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Published in: BMC Neurology 1/2019

Open Access 01-12-2019 | Multiple Sclerosis | Study protocol

The evaluation of an online mindfulness program for people with multiple sclerosis: study protocol

Authors: Amy-Lee Sesel, Louise Sharpe, Heidi N. Beadnall, Michael H. Barnett, Marianna Szabo, Sharon L. Naismith

Published in: BMC Neurology | Issue 1/2019

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Abstract

Background

Multiple sclerosis (MS) is a neurological disease of the central nervous system and is associated with many psychosocial symptoms that are difficult to manage including low mood, anxiety, fatigue and pain, as well as low health-related quality of life. Internet-based psychosocial interventions that use mindfulness-based approaches are gathering much attention in recent literature, particularly in the treatment of chronic illnesses. However, no large randomized controlled trials have been done examining the efficacy of such interventions for people with MS (PwMS).

Methods/design

This study is a randomised controlled trial of an online mindfulness-based intervention (MBI) for PwMS. Participants will be randomised to receive either the MBI or offered the intervention after a waiting period. All participants will be assessed to determine whether they have a history of recurrent depressive disorder. The primary outcome will be severity of depression, according to the Centre of Epidemiology Depression Scale. Secondary outcomes will be anxiety severity, fatigue, pain and quality of life. Assessments will be conducted pre, post-treatment, at three and six-month follow-up. The online mindfulness-based program was developed in collaboration with end-users (n = 19 PwMS) who gave feedback about what would be feasible and acceptable, and the draft program was reviewed by both experts and patients.

Discussion

Multiple sclerosis is the most common acquired chronic neurological disease amongst young adults and is associated with a range of symptoms that can be difficult to cope with. In face-to-face interventions, a MBI demonstrated the largest effect in a recent meta-analysis of psychological treatments for PwMS, but MBIs for PwMS have not been delivered online. Hence, this trial will confirm whether MBIs can be efficacious when delivered online. A range of symptoms are assessed as outcomes so that the nature of benefits associated with the online MBI can be ascertained.

