by Ashvene Sureshkumar, Robert Simpson, Mark Bayley, Monika Kastner, Jillian Scandiffio, Emilia Main, Claire Zhang, Harzaan Gnanakaran, Joshua Wijeratne, Alesha Saxena, Sarah Munce
ObjectiveThis paper aims to standardize a scoping review protocol for completion of a scoping review. The proposed scoping review aims to: 1) determine the extent of the literature on which implementation strategies have been used to develop, deliver, and sustain psychological interventions for people with multiple sclerosis (PwMS) and 2) investigate how equity, diversity, inclusion and accessibility considerations are embedded within these implementation strategies and psychological interventions more broadly.
IntroductionPeople with multiple sclerosis experience high levels of stress, anxiety and depression. Psychological interventions, such as mindfulness-based interventions have been shown to be effective in managing these symptoms, yet their implementation in clinical practice is underexplored. Investigating the implementation of psychological interventions can help contextualize the efficacy and impact of these programs for PwMS. This proposed review aims to fill this knowledge gap by determining which implementation strategies have been used to develop and deliver psychological interventions for PwMS.
MethodsThis scoping review will follow the Joanna Briggs Institute (JBI) methodology and reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review (PRISMA-ScR). The search will be conducted across MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsychInfo (Scopus). Two reviewers will independently conduct screening and data extraction in duplicate, with any disagreements resolved through discussion and involvement of a third reviewer. Data extraction will be guided by the JBI template. Quantitative data will be reported descriptively, and a conventional content analysis will be undertaken for qualitative data.
Inclusion criteriaThis scoping review will include studies globally published in peer-reviewed academic journals in English involving PwMS that report on implementation strategies for live, professional-led psychological interventions. Pharmacological studies or studies focusing only on effectiveness of psychological interventions will be excluded.
While group, task-oriented, community-based exercise programs (CBEPs) delivered in-person can increase exercise and social participation in people with mobility limitations, challenges with transportation, cost and human resources, threaten sustainability. A virtual delivery model may help overcome challenges with accessing and delivering in-person CBEPs. The study objective is to estimate the short-term effect of an 8-week, virtual, group, task-oriented CBEP called TIME™ (Together in Movement and Exercise) at Home compared with a waitlist control on improving everyday function in community-dwelling adults with mobility limitations.
A randomised controlled trial incorporating a type 1 effectiveness-implementation hybrid design is being conducted in four Canadian metropolitan centres. We aim to stratify 200 adults with self-reported mobility limitations by site, participation alone or with a partner, and functional mobility level, and randomise them using REDCap software to either TIME™ at Home or a waitlist control group. During TIME™ at Home classes (2 classes/week, 1.5 hours/class), two trained facilitators stream a 1-hour exercise video and facilitate social interaction prevideo and postvideo using Zoom. A registered healthcare professional at each site completes three e-visits to monitor and support implementation. Masked evaluators with physical therapy training evaluate participants and their caregivers at 0, 2 and 5 months using Zoom. The primary outcome is the change in everyday function from 0 to 2 months, measured using the physical scale of the Subjective Index of Physical and Social Outcome. The study is powered to detect an effect size of 0.4, given α=0.05, power=80% and a 15% attrition rate. Secondary outcomes are mobility, well-being, reliance on walking aids, caregiver assistance, caregiver mood, caregiver confidence in care-recipient balance and cost-effectiveness. A multimethod process evaluation is proposed to increase understanding of implementation fidelity, mechanisms of effect and contextual factors influencing the complex intervention. Qualitative data collection immediately postintervention involves interviewing approximately 16 participants and 4 caregivers from the experimental group, and 8 participants and 4 caregivers from the waitlist control group, and all healthcare professionals, and conducting focus groups with all facilitators to explore experiences during the intervention period. A directed content analysis will be undertaken to help explain the quantitative results.
TIME™ at Home has received ethics approval at all sites. Participants provide verbal informed consent. A data safety monitoring board is monitoring adverse events. We will disseminate findings through lay summaries, conference presentations, reports and journal articles.
With growing access to the internet, online mindfulness programmes have become more commonly used to manage physical and mental health conditions. This scoping review aims to determine the nature and extent of the literature, and key characteristics, of online mindfulness-based interventions (MBIs) for adults with physical or mental health conditions.
A scoping review guided by the Joanna Briggs Institute framework.
MEDLINE, CINAHL, Embase, PsycINFO, Allied and Complementary Medicine and the Cochrane Central Register of Controlled Trials.
Studies focusing on online MBIs, online mindfulness-based stress reduction and online mindfulness-based cognitive therapy (MBCT) in adults with a physical or mental health condition were included.
Study and participant characteristics, key intervention characteristics, outcome measures and results were abstracted.
84 studies were included. Online MBIs have been studied in many different physical and mental health conditions; however, 63 of the included studies were for physical health conditions. MBCT was the most common intervention type assessed, with 33 of the included studies assessing it. Regarding intervention characteristics, intervention duration was similar across intervention type at 8 weeks, with sessions led by therapists, clinicians or mindfulness instructors. Web-based and videoconferencing were the most common delivery formats. Intervention content generally remained similar to standardised MBIs, with the addition of psychoeducation and disease management. Many studies did not report on tailoring the intervention to the participant population. There was a lack of consistency in reporting intervention characteristics.
This review highlights some evidence for online mindfulness programmes for both physical and mental health conditions. However, intervention componentry remains somewhat obscure, and reporting on tailoring appears relatively sparse. Greater consistency in reporting intervention componentry will improve knowledge and study in this area and enhance the translation of these interventions to clinical settings.