1. February 27, 2019
A Cognitive self-management intervention for persons with multiple sclerosis
Janet Morrison, PhD, RN, MSCN
Research Associate V
Research reported here was supported by the National Institute of Nursing Research of the National Institutes of Health under Award Number P30NR The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

2. Background Chronic immune-mediated degenerative disease of the CNS
Prevalence ~ 900,000 in US
3:1 Female to male ratio
Variable and unpredictable symptoms
Fatigue
Depression
Sleep disturbance
Mobility
Impaired cognitive function
Significant impact on maintaining employment, self-management, QoL

3. Study Design Pilot RCT Intervention (n=8) Enhanced usual care (n=8)
8 weekly 90-minute virtual group sessions
Self-Management
Chronic Disease and Cognitive Function
Remote, web-based video conferencing
Enhanced usual care (n=8)
Introduction – tell their stories
Physical Activity
Fatigue, Sleep and Nutrition
Stress Management & Depression
Attention & Processing Speed
Learning & Memory
Executive Function & Visiospatial Skills
Putting it All Together

4. Sample (N=16) Age (years) 56 + 9.9 Female 15 (94%) White 14 (88%)
Non-Hispanic
Married
12 (75%)
Highly educated (> Bachelors degree)
11 (69%)
Relapsing-Remitting course
12 (75%)

5. Outcomes Self-Report Performance MS self-management Self-efficacy
Managing medications, symptoms and daily activities
Cognitive function
Depression
Fatigue
Sleep disturbance
Performance
Neuropsych
Language
Executive function
Attention
Working and episodic memory
Processing speed
Physiologic
Physical activity
Sleep
Self-Report – PROMIS and Neuro-QoL
Neuropsych Performance – NIH Toolbox
Physiologic Performance – Actigraphy

6. Web-based video conferencing Attendance (mean = 7 + .92)
Proof of Concept
Web-based video conferencing
Attendance (mean = )
Positive participant feedback
Couldn’t have participated: BARRIERS
Mobility, fatigue, transportation, traffic

7. Strengths & Limitations
Small sample size (N=16)
Variability
Lack of power
Intensity of intervention
Versus dissertation study
6 months, 2 times/week, supervised exercise

8. Next Steps
Comparative effectiveness trial
More sensitive outcome measures
Repeated measures design

9. THANK YOU