Trial registration

Date of Registration: 25/07/2018.
Appendix
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Literature
1.
go back to reference Christogianni A, Bibb R, Davis SL, Jay O, Barnett M, Evangelou N, et al. Temperature sensitivity in multiple sclerosis: an overview of its impact on sensory and cognitive symptoms. Temperature. 2018;5(3):208–23.CrossRef Christogianni A, Bibb R, Davis SL, Jay O, Barnett M, Evangelou N, et al. Temperature sensitivity in multiple sclerosis: an overview of its impact on sensory and cognitive symptoms. Temperature. 2018;5(3):208–23.CrossRef
2.
go back to reference Thompson AJ, Reingold SC, Cohen JA. Applying the 2017 McDonald diagnostic criteria for multiple sclerosis–Authors' reply. The Lancet Neurology. 2018;17(6):499–500.PubMedCrossRef Thompson AJ, Reingold SC, Cohen JA. Applying the 2017 McDonald diagnostic criteria for multiple sclerosis–Authors' reply. The Lancet Neurology. 2018;17(6):499–500.PubMedCrossRef
3.
go back to reference Fiest KM, Walker JR, Bernstein CN, Graff LA, Zarychanski R, Abou-Setta AM, et al. Systematic review and meta-analysis of interventions for depression and anxiety in persons with multiple sclerosis. Mult Scler Relat Disord. 2016;5:12–26.PubMedCrossRef Fiest KM, Walker JR, Bernstein CN, Graff LA, Zarychanski R, Abou-Setta AM, et al. Systematic review and meta-analysis of interventions for depression and anxiety in persons with multiple sclerosis. Mult Scler Relat Disord. 2016;5:12–26.PubMedCrossRef
4.
go back to reference Hind D, Cotter J, Thake A, Bradburn M, Cooper C, Isaac C, et al. Cognitive behavioural therapy for the treatment of depression in people with multiple sclerosis: a systematic review and meta-analysis. BMC Psychiatry. 2014;14(1):1.CrossRef Hind D, Cotter J, Thake A, Bradburn M, Cooper C, Isaac C, et al. Cognitive behavioural therapy for the treatment of depression in people with multiple sclerosis: a systematic review and meta-analysis. BMC Psychiatry. 2014;14(1):1.CrossRef
5.
go back to reference Mohr DC, Goodkin DE. Treatment of depression in multiple sclerosis: review and meta-analysis. Clin Psychol Sci Pract. 1999;6(1):1–9.CrossRef Mohr DC, Goodkin DE. Treatment of depression in multiple sclerosis: review and meta-analysis. Clin Psychol Sci Pract. 1999;6(1):1–9.CrossRef
6.
go back to reference Asano M, Finlayson ML. Meta-analysis of three different types of fatigue management interventions for people with multiple sclerosis: exercise, education, and medication. Mult Scler Int. 2014;2014.CrossRef Asano M, Finlayson ML. Meta-analysis of three different types of fatigue management interventions for people with multiple sclerosis: exercise, education, and medication. Mult Scler Int. 2014;2014.CrossRef
7.
go back to reference Kuspinar A, Rodriguez AM, Mayo NE. The effects of clinical interventions on health-related quality of life in multiple sclerosis: a meta-analysis. Mult Scler J. 2012;18(12):1686–704.CrossRef Kuspinar A, Rodriguez AM, Mayo NE. The effects of clinical interventions on health-related quality of life in multiple sclerosis: a meta-analysis. Mult Scler J. 2012;18(12):1686–704.CrossRef
8.
go back to reference Button KS, Ioannidis JP, Mokrysz C, Nosek BA, Flint J, Robinson ES, et al. Power failure: why small sample size undermines the reliability of neuroscience. Nat Rev Neurosci. 2013;14(5):365–76.PubMedCrossRef Button KS, Ioannidis JP, Mokrysz C, Nosek BA, Flint J, Robinson ES, et al. Power failure: why small sample size undermines the reliability of neuroscience. Nat Rev Neurosci. 2013;14(5):365–76.PubMedCrossRef
9.
go back to reference Sesel A-L, Sharpe L, Naismith SL. Efficacy of psychosocial interventions for people with multiple sclerosis: a meta-analysis of specific treatment effects. Psychother Psychosom. 2018;87(2):105–11.PubMedCrossRef Sesel A-L, Sharpe L, Naismith SL. Efficacy of psychosocial interventions for people with multiple sclerosis: a meta-analysis of specific treatment effects. Psychother Psychosom. 2018;87(2):105–11.PubMedCrossRef
10.
