Psychological therapies for multiple sclerosis: Moving towards best practices

IDEA Early Career Researcher Talk
Psychological Therapies for Multiple Sclerosis: Moving Towards Best Practices

[00:00] Ansha

Hello everyone, and welcome to our monthly webinar series, the IDEA Early Career Researcher Talk. I am Ansha, and I am hosting this monthly webinar, which brings early career researchers together for an in-depth conversation about their work.
I am a postdoctoral fellow at Queen�s University, where I research disability inclusive mentorship. My research aims to improve the long-term health and work outcomes of persons with disabilities, as well as injured and sick workers with acquired disabilities, through a holistic approach.
Thank you for joining us today. Today�s session features two speakers and co presenters. Thank you, Ashvene and Jillian, for being here. They will be speaking about their work titled Psychological Therapies for Multiple Sclerosis: Moving Towards Best Practices.
Please allow me to briefly introduce our co presenters.
Ashvene is a PhD candidate at the University of Toronto in the Rehabilitation Sciences Institute and a Research Associate with IDEA. She holds a Bachelor of Science in Health Sciences and a master�s in health and Rehabilitation Science from Western University. She is a mixed methods researcher whose work focuses on equity, diversity, inclusion, accessibility, and health services research. Her PhD research involves the development of an implementation toolkit to support online mindfulness-based interventions for people living with multiple sclerosis.

Our second co presenter, Jillian, is also a PhD candidate in Rehabilitation Science at the University of Toronto. She holds a Master�s in Kinesiology and Health Sciences from Queen�s University and a bachelor�s degree in Kinesiology from McMaster University. Her doctoral research focuses on informing the development of a toolkit to support healthcare providers in prescribing physical activity for people living with multiple sclerosis. Her research interests include the promotion and implementation of health behaviour initiatives to improve the well being of people living with MS.

Ashvene and Jillian will share findings from a large meta-analysis of randomized controlled trials. Their presentation will highlight which psychological therapies are most effective, what components drive better outcomes for MS patients, and practical recommendations to improve access to psychological support, including within work contexts.

Before I turn things over to our presenters, a few housekeeping notes. After the presentation, we will move into a Q and A session. Please feel free to submit your questions using the Q and A function throughout the presentation.
Ashvene and Jillian, thank you again for joining us today. The floor is yours.
[03:50] Jillian
Thank you so much for having us. My name is Jillian Scandiffio, and I am a PhD candidate at the Rehabilitation Sciences Institute at the University of Toronto. I will be presenting alongside my lab mate, Ashvene, and we are both supervised by Dr. Robert Simpson and Dr. Sarah Morrow at the Rehabilitation Sciences Institute.
I also want to thank the rest of our team members who contributed to this study. We would not be here today without their support, and their names are listed on the slide.
Today we will be speaking about our project Psychological Therapies for People with Multiple Sclerosis: Moving Towards Best Practices.
To begin, I will provide some background on multiple sclerosis and the work our team has been doing. Then I will discuss the network meta-analysis we conducted, which explored which psychological therapies are effective for people with MS and which are the most effective.
Multiple sclerosis is a chronic, disabling, demyelinating, neurodegenerative condition that affects the central nervous system. According to the NIH, it is the most disabling neurological condition among young adults.
Currently, over 90,000 Canadians are living with multiple sclerosis, and Canada has one of the highest prevalence rates of MS in the world.
People with MS experience a wide range of distressing symptoms, with fatigue being the most common and often rated as the most disabling.
In addition, people with MS are often living with multiple co existing conditions, including elevated rates of depression and anxiety. They are approximately three times more likely to be diagnosed with a mood disorder compared with the general population.
Despite these high rates, there are limited treatment options to address these conditions for people with MS. Medications are often poorly tolerated, and nonpharmacological interventions should be considered, but they are often unavailable.

