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

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The prevalence of depression and anxiety among individuals with upper motor neuron disorders is 23%-46%, considerably greater than the general population prevalence of about 12%.

“The prevalence of depression and anxiety among individuals with UMNDs (23%–46%) is considerably greater than the general population (~12%).27–34”

• cites [27] sourceNot checked — no full text of the source
• cites [28] sourcePartly supported

  The Disorder Prevalence Estimates section (page unavailable) reports general-population lifetime prevalence of any mood disorder at about 12% and 12-month prevalence of any anxiety disorder at about 11%. It does not report a 23%–46% prevalence among people with upper motor neuron disorders or establish that comparison; its approximately 12% figure is not a combined estimate for depression and anxiety. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites [29] sourceNot checked — no full text of the source
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• cites [32] sourceNot checked — no full text of the source
• cites [33] sourceNot checked — no full text of the source
• cites [34] sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Upper motor neuron disorders may arise from traumatic events, nontraumatic events, or inherited or sporadic neurodegenerative disease.

“UMNDs may occur because of a traumatic event, nontraumatic event, or inherited or sporadic neurodegenerative disease.1,3–8”

• cites [1]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [3]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [4] sourceNot checked — no full text of the source
• cites [5] sourceNot checked — no full text of the source
• cites [6] sourceCould not verify

  The Risk Factors for Stroke section discusses genetic contributions to stroke risk, and the Rehabilitation section discusses post-stroke impairments. Neither addresses the claimed causes of upper motor neuron disorders; searches for upper motor neuron disorders, traumatic and nontraumatic events, and inherited or sporadic neurodegenerative disease found no passage establishing that classification. (LLM, conf=0.76)

  Experimental — accuracy not yet measured
• cites [7] sourcePartly supported

  The AGE AT ONSET section distinguishes familial from sporadic ALS, supporting that part of the claim for ALS. It does not address upper motor neuron disorders generally or say that traumatic or nontraumatic events cause them; searches for those terms found no supporting passage. Page numbers are unavailable in our copy. (LLM, conf=0.79)

  Experimental — accuracy not yet measured
• cites [8] sourceCould not verify

  The Discussion (p. 9) defines traumatic brain injury, but does not discuss upper motor neuron disorders or their causes. Searches for upper motor neuron disorders and nontraumatic or neurodegenerative causes found no passage addressing the claim. (LLM, conf=0.74)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim. May combine two claims.

The four common upper motor neuron disorders cause significant decline in physical function and often lead to secondary complications affecting quality of life, including cognitive impairment, fatigue, chronic pain, depression, and anxiety.

“These 4 common UMNDs result in a significant decline in physical function5,7,8,17,18 and often develop secondary complications that affect their quality of life (QOL), including cognitive impairment,19–21 fatigue,22 chronic pain,23,24 depression,25–27 and anxiety.25–27”

• cites [5] sourceNot checked — no full text of the source
• cites [7] sourcePartly supported

  The Site of Onset section (page unavailable) describes limb weakness and difficulty speaking or swallowing in ALS, supporting a decline in physical function for that disorder. This paper addresses ALS, not all four upper motor neuron disorders. In the citing sentence, this source is cited for physical decline; the complications have separate citations. (LLM, conf=0.85)

  Experimental — accuracy not yet measured
• cites [8] sourceSupported
• cites [17] sourceSupported
• cites [18] sourceNot checked — no full text of the source
• cites [19] sourceNot checked — no full text of the source
• cites [20] sourceNot checked — no full text of the source
• cites [21] sourceNot checked — no full text of the source
• cites [25] sourceNot checked — no full text of the source
• cites [26] sourcePartly supported

  The Introduction (page not provided) says depression and anxiety are common in multiple sclerosis and are related to lower quality of life. The citation is attached to depression and anxiety, not the other listed complications, but this paper does not establish that all four upper motor neuron disorders develop them or that the disorders cause them. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Mindfulness-based interventions are associated with improved biological processes.

“but also with improved biological processes.”

• cites [41] sourceCould not verify

  The Results and Discussion report improvements in anxiety, depression, and pain, but do not report improved biological processes. Searches for physiological measures and biomarkers returned reference titles rather than findings supporting this claim in the review. (LLM, conf=0.74)

  Experimental — accuracy not yet measured

May combine two claims.

The 2020 spinal cord injury review included yoga and cognitive behavioral therapy, and only one study delivered a mindfulness-based intervention, making it difficult to determine mindfulness-based intervention efficacy in that population.

“However, this review included studies with yoga and cognitive behavioral therapy, and only 1 study in this review delivered MBI, making it difficult to determine the efficacy of MBI in this population.62”

• cites [62] sourceSupported

Probably not a substantial claim: may not pass S2 (checkable).

