Motivational interviewing to promote health outcomes and behaviour change in multiple sclerosis: a systematic review

Abstract

Objective: To examine the evidence for motivational interviewing when used to assist individuals with multiple sclerosis manage their healthcare. Data sources: The Cochrane, Embase, PsycINFO and PubMed databases were searched for studies published between 1983 and December 2019. The reference lists of included studies were additionally examined and Scopus citation searches conducted. Review methods: Study screening and data extraction were independently completed by two reviewers. Randomised controlled trials comparing motivational interviewing interventions for multiple sclerosis to usual care, wait-list or other active intervention controls were examined. Studies were assessed using the Cochrane Risk of Bias tool. Standardised mean differences (Hedges’ g), 95% confidence intervals and P values were calculated for all health and behavioural outcomes. Results: Ten randomised controlled trials, involving a pooled sample of 987 adults with relapsing–remitting or progressive multiple sclerosis and mild to moderate impairment, were identified. Most trials had a low or unclear risk of methodological bias. Motivational interviewing, when used in conjunction with other counselling or rehabilitation techniques, resulted in significant immediate medium-to-very large improvements in multiple physical, psychological, social and behavioural outcomes (range: g = .34–2.68). Maintenance effects were promising (range: g = .41–1.11), although less frequently assessed ( Nstudies = 5) and of limited duration (1–7 months). Individual and group-based interventions, delivered in-person or by telephone, were all effective. Conclusions: Motivational interviewing is a flexible counselling technique that may improve rehabilitation care for multiple sclerosis. However, evidence for persisting benefits to health outcomes and behaviour is currently limited.