Digital mind–body intervention helps symptom management in liver disease

The 12-week mind–body wellness program involves guidance on ways to increase physical activity and improve mental fitness through Acceptance and Commitment Therapy informed strategies, breathwork, meditation, mindful movement, and liver disease-specific education.

The program “promotes whole-person care,” which “aligns with Integrative Hepatology principles,” presenter Emily Johnson (University of Alberta, Edmonton, Canada) told delegates at AASLD The Liver Meeting in Washington, DC, USA. It is also delivered digitally “to increase access,” she added.

The analysis involved 255 patients with chronic liver disease from the trial, of whom 72% had primary biliary cholangitis (PBC), 20% had cirrhosis, and 8% had PSC. The participants had a mean age of 59 years, the majority (88%) were women, and most (69%) lived in non-urban areas.

In all, 170 individuals were randomly assigned to participate in the eMPower program, either self-directed (n=84) or with weekly check-ins (n=86), for around 90 minutes per week, and 85 to a waitlist control group who received only weekly motivational emails.

Before participating in the program, the level of fatigue among the patients was generally moderate to severe, said Johnson, with mean scores on the Modified Fatigue Impact Scale (MFIS) of 46.7 points, and levels of psychologic distress were high, with a mean Hospital Anxiety and Depression Scale (HADS) score of 12.3 points. In addition, 42% of patients were considered frail, based on the Fried Frailty Phenotype of the Edmonton Frail Scale (EDS), and 57% had moderate-to-high levels of demoralization (Demoralization II).

On completing the eMPower program, patients had a significantly greater improvement in HADS score than controls at 12 weeks, with a mean 3.4-point greater reduction after taking into account baseline values, sex, and age. This exceeded the clinically important meaningful difference of 1.5 to 2.0 points, the presenter pointed out.

Benefits with the eMPower program were seen for both depression and anxiety, with significantly greater mean decreases from baseline of 35% and 20%, respectively, and Johnson commented that this level of improvement is “comparable with what we see for psychological therapies in other chronic disease populations.”

The findings were similar for fatigue, with a significant adjusted mean difference between program participants and controls of 5.9 points on the MFIS at 12 weeks, with greater reductions across different fatigue subtypes – physical, cognitive, and psychosocial – of 13%, 16%, and 16%, respectively.

Significant improvements with the program were also seen across secondary outcomes, including a 27% greater mean reduction in demoralization versus controls, a 0.07-point greater improvement in quality of life (EQ-5D-5L), and a 40% greater reduction in patients meeting the criteria for frailty.

The benefits of the program were reflected in a participant survey, Johnson pointed out. Among the patients with PSC, specifically, responses suggested improvements in physical engagement and flexibility and led to patients feeling “calmer,” whereas before the program they had days thinking “am I going to have a day of fatigue today.”

In a related subgroup analysis of the study population, also presented by Johnson in a poster, which looked at the baseline symptom burden of the group, physical fatigue was found to be “the most central and interconnected symptom, underscoring its potential as a key therapeutic target,” the researchers comment.

Johnson pointed out that there were study limitations, including the fact that the eMPower participants were a prespecified subgroup and so the study was not powered as a stand-alone trial. Additionally, diagnosis and outcomes were self-reported.

However, the “clinically meaningful improvements in mental health, fatigue, demoralization, and quality of life” with the program warrant further work to “explore long-term outcomes and implementation in real-world hepatology settings,” she concluded.