For patients with MS, NP-led care as an add-on improved depression compared with usual care at 3 and 6 months, with no changes in satisfaction with care.


Add-on nurse practitioner (NP) care versus usual care improved anxiety and depression among people with MS in a Canadian clinical trial by Penelope Smyth, MD, FRCPC, and colleagues from the University of Alberta.

“People with MS require specialized care over the decades that they live with MS, but there are currently gaps and challenges in delivering optimal care to people with MS,” Dr. Smyth explains. “Strategies such as adding NPs to healthcare teams could aid in meeting the needs of those living with chronic diseases and could potentially lessen some of the pressures that physicians are experiencing in their practices.”

The researchers aimed to determine “if there were alternate ways of providing care to people with MS beyond physicians working in busy practices,” she continues.

“We set up this trial to see if there was an impact of add-on NP care on depression and anxiety levels among people with MS. In addition, we wished to see if people with MS were as satisfied with care delivered by an NP versus the usual care provided by neurologists and family physicians.”

Study Assigns Patients to NP Arm Versus Usual Care

The clinical trial, results of which were published in BMC Neurology, randomly assigned 228 patients with MS treated at community neurology practices to add-on NP-led care (N=120) or usual care (N=108). The primary endpoint was the change in Hospital Anxiety and Depression Scale (HADS) scores at 3 months. Secondary endpoints included changes in HADS scores at 6 months, level of satisfaction with care based on the Consultant Satisfaction Survey at 6 months, and changes in the EuroQol Five-Dimensional Questionnaire (EQ5D), Multidimensional Scale of Independent Functioning (MSIF), and Caregiver Health-Related Quality of Life in MS (CAREQOL-MS) at 3 and 6 months.

Patients in the NP-led care arm received a comprehensive NP consultation, which included a review of patients’ history; a physical examination; individualized strategies related to lifestyle, mobility, fatigue, bladder/bowel concerns, and mood; examination of patients’ local community; review of resources to improve mood and QOL; and regular follow-up visits at 3 and 6 months either in person or via telehealth or a phone call. Those in the usual care arm received standard care. In the usual care arm, nurse involvement was predominantly limited to helping neurologists update medication lists and facilitating initiation and renewal of disease-modifying therapies.

NP Care Improves Depression Among Patients With MS

In both groups, the mean age of patients was 47 and the mean Expanded Disability Status Scale score was 2.53, indicating minimal/moderate disability. Most patients (85%) had relapsing-remitting MS.

At 3 months, the mean difference in change in HADS for depression was -0.41 (standard deviation [SD], 2.81) in the NP-led care arm compared with 1.11 (SD, 2.98) in the usual care arm (P=0.001). The mean difference in change in HADS for anxiety was -0.32 (SD, 2.73) in the NP-led care arm compared with 0.42 (SD, 2.82) in the usual care arm.

At 6 months, the mean change in HADS for depression was -0.81 (SD, 3.18) in the NP-led care arm and 0.57 (SD, 3.11) in the usual care arm (P=0.003). The mean difference in change for HADS for anxiety was -0.46 in the NP-led care arm compared with 0.36 (SD, 2.55) in the usual care arm (P=0.04; Figure). No statistically significant differences in mean change for EQ5D and MFIS between care arms were observed at 3 and 6 months.

Satisfaction with care was similar between arms. The mean overall satisfaction scores were 63.83 (SD, 5.63) in the NP-led care arm and 62.82 (SD, 5.45) in the usual care arm.

“There are pressures and challenges in delivering care to people living with chronic diseases such as MS within current healthcare system environments,” Dr. Smyth notes. “Healthcare systems need to explore options to caring for those living with chronic diseases.”