Optimising mindfulness-based stress reduction for people with multiple sclerosis

2017 ◽  
Vol 14 (2) ◽  
pp. 154-166 ◽  
Author(s):  
Robert Simpson ◽  
Sharon Byrne ◽  
Karen Wood ◽  
Frances S Mair ◽  
Stewart W Mercer
Keyword(s):  
Multiple Sclerosis ◽  
Stress Reduction ◽  
Controlled Trial ◽  
Self Compassion ◽  
Orientation Session ◽  
Mindfulness Based Stress Reduction ◽  
Group 2 ◽  
Randomised Controlled ◽  
Multiple Sclerosis Patients ◽  
Group 1

Objectives To gather views from patients with multiple sclerosis after completing a standard eight-week mindfulness-based stress reduction course and optimise and test a modified version as required. Methods Two successive groups of 25 multiple sclerosis patients received mindfulness-based stress reduction in a wait-list randomised controlled trial. Seventeen participants and two mindfulness-based stress reduction instructors were individually interviewed after the first (standard) course and 16 participants and the same two instructors were interviewed following the second (optimised) course. Interviews were analysed using a thematic approach. Results Mindfulness-based stress reduction was well received in both groups, with participants describing a beneficial shift in awareness. An initial (at times unpleasant) increase in awareness of disability was generally followed by greater acceptance and self-compassion. Other benefits reported included improved relationships, walking and sleep, with less stress and pain. Mindful-movement and mindful walking were problematic in group 1. This component of mindfulness-based stress reduction was simplified in group 2. A pre-course orientation session was introduced, and some organisational changes made based on feedback from group 1. Feedback from group 2 was positive in all these areas. Discussion Mindfulness-based stress reduction appears beneficial to people with multiple sclerosis, albeit mindful-movement required some modification. Contextual and organisational issues also appear important in this population.

scholarly journals Using normalisation process theory to understand barriers and facilitators to implementing mindfulness-based stress reduction for people with multiple sclerosis

2018 ◽  
Vol 15 (4) ◽  
pp. 306-318 ◽  
Author(s):  
Robert Simpson ◽  
Sharon Simpson ◽  
Karen Wood ◽  
Stewart W Mercer ◽  
Frances S Mair
Keyword(s):  
Multiple Sclerosis ◽  
Stress Reduction ◽  
Qualitative Interviews ◽  
Barriers And Facilitators ◽  
Process Theory ◽  
Normalisation Process Theory ◽  
Orientation Session ◽  
Mindfulness Based Stress Reduction ◽  
Multiple Sclerosis Patients ◽  
Care Facilitators

Objectives To study barriers and facilitators to implementation of mindfulness-based stress reduction for people with multiple sclerosis. Methods Qualitative interviews were used to explore barriers and facilitators to implementation of mindfulness-based stress reduction, including 33 people with multiple sclerosis, 6 multiple sclerosis clinicians and 2 course instructors. Normalisation process theory provided the underpinning conceptual framework. Data were analysed deductively using normalisation process theory constructs (coherence, cognitive participation, collective action and reflexive monitoring). Results Key barriers included mismatched stakeholder expectations, lack of knowledge about mindfulness-based stress reduction, high levels of comorbidity and disability and skepticism about embedding mindfulness-based stress reduction in routine multiple sclerosis care. Facilitators to implementation included introducing a pre-course orientation session; adaptations to mindfulness-based stress reduction to accommodate comorbidity and disability and participants suggested smaller, shorter classes, shortened practices, exclusion of mindful-walking and more time with peers. Post-mindfulness-based stress reduction booster sessions may be required, and objective and subjective reports of benefit would increase clinician confidence in mindfulness-based stress reduction. Discussion Multiple sclerosis patients and clinicians know little about mindfulness-based stress reduction. Mismatched expectations are a barrier to participation, as is rigid application of mindfulness-based stress reduction in the context of disability. Course adaptations in response to patient needs would facilitate uptake and utilisation. Rendering access to mindfulness-based stress reduction rapid and flexible could facilitate implementation. Embedded outcome assessment is desirable.