An additional review of feasibility, acceptability, and adherence of mindfulness-based interventions in multiple sclerosis, brain injury, and spinal cord injury would add to the existing literature and inform future intervention development and implementation.

“additional review of the feasibility and acceptability of MBIs and participant adherence with MBIs in these populations would add to the existing literature and serve to inform the development and implementation of future MBIs.”

• cites [58] sourceNot checked — no full text of the source
• cites [59] sourcePartly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  Experimental — accuracy not yet measured
• cites [60] sourceNot checked — no full text of the source
• cites [61] sourceNot checked — no full text of the source
• cites [62] sourcePartly supported

  The Discussion (page unavailable) identifies dropout, non-adherence, accessibility, and intervention adaptation as issues for future research on mindfulness-based interventions in people with spinal cord injury. It does not call for an additional review of feasibility, acceptability, and adherence across multiple sclerosis, brain injury, and spinal cord injury; its recommendations are chiefly about research in spinal cord injury. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

• AssumptionRests on an assumption: Mindfulness-based interventions are not routinely recommended for people with upper motor neuron disorders.
• AssumptionRests on an assumption: Complications such as mobility limitations, cognitive impairment, pain, and fatigue may act as barriers to participation in mindfulness-based interventions for people with upper motor neuron disorders.

May combine two claims.

Relationship satisfaction and perceived social support are affected among people with an upper motor neuron disorder.

“both of which are affected among those experiencing a UMN disorder.53–57”

• cites [53] sourceNot checked — no full text of the source
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• cites [56] sourceNot checked — no full text of the source
• cites [57] sourcePartly supported

  The sections “The Impact on Social Behavior and Relationships” and “Risks of Social Isolation” report poorer relationship satisfaction and the potential loss of social and emotional support after traumatic brain injury. They do not establish these effects among people with an upper motor neuron disorder; searches for “UMN” and “upper motor neuron” found no such population in our copy. Page numbers were not available. (LLM, conf=0.87)

  Experimental — accuracy not yet measured

May combine two claims.

A recent systematic review of six mindfulness-based intervention studies in multiple sclerosis aggregated qualitative feedback and suggested that mindfulness-based interventions are valued among people with multiple sclerosis and highlighted delivery aspects that may increase feasibility and acceptability.

“One recent systematic review of 6 studies of MBIs delivered to individuals with MS aggregated participants’ qualitative feedback and suggested that the MBIs are valued among people with MS and highlights several aspects of delivery that may increase the feasibility and acceptability of MBIs among people with MS.64”

• cites [64] sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

The relative change method was recently reported in a systematic review on mindfulness-based interventions.

“This method was recently reported in a systematic review on MBIs.41”

• cites [41] sourceSupported

May combine two claims.

The review included 44 studies: 26 randomized controlled trials, 10 nonrandomized controlled trials, and 8 pre-post intervention studies.

“A total of 44 studies were included: 26 randomized controlled trials, 10 nonrandomized controlled trials, and 8 pre-post intervention studies.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The mean age was 45±11 years, and on average 55%±32% of participants were female.

“The mean age was 45±11 years, and on average, 55%±32% of the study participants were female.”

May combine two claims.

Among the 44 included studies, 26 (59%) were in multiple sclerosis, 15 (34%) in brain injury, 1 (2%) in spinal cord injury, and 2 (5%) in amyotrophic lateral sclerosis.

“Of these, 26 studies (59%) were in people with MS, 15 (34%) in people with BI, 1 (2%) in people with SCI, and 2 (5%) in people with ALS.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The percentage of women was higher in multiple sclerosis studies than in studies of other upper motor neuron disorders.

“Consistent with condition distribution, there was a higher percentage of women in MS studies compared with studies in other UMNDs.”

May combine two claims.

The 44 studies included 2313 participants, with a mean sample size of 53±41 participants.

“The total number of participants in the 44 studies was 2313, and the mean ± SD sample size was 53±41 participants.”

May combine two claims.

At 12 months, relative reduction in anxiety scores persisted in ALS (−59%) and BI (−22%) but not MS (0%) compared with passive controls.

“Relative reduction in anxiety scores persisted in ALS (−59%) and BI (−22%) but not in MS (0%) compared with passive controls at 12 months.”

May combine two claims.

Another MS study evaluating online MBI found positive feedback toward the course, although no direct quotes were included.

“Another MS study evaluating online MBI evaluated acceptability via spontaneous and structured feedback sessions and found positive feedback toward the course, although no direct quotes were included.80”

May combine two claims.