In addition to troubling symptoms and comorbidities, people living with MS may also experience major social impacts, including unemployment. Approximately 48 percent of people with MS in Canada report unemployment due to the complexities of disease progression. Factors contributing to this include pain, fatigue, cognitive impairment, and disease severity.
Unemployment among people with MS brings further challenges, including increased stress, anxiety, and depression due to financial insecurity or part time employment, a loss of routine, and a diminished sense of self worth.
Fatigue is the strongest predictor of absenteeism among employed people with MS.
Our study used a network meta-analysis design to synthesize existing studies and determine which psychological therapies are most effective. We screened approximately 7,000 studies and ultimately included 111 studies in our review. These studies involved a total of 3,911 participants.
One key finding was that cognitive behavioural therapy, or CBT, was the most effective therapy overall when compared with other psychological therapies.
Psychological therapies significantly improved four outcome categories:
quality of life
cognition
physical health
mental health
The greatest improvements were seen in mental health outcomes, including anxiety and depression.
Although our analysis examined high quality evidence across many studies, there were important limitations. Several studies did not report their data clearly, and only about 10 percent of studies involved a statistician.
Researchers should clearly define the PICO framework, report demographic data accurately, and provide sufficient statistical information to support future meta-analyses.
We also conducted mediation analyses and found that fatigue was the only significant mediator, meaning interventions addressing fatigue may improve overall outcomes.
I will now pass the presentation to Ashvene to discuss additional analyses.
[19:00] Ashvene

Thank you, Jill.
Now that we know psychological therapies are effective for people with MS, the next question becomes what aspects of these interventions actually drive better outcomes.
We conducted a meta regression analysis to investigate how study characteristics and intervention components influenced outcomes.
Therapies were more effective when they were:
delivered in person or online
led by a licensed psychologist
tailored specifically to people with MS
Interventions that were not tailored or delivered by phone tended to be less effective.
We also conducted an equity, diversity, inclusion, and accessibility analysis.
Participants across the included trials were predominantly younger, white, had lower levels of disability, had an undergraduate degree or higher, and were more likely to be employed full time.
Race, ethnicity, and socioeconomic status were reported in fewer than 20 percent of studies.
Our findings highlight the need for more inclusive recruitment practices so that research findings better represent the broader MS community.
Psychological therapies can also have important implications for workplace disability inclusion.
Fatigue is one of the strongest predictors of workplace absenteeism in people with MS. Addressing fatigue through psychological therapies may improve both mental health and work outcomes.
Psychological therapies should be widely available to people with MS and should prioritize fatigue management.
Access to trained therapists familiar with MS and tailored interventions is also critical.
Future trials should become more inclusive and culturally responsive.
Thank you for the opportunity to share this work. We are happy to take questions.


[39:20] Ansha
Thank you, Jillian and Ashvene.
The floor is now open to the audience.
I will begin with a question. MS is often not adequately recognized within work contexts, even though it creates significant psychological challenges for people living with the condition.

One of your recommendations touched on inclusive employment strategies. What practical recruitment strategies would you recommend for future trials to improve inclusivity?
[41:45] Ashvene
One important issue we identified is eligibility criteria. Many exclusion criteria used in trials are not well justified.
Future research should broaden eligibility criteria to include people with different employment experiences, age groups, comorbidities, and levels of disability severity.
Partnering with community organizations is also critical because these organizations have established trust with their communities.
Researchers should also recruit beyond urban specialty clinics and reach people in rural areas.
Flexible participation formats and transportation support can help reduce barriers to participation.
[44:40] Jillian
I would add that an international consortium of MS researchers published recommendations for more inclusive recruitment in MS research.
One recommendation was to reduce overly restrictive eligibility criteria. Excluding people based on age or certain symptoms limits our understanding of how therapies work in real world populations.
[47:00] Ansha
Another question concerns immigrants with MS and culturally responsive therapies. How should we think about psychological therapy access in a multicultural workforce?

[47:30] Ashvene
Cultural relevance is very important. In our qualitative work, some participants reported difficulty engaging with psychological therapies because the examples used did not reflect their cultural context.
Future research should include diverse participants, offer interventions in multiple languages, and incorporate culturally relevant examples.
Clinicians should also receive training in cultural responsiveness so they can better support diverse patient populations.
[59:30] Ansha
Thank you again to our speakers, Jillian and Ashvene, and to all participants.
A feedback survey will be shared after the session. You can also contact the IDEA national office by email.
Our next Early Career Researcher Talk will take place on March 11 at 12 PM, featuring Janice Lam presenting on Disclosing Disability in Job Applications.
For those requesting a certificate of attendance, please email the IDEA national office.
Thank you all for joining us today.