Azithromycin and metronidazole versus metronidazole-based therapy for the induction of remission in mild to moderate paediatric Crohn’s disease : a randomised controlled trial

Gut ◽  
2018 ◽  
Vol 68 (2) ◽  
pp. 239-247 ◽  
Author(s):  
Arie Levine ◽  
Michal Kori ◽  
Jarek Kierkus ◽  
Rotem Sigall Boneh ◽  
Malgorzata Sladek ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Randomised Controlled Trial ◽  
Crohn's Disease ◽  
Activity Index ◽  
Controlled Trial ◽  
Open Label ◽  
Faecal Calprotectin ◽  
Group 2 ◽  
Randomised Controlled ◽  
Group 1

ObjectiveCrohn’s disease (CD) pathogenesis associated with dysbiosis and presence of pathobionts in the lumen, intracellular compartments and epithelial biofilms. Azithromycin is active in all three compartments. Our goal was to evaluate if azithromycin-based therapy can improve response and induce remission compared with metronidazole alone in paediatric CD.DesignThis blinded randomised controlled trial allocated children 5–18 years with 10<Pediatric Crohn’s Disease Activity Index (PCDAI)≤40 to azithromycin 7.5 mg/kg, 5 days/week for 4 weeks and 3 days/week for another 4 weeks with metronidazole 20 mg/kg/day (group 1) or metronidazole alone (group 2), daily for 8 weeks. Failures from group 2 were offered azithromycin as open label. The primary end point was response defined by a decrease in PCDAI>12.5 or remission using intention to treat analysis.Results73 patients (mean age 13.8±3.1 years) were enrolled, 35 to group 1 and 38 to group 2. Response and remission rates at week 8 were identical 23/35 (66%) in group 1 and 17/38 (45%) and 15/38 (39%) in group 2 (P=0.07 and P=0.025, respectively). The needed to treat for remission was 3.7. Faecal calprotectin declined significantly in group 1 (P=0.003) but not in group 2 (p=0.33), and was lower at week 8 (P=0.052). Additional therapy was required in 6/35(17%) from group 1 versus 16/38(42%) in group 2 (P=0.027) by week 8. Among 12 failures in group 2, open-label azithromycin led to remission in 10/12 (83%).ConclusionsThe combination of azithromycin and metronidazole failed to improve response but was superior for induction of remission and reduction in calprotectin.Trial registration numberNCT01596894.

scholarly journals Estimation of the effects of music therapy on the anxiety and patient’s perception during an upper gastrointestinal endoscopy procedure: a randomised controlled trial

2020 ◽  
Vol 8 (7) ◽  
pp. 2594
Author(s):  
Vikram Kannan ◽  
Sumathy Sundar ◽  
Sajeesh Manikanda Prabhu ◽  
G. Ezhumalai
Keyword(s):  
Music Therapy ◽  
Therapy Group ◽  
Controlled Trial ◽  
Control Group ◽  
Gi Endoscopy ◽  
Group 2 ◽  
Randomised Controlled ◽  
Upper Gastrointestinal ◽  
Therapy Intervention ◽  
Group 1

Background: An upper gastrointestinal (GI) endoscopy procedure is an invasive medical procedure that is used in diagnosis and treatment of various intestinal disorders. Patients posted for upper GI endoscopy procedures often experience significant levels of pre-procedural fear, anxiety and discomfort during the procedure which can negatively affect cooperation levels during the procedure with the attending doctor. A very few studies have explored the beneficial effects of music therapy in this regard and so our study was planned.Methods: A prospective randomised controlled trial was conducted with a sample of 54 patients who were enrolled for this study. They were randomly divided into two groups - group 1 consisting of 27 patients, receiving a music therapy intervention and group 2 consisting of 27 patients who served as a control group. Group 1 received a receptive music therapy intervention in the form vocal, relaxing, improvisational music with patient preferred chants for fifteen minutes before and during the endoscopy procedure. Group 2 did not receive a music therapy intervention.Results: The results indicated that the post intervention, state-anxiety levels was significantly lower in the music therapy group compared to the control group with (p=0.001). Patients’ cooperation levels during the procedure with the attending doctor was significantly higher in the music therapy group than in the control group (p=0.001).Conclusions: Repeated music therapy intervention is highly beneficial in reducing state anxiety levels and improving cooperation levels during the GI endoscopy procedure.

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