Feasibility, Acceptability, and Efficacy of Mindfulness Training in People with Upper Motor Neuron Disorders: A Systematic Review.

OBJECTIVES: This systematic review aims to gain a comprehensive understanding of the feasibility, acceptability, and efficacy of mindfulness-based interventions (MBIs) on depression, anxiety, fatigue, and health-related quality of life among individuals with upper motor neuron disorders (UMND).

DATA SOURCES: PubMed, PsycINFO, EMBASE, and CINAHL were searched for relevant studies published between Jan 2001 and June 2021.

STUDY SELECTION: Clinical trials published in English evaluating MBIs in adults with the four most common UMND (multiple sclerosis, brain injury including stroke, spinal cord injury, and amyotrophic lateral sclerosis) were included.

DATA EXTRACTION: Two reviewers independently performed the risk of bias assessment using standardized tools and extracted desired data electronically.

DATA SYNTHESIS: A total of 44 studies were included: 26 randomized control trials, 10 non-randomized control trials, and 8 pre-post intervention studies. The average (SD) duration of MBIs was 8 (2) weeks. On average (SD), 85% (14%) of participants completed the MBI, and the retention rate at follow-up was 80% (16%). Only 14% of the studies delivered MBIs virtually, and feasibility metrics were similar to in-person studies. Among studies reporting acceptability data, most participants reported satisfaction with the MBI. Randomized control trials which evaluated the effects of MBI on depression, anxiety, fatigue, and quality of life revealed greater relative improvement in these outcomes among MBI participants compared to controls, with differences greater when compared to passive control than active control participants. None of the studies included in this review studied dose-response.

CONCLUSION: Based on current data, MBIs are feasible and offer a promising approach to address the biopsychosocial needs of individuals with UMNDs. MBIs are associated with a high acceptance rate among participants with notable improvements in depression, anxiety, fatigue, and quality of life post-intervention. Future studies are needed to evaluate alternate models of delivery of MBIs and the dose-response relationship.