Jillian Scandiffio, Laura Kathleen Langer, Vjura Senthilnathan, Gregory Feng, Ashvene Sureshkumar, Michelle Bromberg, Jessica Babineau, Sarah J Donkers, Katherine B Knox, Tania Bruno, Lisa A S Walker, Mark Theodore Bayley, Robert Simpson
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引用次数: 0
摘要
背景：多发性硬化症（PwMS）患者经常经历高水平的情绪困扰。需要干预措施来改善PwMS患者的情绪健康；然而，不同的心理治疗方法对PwMS累积结果的有效性尚不清楚。本研究旨在通过系统回顾和网络荟萃分析（NMA）来评估心理治疗在创伤性多发性硬化症中的效果。方法：检索1984年至2025年4月的5个数据库（CINAHL、Cochrane Central Register of Controlled Trials、EMBASE、MEDLINE ALL、APA PsycINFO）。纳入了将心理干预与任何PwMS比较物进行比较的随机对照试验。两名独立审稿人进行数据提取和偏倚风险分析。拟合标准随机效应贝叶斯一致性NMA。结果领域包括心理健康、认知、身体健康、生活质量（QoL）和健康经济学。结果：筛选后，111项研究纳入综述，89项纳入荟萃分析，77项纳入NMA （n = 3911名参与者）。总体而言，认知行为疗法在改善预后方面最为有效，与对照组相比，平均差异变化最大（MD为11.0,95% CI为5.72-16.2）。结论：本系统综述和NMA发现，心理干预在PwMS的心理健康、认知、身体和生活质量结果领域广泛有效，并为其在PwMS护理中的应用提供了强有力的支持。
Effects of psychological therapies in people with multiple sclerosis: a systematic review and network meta-analysis of randomized controlled trials.
Background: People with MS (PwMS) often experience high levels of emotional distress. Interventions to improve emotional wellbeing in PwMS are needed; however, the effectiveness of diverse psychological therapies in PwMS on cumulative outcomes is not well understood. This systematic review and network meta-analysis (NMA) aims to evaluate the effectiveness of psychological therapies in PwMS.
Methods: Five databases were searched (CINAHL, Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE ALL, APA PsycINFO) from 1984 to April 2025. Randomized controlled trials that compared a psychological intervention with any comparator in PwMS were included. Two independent reviewers performed data extraction and risk of bias analysis. A standard random-effects Bayesian consistency NMA was fitted. Outcome domains included mental health, cognition, physical health, quality of life (QoL), and health economics.
Results: After screening, 111 studies were included in the review, 89 included in the meta-analysis, and 77 included in the NMA (n = 3911 participants). Cognitive behavioural therapy was found to be most effective in improving outcomes overall, with the greatest changes in mean difference (MD 11.0, 95% CI 5.72-16.2) when compared with control conditions. Psychological therapies significantly improved mental health outcomes (SMD 1.41; 95% CI 1.00-1.83; p < 0.00001), physical health outcomes (SMD 1.08; 95% CI 0.41-1.74; p < 0.00001), QoL (SMD 0.77; 95% CI 0.21-1.34), and cognition (SMD 0.66, 95% CI 0.24-1.07) in PwMS.
Conclusions: This systematic review and NMA found that psychological interventions are broadly effective in PwMS across mental health, cognitive, physical and QoL outcome domains, and provides strong support for their use in the care of PwMS.
期刊介绍：
The Journal of Neurology is an international peer-reviewed journal which provides a source for publishing original communications and reviews on clinical neurology covering the whole field.
In addition, Letters to the Editors serve as a forum for clinical cases and the exchange of ideas which highlight important new findings. A section on Neurological progress serves to summarise the major findings in certain fields of neurology. Commentaries on new developments in clinical neuroscience, which may be commissioned or submitted, are published as editorials.
Every neurologist interested in the current diagnosis and treatment of neurological disorders needs access to the information contained in this valuable journal.
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