Depressive Symptoms in MS: Remote Exercise, Physiotherapy Shows Promise

Engagement in remote exercise or physiotherapy through personalized programs and communication methods like telephone monitoring, can effectively alleviate depressive symptoms in individuals with multiple sclerosis (MS), producing results comparable to in-person interventions. These are the findings of a study published in the journal Multiple Sclerosis Related Disorders.

Depression is common among patients with MS and can negatively impact their quality of life. Medication, specifically antidepressants, is the first choice to treat depressive symptoms, however, previous research has found that interventions such as exercise and physiotherapy can improve depressive symptoms, and thus, quality of life, leading to more independence in doing activities of daily living. More recent research suggests that remote forms of rehabilitation, also known as telerehabilitation, could achieve similar results and eliminate barriers such as transportation for this patient population.

To assess the efficacy of remote exercise and physiotherapy in alleviating depressive symptoms among patients with MS, researchers systematically reviewed literature and conducted a meta-analysis utilizing various databases.

For the analysis, the studies included had to meet the following inclusion criteria: randomized controlled trials (RCTs) or pilot RCTs published in English between 2012-2022, participants diagnosed with MS age 18 and older, participants assessed for depression with a valid assessment tool, and featuring a remote exercise or physiotherapy intervention.

Out of the 176 studies that were screened, 6 (3 RCTs, 3 pilot RCTs) were included in the final analysis.

The interventions utilized amongst the studies primarily consisted of personalized home-based exercise programs tailored to participants’ individual goals and daily lives, varying in the types of exercises (e.g., balance, aerobic, strengthening) and the format of exercise materials provided.

The systematic review revealed positive outcomes on the impact of remote exercise and physiotherapy programs on depressive symptoms in individuals with MS. Amongst the 6 studies, 4 of them employed individualized interventions, incorporating communication via telephone/remote counseling sessions, and electronic systems were utilized for supervision and program modification.

The meta-analysis concluded that remote exercise and physiotherapy programs are notably more effective than control group interventions in alleviating depression in individuals with MS, as indicated by the random effects model (Hedges’ g = −0.41; SE, 0.17; 95% CI, −0.74 to −0.09; P =.01).

The subgroup meta-analysis categorized studies with alternative interventions as controls (4 studies) and those with no control intervention (2 studies). It revealed a significant reduction in depression with remote exercise or physiotherapy, particularly in the no control intervention subgroup (Hedges’ g = −0.81; SE, 0.2; 95% CI, −1.18 to −0.43; P <.001), while no statistically significant differences were found in the control intervention subgroup (Hedges’ g = −0.25; SE, 0.16; 95% CI, −0.56 to 0.06; P =.12).

The findings of this study may be limited by inadequate reporting on individualized participant program interventions and some studies did not monitor participants’ adherence to their allocated treatment.

“[F]uture research of more forms of remote intervention is necessary to find the appropriate forms of exercise and physiotherapy to improve primarily the daily routine and life of these patients,” the researchers concluded.