***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : Health-related quality of life ( HRQOL ) is often much reduced among individuals with multiple sclerosis ( MS ) , and incidences of depression , fatigue , and anxiety are high . We examined effects of a mindfulness-based intervention ( MBI ) compared to usual care ( UC ) upon HRQOL , depression , and fatigue among adults with relapsing-remitting or secondary progressive MS . Methods : A total of 150 patients were r and omly assigned to the intervention ( n = 76 ) or to UC ( n = 74 ) . MBI consisted of a structured 8-week program of mindfulness training . Assessment s were made at baseline , postintervention , and 6 months follow-up . Primary outcomes included disease-specific and disease-aspecific HRQOL , depression , and fatigue . Anxiety , personal goal attainment , and adherence to homework were secondary outcomes . Results : Attrition was low in the intervention group ( 5 % ) and attendance rate high ( 92 % ) . Employing intention-to-treat analysis , MBI , compared with UC , improved nonphysical dimensions of primary outcomes at postintervention and follow-up ( p < 0.002 ) ; effect sizes , 0.4–0.9 posttreatment and 0.3–0.5 at follow-up . When analyses were repeated among subgroups with clinical ly relevant levels of preintervention depression , fatigue , or anxiety , postintervention and follow-up effects remained significant and effect sizes were larger than for the total sample . Conclusions : In addition to evidence of improved HRQOL and well-being , these findings demonstrate broad feasibility and acceptance of , as well as satisfaction and adherence with , a program of mindfulness training for patients with MS . The results may also have treatment implication s for other chronic disorders that diminish HRQOL . Classification of evidence : This trial provides Class III evidence that MBI compared with UC improved HRQOL , fatigue , and depression up to 6 months postintervention Objective : A stratified , r and omised , waitlist controlled study over 12 months assessed the effectiveness of rehabilitation in persons with multiple sclerosis ( MS ) in an Australian community cohort . Methods : Patients with definite MS ( n = 101 ) recruited from a tertiary hospital data base , r and omised to a treatment group ( n = 49 ) for individualised rehabilitation programme or a control waitlist group ( n = 52 ) . Functional Independence Measure ( FIM ) was used to assess “ activity ” while the Multiple Sclerosis Impact Scale ( MSIS-29 ) and General Health Question naire ( GHQ-28 ) assessed “ participation ” and quality of life ( QoL ) . Assessment s were at baseline and 12 months . Results : Analysis of data from 98 patients ( treatment n = 48 , control n = 50 ) showed reduced disability in the treatment group , with statistically significant differences in post-treatment FIM motor scores for the two groups ( p<0.001 ) . There was a clinical and statistically significant improvement in FIM ( motor ) total scores ( p<0.001 ) , and the FIM motor domains of : transfer ( p<0.001 ) , locomotion ( p<0.001 ) , self-care ( p<0.001 ) and the FIM cognitive subscale ( p<0.016 ) . In the treated group , 70.8 % improved compared with 13 % of controls . Significantly more patients in the control group deteriorated over the study period ( 58.7 % vs 16.7 % ; p<0.001 ) . There were no differences between the control and treatment group scores on the MSIS-physical ( p = 0.18 ) , MSIS-psychological ( p = 0.45 ) or GHQ subscales . Conclusion : An individualised rehabilitation programme reduces disability in persons with MS compared with no intervention . The impact of rehabilitation on QoL needs further evaluation . More information on the effectiveness of the various components of the multidisciplinary rehabilitation programmes are now needed . Australian clinical trials registry : Trials registration number : ACTRNO12605000676617 Objective : The aim of the study was to assess the ef”cacy of a patient-focused professionally guided self-care programme for the management of multiple sclerosis ( MS ) in the community . Design : This was a single-blind r and omized controlled trial . Setting : The study was conducted with people with MS living in the community . Participants : Two hundred and seventy-eight people with MS were invited to take part in the study . One hundred and eighty-nine people consented to take part ( 68 % ) . Of these 183 began the study and 169 ( 92.3 % ) completed it . Seventy-three individuals were in the intervention group and 96 were in the control group . Intervention : The intervention comprised discussion of self-care based on client priorities , using an information booklet about self-care . Main outcome measures : These included the Barthel Index , a measure of mobility , the SF-36 , and the