Acceptability data were reported in 6 BI studies and 3 MS studies.

“Data regarding acceptability was reported in 6 BI101,104,106,108–110 and 3 MS studies.80,83,95”

May combine two claims.

Only 1 MS study reported effects of MBI 12 months post intervention, and the relative reduction in fatigue scores was not clinically significant (−2%).

“Only 1 study among participants with MS reported effects of MBI 12 months post intervention, and the relative reduction in fatigue scores was not clinically significant (−2%).”

May combine two claims.

Among 36 clinical trials with a control group, 22 (61%) had a passive control, 9 (25%) had an active control, and 4 (11%) had both.

“Among the 36 clinical trials with a control group, 22 (61%) included a passive control group, 9 (25%) included an active control group, and 4 (11%) had both active and passive control groups (see table 2).”

May combine two claims.

In one study of mindful listening to music, 94.6% of participants found appointments convenient, and 73.3% reported it was feasible to engage in daily sessions for up to an hour.

“One study101 on mindful listening of music reported that 94.6% of participants found appointments convenient, and 73.3% reported it was feasible to engage in daily sessions for up to an hour.”

May combine two claims.

Mean postintervention retention was 86%±13% for in-person groups and 80%±18% for virtually delivered MBI groups.

“The mean retention rate at post intervention for in-person groups was 86%±13% and for virtually-delivered MBI groups was 80%±18%.”

Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based). The quote only partly states this claim.

Three studies reported 12-month follow-up data for anxiety (1 ALS, 1 MS, 1 BI).

“Three studies reported follow-up data at 12 months (1 ALS, 1 MS, 1 BI).79,99,112”

May combine two claims.

Recommended daily home practice duration ranged from 3 to 60 minutes, with most studies recommending 40 to 45 minutes daily.

“The recommended duration for home practice ranged from 3–60 minutes daily, but the majority recommended 40–45 minutes daily.”

May combine two claims.

A third BI study defined acceptability as absence of adverse effects; no significant adverse effects arose, but 3 participants found some practices challenging because of emotions that surfaced.

“A third BI study defined acceptability as the absence of adverse effects and noted that no significant adverse effects arose but that 3 participants found some of the practices challenging because of the emotions that surfaced.110”

May combine two claims.

Home practice was recommended in 32 of the reviewed studies, representing 73%.

“In addition to weekly sessions, the home practice was recommended in 32 studies (73%) (see table 2).”

May combine two claims.

Average retention at first follow-up was 80%±16% in MBI groups, 84%±16% in passive controls, and 85%±10% in active controls.

“The average retention rate at the first follow-up assessment was 80%±16% in MBI groups compared with 84%±16% in the passive control group and 85%±10% in the active control.”

May combine two claims.

At 12 months, relative reduction in depression scores persisted in ALS (−53%) and BI (−43%) but not MS (−2%) compared with usual controls.

“Relative reduction in depression scores persisted in ALS (−53%) and BI (−43%) but not MS (−2%) compared with usual controls at 12 months.”

May combine two claims.

In studies reporting daily practice duration, average daily practice ranged from 17 to 55 minutes, and overall adherence to home practice ranged from 55% to 87% of recommended practice.

“In the studies that reported participants’ daily practice duration, average daily practice duration ranged from 17–55 minutes (see table 1), and overall adherence to home practice ranged from 55%–87% of recommended practice (see table 1).”

May combine two claims.

Another BI study reported that participants were very positive and consistently reported benefits affecting many areas of life, with some describing the intervention as life changing.

“Another BI study that collected posttreatment feedback reported that participants were very positive and consistently reported benefits that affected many areas of their life, with some participants even describing the intervention as “life changing.”106”

Probably not a substantial claim: may not pass S3 (load-bearing).

The majority of studies reporting fatigue had active controls (n=5).

“The majority of studies reporting fatigue had active controls (n=5).”

May combine two claims.

Although 32 studies recommended daily home practice, only 9 reported adherence with home practice.

“Although 32 studies (73%) recommended daily home practice of mindfulness exercises (see table 2), only 9 studies reported adherence with home practice (see table 1).”

May combine two claims.

Follow-up periods ranged from 1 to 12 months, with most occurring 2 to 6 months after intervention completion.

“The follow-ups ranged from 1–12 months, with the majority 2–6 months after the completion of the intervention.”

May combine two claims.

Most comments indicated satisfaction, while a smaller number reported boredom with repeated practice.

“The majority of comments reported indicated satisfaction (eg, “I am very happy with the online platform”; “I really enjoyed the online version of mindfulness program”). A smaller number of comments reported boredom with repeated practice.”

May combine two claims.