go back to reference Grossman P, Kappos L, Gensicke H, D'souza M, Mohr D, Penner I, et al. MS quality of life, depression, and fatigue improve after mindfulness training a randomized trial. Neurology. 2010;75(13):1141–9.PubMedPubMedCentralCrossRef Grossman P, Kappos L, Gensicke H, D'souza M, Mohr D, Penner I, et al. MS quality of life, depression, and fatigue improve after mindfulness training a randomized trial. Neurology. 2010;75(13):1141–9.PubMedPubMedCentralCrossRef
11.
go back to reference Kabat-Zinn J. Full catastrophe living, revised edition. New York: Bantam; 2013. Kabat-Zinn J. Full catastrophe living, revised edition. New York: Bantam; 2013.
12.
go back to reference Rosenzweig S, Greeson JM, Reibel DK, Green JS, Jasser SA, Beasley D. Mindfulness-based stress reduction for chronic pain conditions: variation in treatment outcomes and role of home meditation practice. J Psychosom Res. 2010;68(1):29–36.PubMedCrossRef Rosenzweig S, Greeson JM, Reibel DK, Green JS, Jasser SA, Beasley D. Mindfulness-based stress reduction for chronic pain conditions: variation in treatment outcomes and role of home meditation practice. J Psychosom Res. 2010;68(1):29–36.PubMedCrossRef
13.
go back to reference Pradhan EK, Baumgarten M, Langenberg P, Handwerger B, Gilpin AK, Magyari T, et al. Effect of mindfulness-based stress reduction in rheumatoid arthritis patients. Arthritis Care & Research. 2007;57(7):1134–42.CrossRef Pradhan EK, Baumgarten M, Langenberg P, Handwerger B, Gilpin AK, Magyari T, et al. Effect of mindfulness-based stress reduction in rheumatoid arthritis patients. Arthritis Care & Research. 2007;57(7):1134–42.CrossRef
14.
go back to reference Parswani MJ, Sharma MP, Iyengar S. Mindfulness-based stress reduction program in coronary heart disease: a randomized control trial. International journal of yoga. 2013;6(2):111.PubMedPubMedCentralCrossRef Parswani MJ, Sharma MP, Iyengar S. Mindfulness-based stress reduction program in coronary heart disease: a randomized control trial. International journal of yoga. 2013;6(2):111.PubMedPubMedCentralCrossRef
15.
go back to reference Speca M, Carlson LE, Goodey E, Angen M. A randomized, wait-list controlled clinical trial: the effect of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients. Psychosom Med. 2000;62(5):613–22.PubMedCrossRef Speca M, Carlson LE, Goodey E, Angen M. A randomized, wait-list controlled clinical trial: the effect of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients. Psychosom Med. 2000;62(5):613–22.PubMedCrossRef
16.
go back to reference Bakhshani N-M, Amirani A, Amirifard H, Shahrakipoor M. The effectiveness of mindfulness-based stress reduction on perceived pain intensity and quality of life in patients with chronic headache. Global J Health Sci. 2016;8(4):142.CrossRef Bakhshani N-M, Amirani A, Amirifard H, Shahrakipoor M. The effectiveness of mindfulness-based stress reduction on perceived pain intensity and quality of life in patients with chronic headache. Global J Health Sci. 2016;8(4):142.CrossRef
17.
go back to reference Surawy C, Roberts J, Silver A. The effect of mindfulness training on mood and measures of fatigue, activity, and quality of life in patients with chronic fatigue syndrome on a hospital waiting list: a series of exploratory studies. Behav Cogn Psychother. 2005;33(1):103–9.CrossRef Surawy C, Roberts J, Silver A. The effect of mindfulness training on mood and measures of fatigue, activity, and quality of life in patients with chronic fatigue syndrome on a hospital waiting list: a series of exploratory studies. Behav Cogn Psychother. 2005;33(1):103–9.CrossRef
18.
go back to reference Bohlmeijer E, Prenger R, Taal E, Cuijpers P. The effects of mindfulness-based stress reduction therapy on mental health of adults with a chronic medical disease: a meta-analysis. J Psychosom Res. 2010;68(6):539–44.PubMedCrossRef Bohlmeijer E, Prenger R, Taal E, Cuijpers P. The effects of mindfulness-based stress reduction therapy on mental health of adults with a chronic medical disease: a meta-analysis. J Psychosom Res. 2010;68(6):539–44.PubMedCrossRef
