The Benefits of Neuropsychological Assessment Feedback in Multiple Sclerosis

Abstract

There is no strong evidence supporting the direct therapeutic benefits of neuropsychological assessment (NPA) with feedback for patients or caregivers. This thesis investigated the psychological benefits of NPA with feedback in multiple sclerosis (MS) in a randomised controlled trial with crossover. Seventy-one MS patients and 53 caregivers were randomly allocated to one of two groups: NPA with feedback, or “sham wait-list” control. The primary patient hypotheses were that NPA with feedback would lead to improved knowledge of cognitive functioning and improved coping. The primary caregiver hypotheses were improved knowledge of patients’ cognitive functioning and reduced caregiving burden. A range of primary and secondary psychological measures was used to evaluate these, and other, outcomes. Instruments were administered by a research assistant blinded to group allocation. A secondary subgroup analysis was conducted to explore the influence of level of cognitive impairment (no abnormalities detected [NAD], Mild and Major impairment). Results at one week post-NPA demonstrated no significant group-by-time interaction effects in either the patient or caregiver groups as a whole, but certain subgroups showed specific benefits. There were no adverse reactions, including in the Major subgroup. This, along with high satisfaction ratings, confirmed the safety and acceptability of the feedback protocol. At one month follow-up, results of within-subjects analyses over time, which used the combined intervention and control sample, showed that patients improved in their knowledge, MS self-efficacy, and mood, and caregivers experienced reduced anxiety. The cognitive subgroups benefited in unique ways. These results provide modest evidence that NPA feedback is an effective psycho-educational intervention in MS. This places NPA feedback within the “wellness” framework of MS management in its potential to improve knowledge, psychological wellbeing, and adjustment over time.