Establishing consensus on lifestyle recommendations and behaviour change strategies to promote brain health-focussed care for multiple sclerosis: A modified e-Delphi study

Introduction: Brain health is a global priority for multiple sclerosis (MS) care. This study aimed to establish consensus on internationally applicable lifestyle recommendations and behaviour change strategies to promote lifelong brain health for people living with MS. Methods: A three-round, modified, e-Delphi survey was conducted. Lifestyle recommendations and behaviour change strategies were generated based on a review of the published literature, qualitative interviews, and expert feedback, respectively. Results: Sixty-nine experts participated, with a final response rate of 75 %. Experts were predominantly female (n = 50, 72 %), 30 to 59 years of age (n = 54, 78 %) and worked in an academic institution (n = 21, 50 %). A majority (n = 16, 80 %) of experts with lived experience had a relapsing-remitting phenotype. Starting with 15 lifestyle recommendations, we iteratively identified new recommendations and combined existing ones, achieving consensus on 17 lifestyle recommendations among experts from healthcare, academia, research and advocacy; 16 among experts with lived experience, and 14 behaviour change strategies, presented as separate frameworks. Conclusions: An e-Delphi process has established lifestyle recommendations and identified behaviour change strategies to promote brain health-focussed care for MS. Reliance on these frameworks with detailed management recommendations may help to establish consistency in lifestyle behaviour management of MS, between and within healthcare systems.