Introduction
Multiple Sclerosis (MS) is a chronic, progressive inflammatory disease of the central nervous system that causes myelin sheath involvement and destruction in the brain and spinal cord. In the first stage of the progression of MS, the myelin sheath of a person’s nerve cell becomes inflamed which is associated with several devastating effects [2]. One of the major problems of MS patients is their functional disability in different areas of life. Functional disability is a functional problem at the physical, personal, and social level in one or multiple aspects of life that one experiences in interacting with environmental factors and health conditions [10]. In recent years, scientists used non-pharmacological interventions in MS treatments. One of these methods is the mindfulness-based stress reduction (MBSR) program with a behavioral intervention based on self-focused attention [15]. It is an 8-week program focused on teaching a variety of mindfulness exercises including sitting meditation, body scan, walking meditation, loving meditation, and gentleness. In this method, the patients learn to increase self-compassion in a non-judgment way; they learn to increase moment-to-moment awareness rather than having automatic reaction as well as learning new ways of responding to situations [16]. In this study, the key question is whether MBSR therapy can affect functional disability in patients with MS.
Materials and Methods
The study population consisted of all male and female patients with MS in Neyshabur City, Iran (N=120). Of these, 47 were selected using a convenience sampling technique and randomly assigned into two groups of intervention (n=22) and control (n=25). Inclusion criteria were as follows: 1. diagnosis of MS by the physician; 2. age range of 20-55 years; 3. reading and writing literacy; 4. having MS over the past 6-12 months; 5. not receiving two psychological interventions at the same time; 6. having consent to participate in the study. Exclusion criteria were as follows: 1. history of psychiatric diseases and taking medications in the past year; 2. having mental retardation, 3. having suicidal thoughts and history of substance abuse and alcohol consumption; 4. absence of more than two sessions in counseling sessions; 5. having no cooperation during the interventions. 
At first, the patients were matched for demographic characteristics (e.g. age, level of education, and the severity of disease) to control the confounding variables. The intervention group received MBSR program for 8 sessions, while the control group received no intervention. Follow-up was performed after one month. The subjects responded to the World Health Organization Disability Assessment questionnaire. It was developed by Aston (2010) to evaluate the functional disability in patients with chronic pains. This tool has 36 items assessing 6 subscales. The Cronbach’s alpha coefficient for the whole questionnaire was 0.95 which indicates the instrument had good validity and reliability for assessment of disability. Repeated measures Analysis of Variance (ANOVA) was performed in SPSS v. 21 software for analyzing collected data.
Results
The results of univariate ANOVA showed the significant effect of time on functional disability (F=29.04, P=0.001) as well as the significant effect of interaction effect of time and group on functional disability (F=26.18, P=0.001). Furthermore, pretest scores were significantly different from posttest and follow-up scores (P=0.001); however, no significant difference was found between posttest and follow-up scores. This indicates the effectiveness of MBSR intervention on functional disability after intervention, which continued in the follow-up phase (Tables 1, 2).
 

 

Conclusion
The purpose of this study was to investigate the effect of MBSR program on functional disability of MS. patients. The results showed that MBSR therapy can reduce the functional disability in patients with MS. Its effectiveness was continued in the follow-up phase.
Grossman et al. [26] believe that MBSR therapy can help people with MS to cope with life’s challenges like functional impairment. By examining 150 patients with secondary progressive multiple sclerosis (SPMS), they showed that MBSR program for 8 weeks, compared to other conventional care methods, affects depression, fatigue, disability, and the Quality of Life and these effects are stable over a six-month follow-up. It can be argued that MBSR program leads to improved function of the patient with MS by reducing psychological stress indices and psychological distress. According to Mills and Allen [27], mindfulness to physical movements and functions in patients with MS serves as a coping strategy, and continuation of moment-to-moment awareness leads to improvement in patient’s motion and function.
MBSR intervention is a self-help method for enhancing the physical and psychological functions in patients with MS. In this regard, Carlson [28] believe that this intervention reduces functional disability and causes multifaceted improvement in physical, social and cognitive functions of the patient by increasing the patient’s awareness of the disease symptoms and conditions, and has a positive effect on the Quality of Life of the patient and his/her family and close relatives. The effectiveness of MBSR program reported in this study may be due to its ease of treatment, faster patient education, and the short duration of intervention sessions. It can also be concluded that these interventions can be used as a useful method to reduce the functional disability of MS patients.
Ethical Considerations
Compliance with ethical guidelines
This study obtained its ethical approval form the Research Ethics Committee of Neyshabur University of Medical Sciences (code: IR.NUMS.REC.1397.4) and is a registered clinical trial (code: IRCT20151228025732N33). All participants of the study signed a written consent form and were assured of the confidentiality of their information.
Funding
This study was extracted from a master thesis approved by Narges Ensan in Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Semnan University.
Authors' contributions
All authors met the writing standards of the International Committee of Medical Journal Publishers and all contributed equally to the writing of this article.
Conflicts of interest
The authors declare no conflict of interest.
Acknowledgements
The authors would like to thank the university, patients participated in the study and all those helped in conducting this study.

References