Among 8 studies reporting acceptability, quantitative satisfaction was high (4.5/5), and qualitative data echoed this.

“Among the 8 studies that reported MBIs’ acceptability, quantitative reports of satisfaction with the intervention were high (4.5/5), and qualitative data echoed this.”

May combine two claims.

Adherence metrics were also similar, although only a few studies reported such data.

“Adherence metrics were also similar, although only a few studies reported such data.”

May combine two claims.

At 12 months, relative improvement in QOL was clinically significant in ALS (16%) but not in MS (3%).

“The relative improvement in QOL was clinically significant in ALS (16%),112 but it was clinically not significant in MS (3%).79”

May combine two claims.

In that MS study, relative improvement in QOL post intervention was 22% and clinically significant at 6-month follow-up (13%) when compared with QOL measured by the Hamburg Quality of Life Questionnaire in MS at post intervention (12%) and 6-month follow-up (−8%).

“In this study, the relative improvement in QOL post intervention (22%) was higher and clinically significant at 6-month follow-up (13%) when compared with QOL measured by the Hamburg Quality of Life Questionnaire in MS at post intervention (12%) and 6-month follow-up (−8%).”

May combine two claims.

On average, retention in MBIs was 85%, and retention at follow-up was 81%.

“On average, retention in MBIs was 85%, and retention at follow-up was 81%.”

May combine two claims.

The majority of studies were conducted among individuals with MS (59%) and were 8 weeks in duration, with weekly sessions ranging from 1.5 to 2.5 hours.

“The majority of the studies in our review were conducted among individuals with MS (59%) and were 8 weeks in duration, with weekly sessions ranging from 1.5–2.5 hours.”

May combine two claims.

Results suggest participants engaged in at least half of assigned home practice, and in many studies over 80% of assigned home practice was completed.

“Although only 9 studies document adherence to home practice, results suggest that participants engaged in at least half of the assigned home practice,76,79 and in many studies, over 80% of the assigned home practice was completed.82,95,101”

May combine two claims.

Available studies across the 4 UMNDs varied greatly, with very few publications focusing on ALS or SCI.

“Available studies across our 4 UMNDs varied greatly, with very few publications focusing on individuals with ALS or SCI.”

Probably not a substantial claim: may not pass S3 (load-bearing).

In 1 MS study, QOL was measured by 2 different tools.

“In 1 MS study, QOL was measured by 2 different tools.”

Not yet classified.

The small number of studies reporting acceptability data preclude meaningful comparisons between the acceptability of in-person versus online or synchronous versus asynchronous delivery.

“The small number of studies reporting acceptability data preclude meaningful comparisons between the acceptability of in-person vs online or synchronous vs asynchronous delivery.”

May combine two claims.

Although relative improvement was greater compared with passive than active controls, MBIs consistently demonstrated at least a 7% relative reduction in symptoms compared with active controls.

“Although there was a greater relative improvement in health-related outcomes in the mindfulness condition compared with passive control conditions than active control conditions, MBIs consistently demonstrated at least a 7% relative reduction in symptoms compared with a variety of active control conditions.41”

Probably not a substantial claim: may not pass S3 (load-bearing).

The systematic review was registered with the Open Science Framework-Center for Open Science.

“The systematic review was registered with Open Science Framework-Center for Open Science.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The review followed the PRISMA guidelines.

“The systematic review followed the preferred reporting items for systematic reviews and meta-analyses guidelines.65”

Probably not a substantial claim: may not pass S3 (load-bearing).

Two authors screened titles and abstracts for eligibility after duplicate removal.

“Titles and abstracts returned by our search strategy (fig 1) after the removal of duplicates were screened for eligibility by 2 authors.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Data extraction was done independently by two authors.

“Data extraction was performed by 2 authors independently.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Two reviewers independently assessed risk of bias with standardized tools and extracted the desired data electronically.

“Two reviewers independently performed the risk of bias assessment using standardized tools and extracted desired data electronically.”

Probably not a substantial claim: may not pass S3 (load-bearing).

After data extraction, all authors reviewed the information.

“After data extraction, the information was reviewed by all authors.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Upper motor neuron disorders result from damage to upper motor neurons, upper motor neuron pathways, and connections in the cortex, internal capsule, brainstem, and spinal cord.

“Upper motor neuron disorders (UMNDs) result from damage to upper motor neurons (UMNs), UMN pathways, and connections in the cortex, internal capsule, brainstem, and spinal cord.1,2”

• cites [1]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [2] sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Discrepancies during data extraction were resolved by consultation between the two authors after referring to the original article.

“Any discrepancies during this process were settled by consultation between the 2 authors after referring to the original article.”

