12 weeks in the waitlist group, but dropped significantly after the intervention.

Regarding diet, the consumption of fruit and vegetables didn’t significantly change during the intervention period for either group. However, the immediate intervention group had a significantly higher intake at 24 weeks compared to the start of the study, or baseline.

This suggests the diet component of the intervention didn’t have good adherence, although it’s possible the food questionnaire used couldn’t accurately capture the amount of fruits and vegetables in specialized diets, the researchers noted.

The course completion rate was significantly higher for the immediate intervention group (47.9%) than for the waitlist group (18.8%), suggesting delaying the intervention decreased course completion.

“Future web-based waitlist-controlled trials will need to implement methods to improve course completion in the wait list-control group,” the researchers wrote. “The results from the present study add to the growing body of literature regarding the beneficial effects of wellness in MS care and demonstrate that web-based programs are a potentially efficacious and feasible method for disseminating wellness information to improve physical [quality of life] and reduce fatigue among people with MS.”