Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, 490 Blue Hills Avenue, Hartford, CT, 06112, USA; Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University, 370 Bassett Road, North Haven, CT 06473, USA; Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, 370 Bassett Road, North Haven, CT 06473, USA; Department of Neurology, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030, USA.
Department of Rehabilitation Medicine, University of Washington, 325 Ninth Avenue, Seattle, WA, 98104, USA; Multiple Sclerosis Center of Excellence West, Veterans Affairs, 1660 South Columbian Way, Seattle, WA, 98108, USA; Rehabilitation Care Service, VA Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA, 98108, USA.
Mult Scler Relat Disord. 2024 Aug;88:105718. doi: 10.1016/j.msard.2024.105718. Epub 2024 Jun 10.
Persons with multiple sclerosis (PwMS) can experience deficits in prospective memory (PM) or "remembering to remember," which are associated with functional difficulties. However, no cognitive rehabilitation intervention has specifically addressed improving PM in PwMS. The Telehealth PM Intervention (TPMI) provides a novel combination of two strategies-visual imagery and implementation intentions-that have each been beneficial in other populations. This study aimed to evaluate the feasibility of TPMI and its preliminary efficacy, which could be used to inform future trials.
Participants (n = 35) were PwMS who were pre-screened and endorsed experiencing problems "remembering places they have to be" and "things they have to do." After completing a baseline evaluation, which included objective (Memory for Intentions Test; MIST) and subjective (Perceived Deficits Questionnaire; PDQ-PM) measures of PM, participants were randomized to either the active treatment (TPMI; n = 17) or active control group (Control; n = 18). TPMI was offered through remote one-on-one sessions twice a week over a four-week period. Participants were asked about treatment credibility and expectancy during the first session. The MIST and PDQ-PM were repeated at post-treatment, where treatment satisfaction was also captured. Mann-Whitney U and chi-square tests were used to examine the feasibility measures, while repeated measures ANOVAs were used to examine changes in the PM outcomes.
A total of 88.2 % of the TPMI group completed all eight sessions, with moderate-to-high (≥7 out of 10) treatment credibility/expectancy and satisfaction reported by 93.3 % and 86.7 %, respectively. While there were no significant effects on overall PM, the TPMI group had an improvement in objective time-based PM after adjusting for baseline differences (F(1,29) = 4.61, p = 0.040; d = 0.80). Furthermore, the TPMI group had a significant reduction in the number of time-based loss of content errors compared to the Control group, which remained significant after covariate adjustment (F(1,25) = 4.29, p = 0.049; d = 0.83).
TPMI is a feasible intervention, with high completion rates and moderate-to-high treatment ratings, that can be delivered remotely. Early evidence shows its potential benefit for improving time-based PM, a particular concern for PwMS, which should be further evaluated in a larger clinical trial.
多发性硬化症患者（PwMS）可能会出现前瞻性记忆（PM）或“记住要记住的事情”的缺陷，这与功能障碍有关。然而，目前还没有专门针对改善 PwMS 的 PM 的认知康复干预措施。远程 PM 干预（TPMI）提供了两种策略的新颖组合-视觉意象和实施意图-这两种策略在其他人群中都有益。本研究旨在评估 TPMI 的可行性及其初步疗效，这可以为未来的试验提供信息。
参与者（n = 35）是经过预筛选并表示存在“记住要去的地方”和“要做的事情”问题的 PwMS。在完成基线评估后，包括客观（意向记忆测试；MIST）和主观（感知缺陷问卷；PDQ-PM）PM 测量，参与者被随机分配到主动治疗组（TPMI；n = 17）或主动对照组（Control；n = 18）。TPMI 在四周内每周通过远程一对一会议提供两次。在第一次会议期间，参与者被问到关于治疗可信度和期望的问题。在治疗后，再次重复 MIST 和 PDQ-PM，并同时捕捉治疗满意度。使用曼-惠特尼 U 检验和卡方检验来检验可行性措施，而重复测量方差分析则用于检验 PM 结果的变化。
TPMI 组共有 88.2%的参与者完成了所有八次治疗，报告的治疗可信度/期望和满意度分别为中高度（≥7 分），分别为 93.3%和 86.7%。尽管整体 PM 没有显著效果，但 TPMI 组在调整基线差异后客观时间基础 PM 有所改善（F（1，29）= 4.61，p = 0.040；d = 0.80）。此外，与对照组相比，TPMI 组的基于时间的内容丢失错误数量显著减少，即使在协变量调整后仍保持显著（F（1，25）= 4.29，p = 0.049；d = 0.83）。
TPMI 是一种可行的干预措施，具有较高的完成率和中高度的治疗评分，可以远程提供。早期证据表明，它对改善时间基础 PM 有潜在益处，这是 PwMS 的一个特别关注点，应在更大的临床试验中进一步评估。