Classified as probably not a substantial claim. May combine two claims.

Risk of bias was appraised with ROBIN-II for randomized controlled trials and ROBIN-I for nonrandomized controlled trials.

“we appraised studies using the risk of bias in nonrandomized studies of intervention (ROBIN)-II for randomized controlled trials (RCTs) and ROBIN-I tool for non-RCTs.67,68”

The quote only partly states this claim.

Mindfulness-based interventions are associated with a high acceptance rate among participants.

“MBIs are associated with a high acceptance rate among participants”

Probably not a substantial claim: may not pass S3 (load-bearing).

Missing data and outliers were audited after data collection.

“We audited any missing data and outliers after data collection.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The overall risk of bias for each study was assigned according to Cochrane Scientific Committee recommendations.

“The overall risk of bias for each study was assigned based on the Cochrane Scientific Committee recommendation available at https://methods.cochrane.org/risk-bias-2 and https://methods.cochrane.org/methods-cochrane/robins-i-tool.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Biological factors such as direct neuronal damage after upper motor neuron disorders result in pain.

“biological factors such as direct damage to the neurons after UMNDs result in pain.”

• cites [39] sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Pre-post studies were assessed with the National Heart, Lung, and Blood Institute Quality Assessment Tool.

“We used the Quality Assessment Tool developed by the National Heart, Lung, and Blood Institute for pre-post studies.69”

May combine two claims. The quote only partly states this claim.

Mindfulness-based interventions are associated with notable improvements in depression, anxiety, fatigue, and quality of life after intervention.

“with notable improvements in depression, anxiety, fatigue, and quality of life post intervention.”

May combine two claims.

Of 8 pre-post studies, only 1 was poor quality, and most were fair or good quality (88%).

“Of 8 pre-post studies, only 1 pre-post study was considered poor quality, and the majority were considered either fair or good quality (88%).”

May combine two claims.

Three meta-analyses of mindfulness-based intervention studies in multiple sclerosis conducted in 2019 and 2020 revealed moderate to large effects on well-being, stress, anxiety, and depression.

“moderate to large effects on well-being, stress, anxiety, and depression60”

• cites [60] sourceNot checked — no full text of the source

May combine two claims.

Non-RCTs (n=10) either lacked information needed for risk-of-bias assessment (n=7) or had serious concerns (n=3).

“Non-RCTs (n=10) either lacked information (n=7) required to assess the risk of bias or had serious concerns (n=3).”

May combine two claims.

Among 25 RCTs evaluating health-related outcomes, 19 (76%) had low or some risk of bias and 6 (24%) had high risk of bias.

“Among the 25 RCTs included in the evaluation of health-related outcomes, 19 (76%) were appraised to have a low risk or some risk of bias, and 6 (24%) had a high risk of bias (see supplemental table S1).”

May combine two claims.

The present study found that MBIs led to clinically significant improvements in depression, anxiety, fatigue, and QOL symptoms compared with passive and active control groups (>5% relative change).

“Specifically, the present study found that MBIs led to clinically significant improvements in depression, anxiety, fatigue, and QOL symptoms compared with passive and active control groups (ie, >5% relative change).”

May combine two claims.

MBIs improved symptoms of depression, anxiety, and fatigue and improved quality of life in people with UMNDs, particularly compared with passive controls but also compared with active controls.

“MBIs improved symptoms of depression, anxiety, and fatigue and improved quality of life in people with UMNDs, particularly compared with passive controls but also compared with active controls.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The review excluded studies published before 2001 and included only English-language studies.

“We excluded studies published prior to 2001 and only included studies published in English.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Intervention inclusion criteria were limited to available descriptions, which may have made it difficult to ascertain all aspects of interventions as they relate to MBIs.

“Intervention inclusion criteria were limited to descriptions available, which may have made it difficult to ascertain all aspects of the interventions as they relate to MBIs.”

May combine two claims.

MBIs are feasible and acceptable to people with UMNDs.

“Based on our systematic review, we conclude that MBIs are feasible and acceptable to people with UMNDs”

Classified as probably not a substantial claim.

Generalizability of the findings to people with ALS and SCI should consider these limitations.

“As a result, the generalizability of our findings to people with ALS and SCI should consider these limitations.”

May combine two claims.

Among RCTs in the efficacy analysis, 19% of depression/anxiety studies, 29% of fatigue studies, and 10% of QOL studies were high risk of bias.

“Among the RCTs included in the efficacy analysis, 19% of the studies in depression and anxiety analysis, 29% of the studies included in fatigue analysis, and 10% of the studies included in QOL analysis were categorized as high risk of bias (see supplemental table S1).”