19.
go back to reference Ehde DM, Elzea JL, Verrall AM, Gibbons LE, Smith AE, Amtmann D. Efficacy of a telephone-delivered self-management intervention for persons with multiple sclerosis: a randomized controlled trial with a one-year follow-up. Arch Phys Med Rehabil. 2015;96(11):1945–58. e2.PubMedCrossRef Ehde DM, Elzea JL, Verrall AM, Gibbons LE, Smith AE, Amtmann D. Efficacy of a telephone-delivered self-management intervention for persons with multiple sclerosis: a randomized controlled trial with a one-year follow-up. Arch Phys Med Rehabil. 2015;96(11):1945–58. e2.PubMedCrossRef
20.
go back to reference Mohr DC, Hart SL, Julian L, Catledge C, Honos-Webb L, Vella L, et al. Telephone-administered psychotherapy for depression. Arch Gen Psychiatry. 2005;62(9):1007–14.PubMedCrossRef Mohr DC, Hart SL, Julian L, Catledge C, Honos-Webb L, Vella L, et al. Telephone-administered psychotherapy for depression. Arch Gen Psychiatry. 2005;62(9):1007–14.PubMedCrossRef
21.
go back to reference Bombardier CH, Ehde DM, Gibbons LE, Wadhwani R, Sullivan MD, Rosenberg DE, et al. Telephone-based physical activity counseling for major depression in people with multiple sclerosis. J Consult Clin Psychol. 2013;81(1):89–99.PubMedCrossRef Bombardier CH, Ehde DM, Gibbons LE, Wadhwani R, Sullivan MD, Rosenberg DE, et al. Telephone-based physical activity counseling for major depression in people with multiple sclerosis. J Consult Clin Psychol. 2013;81(1):89–99.PubMedCrossRef
22.
go back to reference Finlayson M, Preissner K, Cho C, Plow M. Randomized trial of a teleconference-delivered fatigue management program for people with multiple sclerosis. Mult Scler J. 2011;17(9):1130–40.CrossRef Finlayson M, Preissner K, Cho C, Plow M. Randomized trial of a teleconference-delivered fatigue management program for people with multiple sclerosis. Mult Scler J. 2011;17(9):1130–40.CrossRef
23.
go back to reference McCabe MP, Ebacioni KJ, Simmons R, McDonald E, Melton L. Unmet education, psychological and peer support needs of people with multiple sclerosis. J Psychosom Res. 2015;78(1):82–7.PubMedCrossRef McCabe MP, Ebacioni KJ, Simmons R, McDonald E, Melton L. Unmet education, psychological and peer support needs of people with multiple sclerosis. J Psychosom Res. 2015;78(1):82–7.PubMedCrossRef
24.
go back to reference Andersson G, Cuijpers P, Carlbring P, Riper H, Hedman E. Guided internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: a systematic review and meta-analysis. World Psychiatry. 2014;13(3):288–95.PubMedPubMedCentralCrossRef Andersson G, Cuijpers P, Carlbring P, Riper H, Hedman E. Guided internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: a systematic review and meta-analysis. World Psychiatry. 2014;13(3):288–95.PubMedPubMedCentralCrossRef
25.
go back to reference Cooper CL, Hind D, Parry GD, Isaac CL, Dimairo M, O'Cathain A, et al. Computerised cognitive behavioural therapy for the treatment of depression in people with multiple sclerosis: external pilot trial. Trials. 2011;12:259.PubMedPubMedCentralCrossRef Cooper CL, Hind D, Parry GD, Isaac CL, Dimairo M, O'Cathain A, et al. Computerised cognitive behavioural therapy for the treatment of depression in people with multiple sclerosis: external pilot trial. Trials. 2011;12:259.PubMedPubMedCentralCrossRef
26.
go back to reference Moss-Morris R, McCrone P, Yardley L, van Kessel K, Wills G, Dennison L. A pilot randomised controlled trial of an internet-based cognitive behavioural therapy self-management programme (MS Invigor8) for multiple sclerosis fatigue. Behav Res Ther. 2012;50(6):415–21.PubMedCrossRef Moss-Morris R, McCrone P, Yardley L, van Kessel K, Wills G, Dennison L. A pilot randomised controlled trial of an internet-based cognitive behavioural therapy self-management programme (MS Invigor8) for multiple sclerosis fatigue. Behav Res Ther. 2012;50(6):415–21.PubMedCrossRef
27.
