Mediating and Moderating Factors of the Effect of Psychological Therapies Among People With Multiple Sclerosis
TL;DR
The results suggest that individuals' level of education and whether their fatigue has been addressed are important considerations in the use of psychological interventions among people with MS.
Abstract
Background: People living with multiple sclerosis (MS) can experience a range of psychological, emotional, and somatic symptoms. Current literature on psychological therapies for people with MS is limited, particularly regarding mechanisms of action and the characteristics of those likely to benefit. This study identifies mediating and moderating factors involved in the relationship between psychological therapies and outcomes among people with MS. Methods: Five major databases were searched for randomized controlled trials comparing any psychological therapy in people with MS. Included studies were compiled and screened for inclusion by mediation and moderation analyses using an a priori list of variables. Mediation and moderation analyses were then conducted, examining pooled mean changes across outcomes (physical, cognitive, psychological, quality of life, feasibility, and health economics). Results: In total, 68 studies were included in mediator analyses and 65 in moderator analyses. In mediation analyses, psychological interventions had a significant direct effect on outcomes regardless of mediator (P < .0001), with the exception of fatigue. Fatigue had a borderline significant indirect effect (average causal mediation effect, 4.44; 95% CI, 0.02-10.03; P = .06). In moderator analyses, a positive interaction was observed between level of education (ie, undergraduate degree or higher) and outcomes (P < .0001; 95% CI, 0.05-0.57). Conclusions: These results suggest that individuals' level of education and whether their fatigue has been addressed are important considerations in the use of psychological interventions among people with MS.