Relaxation and related therapies for people with multiple sclerosis (MS): A systematic review.

OBJECTIVE: To establish the effectiveness of relaxation and related therapies in treating Multiple Sclerosis related symptoms and sequelae. DATA SOURCES: PsycINFO, PubMed, Embase, CINAHL, ProQuest Dissertations and Theses Global databases were searched. METHODS: We included studies from database inception until 31 December 2021 involving adult participants diagnosed with multiple sclerosis or disseminated sclerosis, which featured quantitative data regarding the impact of relaxation interventions on multiple sclerosis-related symptoms and sequelae. Studies which examined multi-modal therapies - relaxation delivered in combination with non-relaxation interventions - were excluded. Risk of bias was assessed using the Revised Risk of Bias tool for randomised trials - ROB2, Risk of Bias in Non-Randomised Studies of Interventions ROBINS-I), and within and between-group effects were calculated (Hedges' g). RESULTS: Twenty-eight studies met inclusion criteria. Twenty-three of these were randomised controlled trials, with 1246 total participants. This review reports on this data, with non-randomised study data reported in supplemental material. Post -intervention relaxation was associated with medium to large effect-size improvement for depression, anxiety, stress and fatigue. The effects of relaxation were superior to wait-list or no treatment control conditions; however, comparisons with established psychological or physical therapies were mixed. Individual studies reported sustained effects (≤ 6 months) with relaxation for stress, pain and quality of life. Most studies were rated as having a high/serious risk of bias. CONCLUSION: There is emerging evidence that relaxation therapies can improve outcomes for persons with multiple sclerosis. Given the high risk of bias found for included studies, stronger conclusions cannot be drawn.

Patient experience of neurologic rehabilitation: a qualitative investigation.

OBJECTIVE: To understand the experiences of patients who had undergone neurologic rehabilitation. DESIGN: An interpretative phenomenological analysis of semistructured interviews. SETTING: Neurologic rehabilitation unit. PARTICIPANTS: A purposive convenience sample of 8 past patients. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Participants' reports of neurologic rehabilitation obtained via in-depth semistructured interviews. RESULTS: Participants predominantly described positive experiences of rehabilitation. The superordinate theme person-centeredness was developed, which included 4 key themes: ownership, personal value, holistic approach, and therapeutic atmosphere. These reflected patients' perceptions of choice and control and feelings of personal respect and self-worth. These appeared to be promoted through the multidimensional benefits of the unit (eg, the understanding and friendly nature of staff and other patients, physical improvements, psychologic gains) as well as the unit's informal, relaxed environment. When present, these factors created a positive rehabilitation experience; when absent, a negative experience. CONCLUSIONS: These findings support those from other literature, which has identified person-centered care as a core element of successful rehabilitation and linked its absence to dissatisfaction with health care. This research has increased our understanding of patients' experience of neurologic rehabilitation, and could inform the development of a patient-centered assessment instrument for neurologic rehabilitation.

Flooding treatment of phobia to having her feet touched by physiotherapists, in a young woman with Down's syndrome and a traumatic brain injury.

This case study describes the treatment of a 32-year-old woman with Down's syndrome and a recent head injury, for phobia to treatment of her feet by physiotherapists. The phobia had the potential to severely limit rehabilitation progress in terms of the client regaining the ability to stand, assist with transfers (including to and from a car), and walk. A single session, in vivo, flooding intervention was used. The treatment resulted in a substantial change in tolerance of physiotherapists' touching of feet to the extent rehabilitation was able to proceed within the bounds of expectation had a phobia not been evident. Benefits were maintained at multiple follow-ups. The results of the case study extend the evidence for the utility of such behavioural interventions to people with complex disability and unusual phobias in neurological rehabilitation systems.