go back to reference Fischer A, Schröder J, Vettorazzi E, Wolf OT, Pöttgen J, Lau S, et al. An online programme to reduce depression in patients with multiple sclerosis: a randomised controlled trial. Lancet Psychiatry. 2015;2(3):217–23.PubMedCrossRef Fischer A, Schröder J, Vettorazzi E, Wolf OT, Pöttgen J, Lau S, et al. An online programme to reduce depression in patients with multiple sclerosis: a randomised controlled trial. Lancet Psychiatry. 2015;2(3):217–23.PubMedCrossRef
28.
go back to reference Chiaravalloti ND, DeLuca J. Cognitive impairment in multiple sclerosis. The Lancet Neurology. 2008;7(12):1139–51.PubMedCrossRef Chiaravalloti ND, DeLuca J. Cognitive impairment in multiple sclerosis. The Lancet Neurology. 2008;7(12):1139–51.PubMedCrossRef
29.
go back to reference Piet J, Hougaard E. The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: a systematic review and meta-analysis. Clin Psychol Rev. 2011;31(6):1032–40.PubMedCrossRef Piet J, Hougaard E. The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: a systematic review and meta-analysis. Clin Psychol Rev. 2011;31(6):1032–40.PubMedCrossRef
30.
go back to reference Chwastiak L, Ehde DM, Gibbons LE, Sullivan M, Bowen JD, Kraft GH. Depressive symptoms and severity of illness in multiple sclerosis: epidemiologic study of a large community sample. Am J Psychiatry. 2002;159(11):1862–8.PubMedCrossRef Chwastiak L, Ehde DM, Gibbons LE, Sullivan M, Bowen JD, Kraft GH. Depressive symptoms and severity of illness in multiple sclerosis: epidemiologic study of a large community sample. Am J Psychiatry. 2002;159(11):1862–8.PubMedCrossRef
31.
go back to reference Zautra AJ, Davis MC, Reich JW, Nicassario P, Tennen H, Finan P, et al. Comparison of cognitive behavioral and mindfulness meditation interventions on adaptation to rheumatoid arthritis for patients with and without history of recurrent depression. J Consult Clin Psychol. 2008;76(3):408.PubMedCrossRef Zautra AJ, Davis MC, Reich JW, Nicassario P, Tennen H, Finan P, et al. Comparison of cognitive behavioral and mindfulness meditation interventions on adaptation to rheumatoid arthritis for patients with and without history of recurrent depression. J Consult Clin Psychol. 2008;76(3):408.PubMedCrossRef
32.
go back to reference Matcham F, Rayner L, Steer S, Hotopf M. The prevalence of depression in rheumatoid arthritis: a systematic review and meta-analysis. Rheumatology. 2013;52(12):2136–48.PubMedCrossRefPubMedCentral Matcham F, Rayner L, Steer S, Hotopf M. The prevalence of depression in rheumatoid arthritis: a systematic review and meta-analysis. Rheumatology. 2013;52(12):2136–48.PubMedCrossRefPubMedCentral
33.
34.
go back to reference Brandt J, Spencer M, Folstein M. The telephone interview for cognitive status. Neuropsychiatry Neuropsychol Behav Neurol. 1988;1(2):111–7. Brandt J, Spencer M, Folstein M. The telephone interview for cognitive status. Neuropsychiatry Neuropsychol Behav Neurol. 1988;1(2):111–7.
35.
go back to reference Spitzer RL, deGruy Ill M, Hahn SR, Brody M, Johnson JG. Utility of a new procedure for diagnosing mental disorders in primary care: the PRIME-MD 1000 study. Jama. 1994;272:1749–56.PubMedCrossRef Spitzer RL, deGruy Ill M, Hahn SR, Brody M, Johnson JG. Utility of a new procedure for diagnosing mental disorders in primary care: the PRIME-MD 1000 study. Jama. 1994;272:1749–56.PubMedCrossRef
36.
go back to reference Sjonnesen K, Berzins S, Fiest KM, Bulloch AG, Metz LM, Thombs BD, et al. Evaluation of the 9–item patient health questionnaire (PHQ–9) as an assessment instrument for symptoms of depression in patients with multiple sclerosis. Postgrad Med. 2012;124(5):69–77.PubMedCrossRef Sjonnesen K, Berzins S, Fiest KM, Bulloch AG, Metz LM, Thombs BD, et al. Evaluation of the 9–item patient health questionnaire (PHQ–9) as an assessment instrument for symptoms of depression in patients with multiple sclerosis. Postgrad Med. 2012;124(5):69–77.PubMedCrossRef
37.
go back to reference Radloff LS. The CES-D scale a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401.CrossRef Radloff LS. The CES-D scale a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401.CrossRef
38.