St and ard Day Dependency Record ( SDDR ) which measures the need for assistance with daily activities . Assessment s were conducted at baseline and again six months later . Results : Changes in health status were small . However , at follow-up the intervention group had better SF-36 health scores , in mental health ( p = 0.04 ) , and vitality ( p = 0.05 ) and considered help with daily activities to be less essential , as measured by the SDDR ( p = 0.04 ) , than the control group . Participants in the intervention group had maintained levels of independence at follow-up ( p = 0.62 ) while the control group showed a signi”cant decrease in independence ( p = 0.001 ) . Conclusion : This intervention could be a useful aid for health professionals who are supporting people with MS living in the community The research ers studied the effectiveness of a nursing intervention in promoting adjustment and symptom management in individuals with multiple sclerosis ( MS ) . This was a 4-year longitudinal study to determine whether the 4-week intensive outpatient program was effective in increasing adjustment to MS and if the treatment effect would last over time . A sample of 27 individuals with MS participated in the study . Treatment participants had significant improvements in symptom management at the 4-year follow up . This improvement was attributable to significant improvements in sleep and fatigue levels . Although adjustment and self-efficacy scores improved in the treatment group over time , this improvement was not superior to the control group . This was anticipated because the behavioral changes would precede improvement in adjustment to life following the diagnosis of MS Objectives : This trial examined the efficacy of a stress management program in reducing neuroimaging markers of multiple sclerosis ( MS ) disease activity . Methods : A total of 121 patients with relapsing forms of MS were r and omized to receive stress management therapy for MS ( SMT-MS ) or a wait-list control condition . SMT-MS provided 16 individual treatment sessions over 24 weeks , followed by a 24-week post-treatment follow-up . The primary outcome was the cumulative number of new gadolinium-enhancing ( Gd+ ) brain lesions on MRI at weeks 8 , 16 , and 24 . Secondary outcomes included new or enlarging T2 MRI lesions , brain volume change , clinical exacerbation , and stress . Results : SMT-MS result ed in a reduction in cumulative Gd+ lesions ( p = 0.04 ) and greater numbers of participants remained free of Gd+ lesions during the treatment ( 76.8 % vs 54.7 % , p = 0.02 ) , compared to participants receiving the control treatment . SMT-MS also result ed in significantly reduced numbers of cumulative new T2 lesions ( p = 0.005 ) and a greater number of participants remaining free of new T2 lesions ( 69.5 % vs 42.7 % , p = 0.006 ) . These effects were no longer detectable during the 24-week post-treatment follow-up period . Conclusions : This trial indicates that SMT-MS may be useful in reducing the development of new MRI brain lesions while patients are in treatment . Classification of evidence : This study provides Class I evidence that SMT-MS , a manualized stress management therapy program , reduced the number of Gd+ lesions in patients with MS during a 24-week treatment period . This benefit was not sustained beyond 24 weeks , and there were no clinical benefits . Trial registration : Clinical Trials.gov , number NCT00147446 Objective : There has long been a belief that depression contributes to fatigue in multiple sclerosis ( MS ) although supporting data are minimal at best . Clinical guidelines for the treatment of fatigue include recommendations for the treatment of depression in the absence of clear empirical support . The goal of this study was to examine the effects of treatment for depression on fatigue in MS . Methods : Sixty patients with a relapsing form of MS and moderate to severe depression were r and omly assigned to one of three vali date d 16‐week treatments for depression : individual cognitive behavioral therapy , group psychotherapy , or sertraline . Assessment s at baseline and treatment cessation included the primary outcome measure , fatigue assessment instrument ( FAI ) , and Beck depression inventory ( BDI ) . Results : The total FAI and the global fatigue severity subscale were significantly reduced over the course of treatment ( p values < .02 ) . Other subscales did not change significantly . Secondary analyses showed change in global fatigue severity was associated with change in BDI ( p = .03 ) but change in total FAI was only marginally related to change in BDI ( p = .05 ) . These relationships were due entirely to change in mood ( p values < .02 ) and not to change in cognitive or vegetative symptoms ( p values > .17 ) . Conclusions : These