Akbarfahimi Malahat, Nabavi Seyed Massood, Kor Benyamin, Rezaie Leeba, Paschall Ethan
Department of Occupational Therapy, School of Rehabilitation Sciences, Neuroscience Research Center, Iran University of Medical Sciences, Tehran, Iran.
Regenerative Biomedicine Department, Cell Research Center, Royan Institute for Stem Cell Biology and Technology, ACCR, Tehran, Iran.
Neuropsychiatr Dis Treat. 2020 May 29;16:1369-1379. doi: 10.2147/NDT.S249277. eCollection 2020.
Sleep difficulties are common in patients with multiple sclerosis (MS), which may increase feelings of fatigue, negatively interfere with daily activities, and consequently reduce their quality of life. Studies examining the effects of sleep-targeted interventions in MS are currently limited in the literature. Therefore, we aim to assess the effects of occupational therapy interventions on sleep quality, fatigue, and quality of life in patients with MS.
In a single-blind, randomized, controlled trial, which occurred between April 2018 and March 2019 in Tehran, Iran, 20 eligible patients with MS were assessed using the Pittsburgh Sleep Quality Index (PSQI), Fatigue Impact Scale (FIS), Fatigue Severity Scale (FSS), and Short-Form Health Survey (SF-36). Patients were allocated randomly into the two following groups: patients receiving care-as-usual for MS (CAU) and patients receiving care-as-usual plus intervention (CAU + intervention). Both intervention groups underwent 2-3 sessions per week lasting 30-45 minutes for 8 weeks and received follow-up assessments. Data were analyzed using independent sample t-tests and Mann-Whitney U tests using SPSS (16 ver.) statistical software.
In the intervention group, sleep quality improved significantly across all items (<0.001, effect size = 0.60) except for sleep efficiency and the use of sleep medications. FSS and FIS in the sleep intervention group were significantly reduced (<0.001, effect size = 0.76 and <0.001, effect size = 0.82, respectively). The quality of life in the intervention group improved significantly (<0.004, effect size = 0.51-0.76) with the exception of the social functioning subgroup.
Although this is the result of a pilot study and more patients should be added, this intervention program demonstrates improvement in sleep quality and quality of life while decreasing fatigue in patients with MS. Adjunction of this program, if results are similar with more patients, to routine occupational therapy (OT) interventions can help improve the rehabilitation program of MS patients.
睡眠困难在多发性硬化症（MS）患者中很常见，这可能会增加疲劳感，对日常活动产生负面影响，进而降低他们的生活质量。目前，文献中关于针对MS患者进行睡眠干预效果的研究有限。因此，我们旨在评估职业治疗干预对MS患者睡眠质量、疲劳及生活质量的影响。
在2018年4月至2019年3月于伊朗德黑兰进行的一项单盲、随机对照试验中，20名符合条件的MS患者使用匹兹堡睡眠质量指数（PSQI）、疲劳影响量表（FIS）、疲劳严重程度量表（FSS）和简短健康调查问卷（SF - 36）进行评估。患者被随机分为以下两组：接受MS常规护理的患者（CAU）和接受常规护理加干预的患者（CAU + 干预）。两个干预组每周进行2 - 3次，每次持续30 - 45分钟，共8周，并接受随访评估。使用SPSS（16版）统计软件通过独立样本t检验和曼 - 惠特尼U检验对数据进行分析。
在干预组中，除睡眠效率和助眠药物使用外，所有项目的睡眠质量均显著改善（<0.001，效应量 = 0.60）。睡眠干预组的FSS和FIS显著降低（分别为<0.001，效应量 = 0.76和<0.001，效应量 = 0.82）。干预组的生活质量显著改善（<0.004，效应量 = 0.51 - 0.76），社会功能亚组除外。
尽管这是一项初步研究的结果，且应纳入更多患者，但该干预方案显示出MS患者的睡眠质量和生活质量得到改善，同时疲劳感减轻。如果在更多患者中得到相似结果，将该方案附加到常规职业治疗（OT）干预中，有助于改善MS患者的康复方案。
