An online lifestyle modification course for people with multiple sclerosis: a randomised controlled trial of course effectiveness.

The Multiple Sclerosis Online Course (MSOC) Two arms of the MSOC were developed with the aim of conducting an RCT (an intervention arm and a standard-care arm). Each arm is delivered through the same website. Both arms are identical in format and template designs. Each course is delivered in seven modules over six weeks: introduction and overview of multiple sclerosis (MS), diet, physical activity, exposure to sunlight and vitamin D, stress reduction, family, and concluding remarks. Each module consists of a range of different content types: text, video/animation, audio, interactive tasks, and quizzes. Participant profiles may be uploaded with a photo and any infomration particpants wish to share. A community forum in each arm is open to participants only. There will be no real time moderation. However platform designers will populate the forums with links to articles to stimluate voluntary discussion between participants without the need for constant moderation. One researcher will review the forums weekly throughout the course to check for appropriateness of content. The designers have incorporated a "word recognition" element that automatically recognises and removes any comment with recognised inappropriate (eg racist, swearing) comments. However, the intervention arm and standard care arm differ in content. 1) Intervention arm (MS online intervention course) Content in the intervention arm was adapted from an evidence-based lifestyle modification program for people with MS outlined in print ( Jelinek, G.A. Overcoming multiple sclerosis: the evidence-based 7 step recovery program. 2016. 2nd edition. ISBN 978 1 76011 255 4) previously presented in a face-to-face format. The integrated lifestyle modification program translates the research evidence regarding modification of lifestyle related risk factors and health outcomes based on a detailed review of the literature around modifiable lifestyle risk factors that may influence MS disease progression. The intervention arms consists of 7 modules that are taken during the online course. Each module takes around one hour to complete. Modules are released on two separate weekdays over a 4-week period but participants are given an extra 2 weeks at the end to complete all modules in the event they cannot complete modules during the 4-week period. The modules are summarised below: Module 1: Introduction to the program and participants Welcome to the course and overview of MS (medical definition). How to study the course; introduction to the web-based intervention: how to proceed, how to navigate, what to expect and to outline the endpoints for participants. Module 2: Diet Evidence behind a dietary influence on MS disease activity and QOL: evidence on saturated fat, and evidence regarding diet and its relationships with MS onset and progression. Introduction to dietary plan and benefits of different food groups. Module 3: Sunlight and vitamin D Detailed background information about how vitamin D is made from the action of sunlight is presented, along with evidence supporting a role of vitamin D in MS disease activity. Recommendations for optimal levels of supplementation and blood levels are presented. Module 4: Physical activity/Exercise The benefits of exercise are explained for people with MS (neurological, cognitive, physical), how and why. In addition, evidence regarding the benefits of exercise will be presented. How to implement an exercise plan with video examples provided. Module 5: Stress and stress reduction Introduction to mental health and relevance in MS. Participants are introduced to the science behind stress and its link to inflammation/MS. Mind-body connection, meditation and other stress reduction techniques and how to develop a mental health and wellbeing improvement strategy are presented. There is one 10 minute sample voice over guided meditation (asynchronous) by Associate Professor Craig Hassed (Centre for Consciousness and Contemplative Studies, Monash University), world expert on mindfulness. There are no face to face sessions as the course is asynchronous. Module 6: Family primary prevention Participants are introduced to the issue of primary prevention of MS in close family members who are at increased risk of developing the disease, and strategies for reducing this risk. This session will cover risks associated with smoking and the risks and benefits of moderate alcohol use. Module 7: Review and consolidation Program overview and recap, and an outline of next steps to take. Advise on follow-up questionnaires for longitudinal follow-up, and link to forums for further engagement (aimed at enhancing retention).