A pilot randomised controlled trial of an Internet-based cognitive behavioural therapy self-management programme (MS Invigor8) for multiple sclerosis fatigue

The majority of people affected by Multiple Sclerosis (paMS) experience severe and disabling fatigue. A recent randomised controlled trial (RCT) showed that cognitive behaviour therapy with a clinical psychologist was an effective treatment for MS fatigue. An Internet-based version of this intervention, MS Invigor8, was developed for the current study using agile design and input from paMS. MS Invigor8 includes eight tailored, interactive sessions. The aim was to test the feasibility and potential efficacy and cost-effectiveness of the programme in a pilot RCT. 40 patients were randomised to MS Invigor8 (n = 23) or standard care (n = 17). The MS Invigor8 group accessed sessions over 8–10 weeks and received up to three 30–60 min telephone support sessions. Participants completed online standardised questionnaires assessing fatigue, mood, quality of life and service use at baseline and 10 weeks follow-up. Large between group treatment effects were found for the primary outcomes of fatigue severity (d = 1.19) and impact (d = 1.02). The MS Invigor8 group also reported significantly greater improvements in anxiety, depression and quality-adjusted life years. These data suggest that Internet-based CBT may be a clinically and cost-effective treatment for MS fatigue. A larger RCT with longer term follow-up is warranted.

► MS Invigor8 is an 8 session web-based interactive CBT program for MS fatigue.
► 40 people with MS fatigue were randomized to the MS Invigor8 program or standard care.
► MS Invigor8 group reported significantly less fatigue (d = 1.2) at 10 weeks follow-up.
► The MS Invigor8 group also reported less anxiety and depression.
► Internet-based CBT may be a cost-effective treatment for MS fatigue.