Elevida-Go! – a digital treatment program to improve fatigue in MS by CBT and exercise: findings from a feasibility study

Background The cognitive behavioral therapy (CBT) based digital health application elevida has been shown to reduce Multiple Sclerosis (MS)-related fatigue, and there is substantial evidence that exercise can also alleviate fatigue. However, the combined effect of CBT and exercise remains unknown. Objective To develop a combined CBT and exercise intervention for MS fatigue and evaluate its acceptance, feasibility and preliminary effectiveness. Method To expand elevida’s exercise-related content, four new modules were developed and adapted based on qualitative feedback from persons with MS (pwMS). A single-arm feasibility study was conducted with MS patients using the resulting program, which was termed elevida-Go! . Acceptance data were gathered through standardized qualitative interviews, while initial efficacy was assessed after 4 and 6 months. Daily steps were measured by a digital step counter over the first 4 months. Further outcomes included patient-rated fatigue, information processing speed, depression, anxiety, daily activity, physical activity (PA), and quality of life (QoL). T-tests for dependent measures were computed to analyze feasibility. Results Five pwMS (n = 4 female, age M = 41 years, range 31–58) participated in the qualitative evaluation and rated the quality of the program as very good, generally meeting their expectations. All participants were satisfied with the level of help received and would recommend the program to other pwMS with fatigue, and 4 of 5 participants reported that it had improved their ability to cope with their problems. In the feasibility study (n = 24, 79% female, age M = 41 years, range 23–61) acceptance and usability of the expanded programme was confirmed as high. Pre-post analyses showed improvements in fatigue (d = 1.10, CI = .57 to 1.61), daily activity (d = .93, CI = .46 to 1.45), physical activity (d = .47, CI = .04 to .90), anxiety (d = .41, CI=-.02 to .83), and QoL (d = .57, CI = .12 to 1.01). Improvements in fatigue, daily activity, and anxiety persisted at the 6-month follow-up. Conclusion Elevida-Go! demonstrated high acceptability and usability among study participants. Preliminary efficacy data appear promising, warranting further investigation in a randomized controlled trial.