Discussion
fatigue
OVARIAN CANCER, CARDIOVASCULAR DISEASES, MULTIPLE SCLEROSIS, BLIND, LEAKAGE
The findings of the study showed that the nurse-led fatigue management and the familiarity with fatigue reduction methods can improve fatigue, sleep quality, and self –efficacy of patients with MS. The high effect size values of the changes indicate that these improvements are clinically important. Evidence shows that few studies have examined the impact of the nurses-led fatigue management on sleep quality and patients’ self-efficacy. However, these interventions in other patient groups have shown positive effects [It is worth noting that patients who entered the current study had high fatigue scores at baseline. The findings showed that distance nurse-led fatigue management can reduce fatigue in patients with MS. Similarly, in a study of patients with ovarian cancer, nurse-led home based exercise, and cognitive behavioral therapy were effective in reducing the patients’ fatigue [Another finding of the study was that the distance nurse-led fatigue management could improve sleep quality of the patients. Similarly, in the study of Al-Sharman et al., aerobic exercises were effective on sleep quality and biological markers in patients with MS [One of the other findings of the present study was the improvement of self-efficacy after participating in the distance nurse-led fatigue program. Similarly, in a study in Shanghai, China, a nurse-led phone follow-up education program based on self-efficacy was effective on the improvement of self -efficacy of patients with cardiovascular diseases [Evidence shows that during COVID-19 pandemic, patients with MS experienced higher fatigue and weaker mental health indicators. In addition, they left their home less frequently and had less daily activities [Based on our searches, the present study seems to be the first study on nurse-led fatigue management in patients with multiple sclerosis. Hence, the lessons learned from this research should be useful in designing and implementing future studies. One of the strengths of this study is the provision of non-attendance and distance training. This intervention provided the participants access to training they needed and there was no need to visit in person to receive training during COVID-19 pandemic. Hence, we recommend to emphasize the use of distance nursing for this group of patients. Another strength of this study is assigning the personal username and password for each participant to enter the Skyroom website, which reduced the possibility of sharing educational materials between the members of the intervention and control groups. In addition, patients in the intervention group were urged not to talk about the educational program with other patients. However, there is a possibility of information leakage between the two groups, which is one of the limitations of the study. In addition, due to the nature of our intervention, it was not possible to blind the participants, but in order to blind the researcher, pre- and post-intervention data were collected by a research assistant. Another limitation of this study was the short-term follow-up period. Therefore, the effectiveness of similar interventions should be examined for a longer period of time. One more limitation is that the attrition occurred only in the intervention group. Nevertheless, two groups were comparable based on general information and baseline main variables. Moreover, since quasi-experimental studies are subject to threats of internal validity, we recommend that the study design be improved in future research projects.