findings suggest that treatment for depression is associated with reductions in the severity of fatigue symptoms , and that this relationship is due primarily to treatment related changes in mood Negative emotions , such as depression and anxiety , have been associated with the development of coronary heart disease ( CHD ) . In multivariate models , negative emotions have predicted CHD outcomes , such as nonfatal myocardial infa rct ion and CHD mortality . Few studies , however , have investigated this relation while controlling for variables associated with the metabolic syndrome or those indicative of sympathetic nervous system activity . We prospect ively examined the relation between negative emotions and incident CHD in older men ( mean 60.3 + /- 7.9 years ) participating in the Normative Aging Study ( NAS ) . Four hundred ninety-eight men who completed the Minnesota Multiphasic Personality Inventory ( MMPI ) and who participated in a subsequent laboratory assessment were included in the study . All men were not on medication and free of diagnosed CHD and diabetes .  Negative emotions were measured by the  MMPI Welsh A scale  , which is comprised of 39 items measuring symptoms of depression and anxiety . Negative emotion score , sociodemographic characteristics , health behaviors , components of the metabolic syndrome , and stress hormones  were used to predict incident CHD over a 3-year follow-up period . During follow-up , 45 CHD events were observed . In unadjusted logistic regression analyses , negative emotions significantly predicted the incidence of CHD ( odds ratio [ OR ] 1.06 , 95 % confidence interval [ CI ] 1.01 to 1.10 , p = 0.02 ) . After adjusting for potential covariates , negative emotions continued to predict the incidence of CHD ( OR 1.06 , 95 % CI 1.01 to 1.12 , p = 0.02 ) A linear , dose-response relation was observed ( chi-square 10.8 , degree of freedom 2 , p = 0.005 ) : participants who had the highest level of negative emotions experienced the greatest incidence of CHD Objectives : Cognitive problems in multiple sclerosis are common but any possible benefits of treatment remain uncertain . The aim of the study was to evaluate the benefits of providing a psychology service , including cognitive assessment and intervention , to patients with multiple sclerosis . Method : The study was a single blind r and omised controlled trial . A total of 240 patients with clinical ly definite , laboratory supported , or clinical ly probable multiple sclerosis were recruited from an multiple sclerosis management clinic and assessed on a brief screening battery . They were r and omised into three groups . The control group received no further intervention . The assessment group received a  detailed cognitive assessment  , the result of which was fed back to staff involved in the patients ' care . The treatment group received the same detailed cognitive assessment and a treatment programme design ed to help reduce the impact of their cognitive problems . Patients were followed up 4 and 8 months later on the general health question naire ( GHQ-28 ) , extended activities of daily living scale , SF-36 , everyday memory question naire , dysexecutive syndrome question naire , and memory aids question naire . Results : The three groups were compared on the outcome measures at 4 and 8 months after recruitment . There were few significant differences between the groups and those that occurred favoured the control group . Overall , the results showed no effect of the interventions on mood , quality of life , subjective cognitive impairment or independence . Conclusions : The study failed to detect any significant effects of cognitive assessment or cognitive intervention in this cohort of people with multiple sclerosis Background Contrary to strong recommendations for high-dose intravenous corticosteroid treatment for relapses in multiple sclerosis ( MS ) , uncertainty remains about most aspects of relapse management . Oral corticosteroids administered by physicians or patients themselves or no corticosteroids also appear justifiable . Objective To evaluate an education program that aims to involve patients with MS in decisions on relapse management . Methods In three German MS centers , 150 patients with relapsing MS were r and omly assigned to a single , 4-h group session or a st and ard information leaflet . The primary 
    Output:
    
Results from the included studies indicate a general improvement in both psychological and physiological outcomes following psychological treatment .
The most highly influenced physical symptoms include fatigue , sleep disturbances , pain , and physical vitality .
Conclusions Findings from the review suggest a positive relationship between psychological interventions and physiological Multiple Sclerosis symptoms .