Which behavioural and exercise interventions targeting fatigue show the most promise in multiple sclerosis? A systematic review with narrative synthesis and meta-analysis

TY - JOUR

T1 - Which behavioural and exercise interventions targeting fatigue show the most promise in multiple sclerosis? A systematic review with narrative synthesis and meta-analysis

AU - Moss-Morris, Rona

AU - Harrison, Anthony

AU - Safari, Reza

AU - Norton, Sam

AU - van der Linden, Marietta L

AU - Picariello, Federica

AU - Thomas, Sarah

AU - White, Claire Margaret

AU - Mercer, Tom

N1 - Funding Information: This work was supported by the MS Society UK under Grant 26 . We would also like to thank Dr Jane Petty, Stephanie Hanna, Carole Bennett and Kay-Anne Sheen, patient and public involvement members, for their help and support with the review and associated MS Society stakeholder event. Louise Sweeney, Samantha Goodliffe and Georgia Andreopoulou assisted with data extraction. Funding Information: This work was supported by the MS Society UK under Grant 26. We would also like to thank Dr Jane Petty, Stephanie Hanna, Carole Bennett and Kay-Anne Sheen, patient and public involvement members, for their help and support with the review and associated MS Society stakeholder event. Louise Sweeney, Samantha Goodliffe and Georgia Andreopoulou assisted with data extraction. Publisher Copyright: © 2019 Elsevier Ltd Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/2/1

Y1 - 2021/2/1

N2 - Fatigue is a common and highly debilitating symptom of multiple sclerosis (MS). This meta-analytic systematic review with detailed narrative synthesis examined randomised-controlled (RCTs) and controlled trials of behavioural and exercise interventions targeting fatigue in adults with MS to assess which treatments offer the most promise in reducing fatigue severity/impact. Medline, EMBASE and PsycInfo electronic databases, amongst others, were searched through to August 2018. Thirty-four trials (12 exercise, 16 behavioural and 6 combined; n = 2,434 participants) met inclusion criteria. Data from 31 studies (n = 1,991 participants) contributed to the meta-analysis. Risk of bias (using the Cochrane tool) and study quality (GRADE) were assessed. The pooled (SMD) end-of-treatment effects on self-reported fatigue were: exercise interventions (n = 13) -.84 (95% CI -1.20 to -.47); behavioural interventions (n = 16) -.37 (95% CI -.53 to -.22); combined interventions (n = 5) -.16 (95% CI: -.36 to .04). Heterogeneity was high overall. Study quality was very low for exercise interventions and moderate for behavioural and combined interventions. Considering health care professional time, subgroup results suggest web-based cognitive behavioural therapy for fatigue, balance and/or multicomponent exercise interventions may be the cost-efficient therapies. These need testing in large RCTs with long-term follow-up to help define an implementable fatigue management pathway in MS.

AB - Fatigue is a common and highly debilitating symptom of multiple sclerosis (MS). This meta-analytic systematic review with detailed narrative synthesis examined randomised-controlled (RCTs) and controlled trials of behavioural and exercise interventions targeting fatigue in adults with MS to assess which treatments offer the most promise in reducing fatigue severity/impact. Medline, EMBASE and PsycInfo electronic databases, amongst others, were searched through to August 2018. Thirty-four trials (12 exercise, 16 behavioural and 6 combined; n = 2,434 participants) met inclusion criteria. Data from 31 studies (n = 1,991 participants) contributed to the meta-analysis. Risk of bias (using the Cochrane tool) and study quality (GRADE) were assessed. The pooled (SMD) end-of-treatment effects on self-reported fatigue were: exercise interventions (n = 13) -.84 (95% CI -1.20 to -.47); behavioural interventions (n = 16) -.37 (95% CI -.53 to -.22); combined interventions (n = 5) -.16 (95% CI: -.36 to .04). Heterogeneity was high overall. Study quality was very low for exercise interventions and moderate for behavioural and combined interventions. Considering health care professional time, subgroup results suggest web-based cognitive behavioural therapy for fatigue, balance and/or multicomponent exercise interventions may be the cost-efficient therapies. These need testing in large RCTs with long-term follow-up to help define an implementable fatigue management pathway in MS.

KW - Fatigue

KW - Multiple Sclerosis

KW - Meta-analyses

KW - Randomised controlled trials

KW - Behavioural interventions

KW - Exercise interventions

UR - http://www.scopus.com/inward/record.url?scp=85075864636&partnerID=8YFLogxK

U2 - 10.1016/j.brat.2019.103464

DO - 10.1016/j.brat.2019.103464

M3 - Article

SN - 0005-7967

VL - 137

JO - Behaviour Research and Therapy

JF - Behaviour Research and Therapy

M1 - 103464

ER -