Jacobson's Progressive Muscle Relaxation for Fatigue and Kinesiophobia in Multiple Sclerosis

This study was conducted to examine the association between participation in a structured JPMRT program and changes in fatigue impact and kinesiophobia among patients with MS. The study also examined improvement in participants' ability to correctly perform the relaxation technique and the relationship between fatigue impact and kinesiophobia following the intervention. A quasi-experimental, two-group pretest-posttest design was used. The study was conducted at the Neurological Clinic and Neurological Department of Menoufia University Hospital, Menoufia, Egypt. Participants were recruited using a convenience sampling approach. Because JPMRT involved direct instruction, demonstration, supervised practice, and home practice, the investigators considered that concurrent recruitment could increase the possibility of contamination through communication between participants. Therefore, a non-random sequential allocation procedure was used. Participants in the control group were recruited and assessed first, followed by recruitment and intervention of participants in the study group. The study included 70 eligible participants, with 35 participants in each group. All participants completed the study and the post-intervention assessment. No participants were lost to follow-up, withdrew from the study, or discontinued the intervention. The JPMRT program was standardized to promote consistency in intervention delivery. The supervised component involved instruction regarding the concept and purpose of progressive muscle relaxation, demonstration of the technique, participant redemonstration, corrective feedback, and guided practice. Participants were trained to sequentially contract and relax major muscle groups while focusing on relaxation and breathing. Educational materials containing illustrated instructions and the essential steps of the technique were also provided to support independent practice. The supervised training was conducted in small groups in a quiet, comfortable, and well-ventilated environment. The intervention was delivered according to a predetermined protocol developed by the researchers based on the original work of Jacobson. Research team members involved in intervention delivery were trained in the standardized protocol before the intervention began. To reduce potential assessment bias, outcome assessment was conducted by a researcher who was not involved in delivering the intervention. After the supervised training period, participants in the JPMRT group continued practicing the technique independently at home. Home practice was supported through regular follow-up and reminders. Participants were encouraged to report difficulties with the technique and received clarification and support during the home-practice period. Adherence to home practice was monitored throughout the intervention. Participants in the control group continued to receive routine neurological care, including their prescribed medical treatment and usual follow-up according to their clinical needs. They did not receive the JPMRT training or home-practice program during the study period. For ethical fairness, educational materials and instructions regarding JPMRT were provided to control-group participants after completion of the study and data collection. Fatigue impact was assessed using the Modified Fatigue Impact Scale (MFIS), which evaluates the perceived impact of fatigue on physical, cognitive, and psychosocial functioning. Kinesiophobia was assessed using the Tampa Scale of Kinesiophobia (TSK), which measures fear of movement and related beliefs. The Arabic versions used in the study had previously undergone validation, and reliability was also assessed in the study population. Performance of JPMRT was assessed using a structured performance checklist among participants who received the intervention. Assessments were conducted before the intervention and following completion of the intervention period. The same standardized procedures and outcome measures were used for the pre-intervention and post-intervention assessments. Participants were identified using coded study numbers to maintain confidentiality. The researcher responsible for outcome assessment was independent of intervention delivery and was blinded to participants' group allocation. Data were analyzed using IBM SPSS Statistics version 26.0. Categorical variables were summarized using frequencies and percentages, while continuous variables were summarized using appropriate measures of central tendency and dispersion. Between-group comparisons and within-group pre-post comparisons were conducted using non-parametric statistical procedures because the primary outcomes did not meet the assumptions required for parametric analysis. Effect sizes were calculated to describe the magnitude of observed differences, and correlation analysis was used to examine the relationship between post-intervention kinesiophobia and fatigue impact. The study was approved by the Research Ethics Committee of the Faculty of Nursing, Menoufia University (ERCNMA 1000/7/5/112/25) and by the relevant administrative authorities of Menoufia University Hospital. The study was conducted in accordance with the ethical principles of the Declaration of Helsinki and its subsequent amendments. Written informed consent was obtained from all participants before enrollment. Participation was voluntary, and participants were informed of their right to withdraw without consequences to their medical care. Confidentiality and anonymity were maintained throughout the study. The study was conducted prospectively but was not registered in a public clinical trials registry before participant recruitment. Consequently, no registration number or registration date was available at the time of the study. An important methodological consideration was the non-random sequential allocation. Although this approach was selected to reduce potential contamination between groups, recruiting the groups during different periods may have introduced selection bias and temporal confounding. Differences in participant characteristics, clinical circumstances, healthcare processes, seasonal influences, medication or disease-related factors, and other contextual factors could not be completely excluded. Therefore, non-significant baseline differences were not interpreted as proof of complete equivalence between the groups. The study was designed to provide preliminary evidence regarding the association between participation in JPMRT and changes in fatigue impact and kinesiophobia. The findings were interpreted in light of the quasi-experimental design, non-random allocation, single-center setting, relatively small sample, potential temporal and selection bias, and absence of long-term follow-up. Further randomized controlled studies with concurrent recruitment, appropriate randomization, larger and more diverse samples, and longer follow-up were identified as appropriate next steps for confirming and extending the findings.