Lifestyle Redesign for Multiple Sclerosis: A Community-Based Occupational Therapy Program

Background: Multiple Sclerosis (MS) can affect an individual’s ability to perform daily activities due to functional difficulties. Occupational therapy (OT) helps people to participate in these activities of daily life to improve health and independence across the lifespan. Lifestyle Redesign^® (LRD) is the process of acquiring health-promoting habits and routines to improve overall function, health, and quality of life. The LRD technique has been shown to slow declines associated with typical aging, and improve overall health, functioning, and life satisfaction.

Objectives: To apply the LRD technique to a community-based population with MS for quality improvement purposes.

Methods: This community-based program is a 12-week course in which OT students deliver group and individual LRD interventions once per week for participants living with MS. The National MS Society recruits the participants, who also receive physical therapy (PT) for the duration of the program. The LRD technique uses didactic presentation, occupational self-analysis, and hands-on activity-based learning to address topics such as fatigue management, bowel and bladder function, stress management, adaptive equipment, self-advocacy, and sexual function. Outcome measures utilized pre- and post-program were the Canadian Occupational Performance Measure (COPM) and Modified Fatigue Impact Scale (MFIS). Paired-samples t-tests were used to determine significant changes pre- and post-program.

Results: COPM Performance score mean increased by 1.77 points (p<.0001, df=94), and COPM Satisfaction score increased by 2.71 points (p<.0001, df=94). On average, participants improved their perceived participation and overall satisfaction in self-identified areas of function and lifestyle difficulty. MFIS Physical Subscale mean decreased by 4.07 points (p<.0001, df=41), Cognitive Subscale mean decreased by 4.26 points (p=.0002, df=41), and Psychosocial Subscale mean decreased by 0.94 points (p=.0057, df=41). Total MFIS Score revealed a mean decrease of 9.24 points (p<.0001, df=41). On average, participants felt the impact of fatigue on various areas of functioning was lessened by the end of the program.

Conclusions: This quality improvement study suggests LRD can be an effective OT intervention for people living with MS to improve their function, health, and quality of life. More controlled research is needed to further investigate effects of LRD without confounding factors (e.g. PT) in MS care.