go back to reference Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–7.PubMedCrossRef Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–7.PubMedCrossRef
39.
go back to reference Cleeland C. Measurement of pain by subjective report. Advances in pain research and therapy. 1989;12:391–403. Cleeland C. Measurement of pain by subjective report. Advances in pain research and therapy. 1989;12:391–403.
40.
go back to reference Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD. The fatigue severity scale: application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol. 1989;46(10):1121–3.PubMedCrossRef Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD. The fatigue severity scale: application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol. 1989;46(10):1121–3.PubMedCrossRef
41.
go back to reference Hobart J, Lamping D, Fitzpatrick R, Riazi A, Thompson A. The multiple sclerosis impact scale (MSIS-29). Brain. 2001;124(5):962–73.PubMedCrossRef Hobart J, Lamping D, Fitzpatrick R, Riazi A, Thompson A. The multiple sclerosis impact scale (MSIS-29). Brain. 2001;124(5):962–73.PubMedCrossRef
42.
go back to reference Devilly GJ, Borkovec TD. Psychometric properties of the credibility/expectancy questionnaire. J Behav Ther Exp Psychiatry. 2000;31(2):73–86.PubMedCrossRef Devilly GJ, Borkovec TD. Psychometric properties of the credibility/expectancy questionnaire. J Behav Ther Exp Psychiatry. 2000;31(2):73–86.PubMedCrossRef
43.
go back to reference Hohol M, Orav E, Weiner H. Disease steps in multiple sclerosis a simple approach to evaluate disease progression. Neurology. 1995;45(2):251–5.PubMedCrossRef Hohol M, Orav E, Weiner H. Disease steps in multiple sclerosis a simple approach to evaluate disease progression. Neurology. 1995;45(2):251–5.PubMedCrossRef
44.
go back to reference Carp I. IBM SPSS statistics for windows, version 22.0. Armonk, NY: IBM Corp; 2013. Carp I. IBM SPSS statistics for windows, version 22.0. Armonk, NY: IBM Corp; 2013.
45.
go back to reference Cerqueira JJ, Compston DAS, Geraldes R, Rosa MM, Schmierer K, Thompson A, et al. Time matters in multiple sclerosis: can early treatment and long-term follow-up ensure everyone benefits from the latest advances in multiple sclerosis? J Neurol Neurosurg Psychiatry. 2018:jnnp–2017-317509. Cerqueira JJ, Compston DAS, Geraldes R, Rosa MM, Schmierer K, Thompson A, et al. Time matters in multiple sclerosis: can early treatment and long-term follow-up ensure everyone benefits from the latest advances in multiple sclerosis? J Neurol Neurosurg Psychiatry. 2018:jnnp–2017-317509.
46.
go back to reference Landfeldt E, Castelo-Branco A, Svedbom A, Löfroth E, Kavaliunas A, Hillert J. The long-term impact of early treatment of multiple sclerosis on the risk of disability pension. J Neurol. 2018;265(3):701–7.PubMedPubMedCentralCrossRef Landfeldt E, Castelo-Branco A, Svedbom A, Löfroth E, Kavaliunas A, Hillert J. The long-term impact of early treatment of multiple sclerosis on the risk of disability pension. J Neurol. 2018;265(3):701–7.PubMedPubMedCentralCrossRef
47.
go back to reference Palmer A. Economic impact of multiple sclerosis in 2010: Australian MS longitudinal study; 2011. Palmer A. Economic impact of multiple sclerosis in 2010: Australian MS longitudinal study; 2011.
48.
go back to reference Boland P, Levack WM, Hudson S, Bell E. A qualitative exploration of barriers and facilitators to coping experienced by couples when one has multiple sclerosis. Int J Ther Rehabil. 2018;25(5):240–6.CrossRef Boland P, Levack WM, Hudson S, Bell E. A qualitative exploration of barriers and facilitators to coping experienced by couples when one has multiple sclerosis. Int J Ther Rehabil. 2018;25(5):240–6.CrossRef
Metadata
Title
The evaluation of an online mindfulness program for people with multiple sclerosis: study protocol
Authors
Amy-Lee Sesel
Louise Sharpe
Heidi N. Beadnall
Michael H. Barnett
Marianna Szabo
Sharon L. Naismith
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2019
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/s12883-019-1356-9

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