{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T14:17:15Z","timestamp":1787926635895,"version":"build-2784847793"},"reference-count":21,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100017694","name":"Hermann und Lilly Schilling-Stiftung f\u00fcr Medizinische Forschung","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100017694","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Multiple Sclerosis Journal \u2013 Experimental, Translational and Clinical"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Fatigue is a common symptom in people with multiple sclerosis (pwMS) with severe implications. A self-guided, internet-based intervention to reduce fatigue in MS, based on cognitive behavioral therapy (CBT), is approved as a digital health application (DiGA) in the German healthcare system. However, real-world evidence for efficacy is lacking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Of the 165 patients screened for fatigue using the Fatigue Scale for Motor and Cognitive Functions (FSMC), 129 were diagnosed with fatigue (FSMC \u2265 43) and enrolled. Patients with fatigue were randomized 1:1 to either a 12-week CBT-based online intervention (elevida, a CE-certified, self-guided DiGA for the management of MS-related fatigue; n\u2009=\u200964) or a psychoeducation arm (n\u2009=\u200965). After 12 weeks, patients in the psychoeducation group could cross-over to the CBT-based online intervention group. The primary outcome was FSMC-change.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The 12-week follow-up showed a reduction in FSMC in the primary CBT-based online intervention group (repeated measures ANOVA: F(1,48)\u2009=\u200910.99, p\u2009=\u20090.002), as well as the crossover-group (repeated measures ANOVA: F(1,15)\u2009=\u20095.81, p\u2009=\u20090.029). However, between-group analyses did not demonstrate superiority of the CBT-based online intervention over psychoeducation (mean difference 1.8 points, 95% CI \u22122.0 to 5.6; p\u2009=\u20090.35).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our results highlight CBT-based online interventions as promising supportive tools for managing cognitive fatigue in pwMS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/20552173261468118","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T15:03:01Z","timestamp":1787670181000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Real world observation of fatigue in multiple sclerosis comparing self-guided online cognitive behavioral therapy versus psychoeducation"],"prefix":"10.1177","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-7707-9050","authenticated-orcid":false,"given":"Maria","family":"Protopapa","sequence":"first","affiliation":[{"name":"University Medical Center of the Johannes Gutenberg University Mainz"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jana","family":"Samarin","sequence":"additional","affiliation":[{"name":"University Medical Center of the Johannes Gutenberg University Mainz"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muriel","family":"Schraad","sequence":"additional","affiliation":[{"name":"University Medical Center of the Johannes Gutenberg University Mainz"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Livia S","family":"Lang","sequence":"additional","affiliation":[{"name":"University Medical Center of the Johannes Gutenberg University Mainz"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianne","family":"Hahn","sequence":"additional","affiliation":[{"name":"University Medical Center of the Johannes Gutenberg University Mainz"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frauke","family":"Zipp","sequence":"additional","affiliation":[{"name":"University Medical Center of the Johannes Gutenberg University Mainz"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2179-3655","authenticated-orcid":false,"given":"Stefan","family":"Bittner","sequence":"additional","affiliation":[{"name":"University Medical Center of the Johannes Gutenberg University Mainz"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12883-021-02396-1"},{"key":"e_1_3_3_3_2","first-page":"741","article-title":"Chronic fatigue syndrome: diagnosis and treatment","volume":"86","author":"Yancey JR","year":"2012","unstructured":"Yancey JR, Thomas SM. Chronic fatigue syndrome: diagnosis and treatment. 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