• Application of ultrasound in the assessment of plantar fascia in patients with plantar fasciitis: a systematic review

      Mohseni-Bandpei, M.A; Nakhaee, M; Mousavi, M.E; Shakourirad, A; Safari, Reza; Kashani, R.V; University of Social Welfare and Rehabilitation Sciences; University of Lahore, Pakistan (Elsevier, 2014-05-03)
      Plantar fasciitis (PFS) is one of the most common causes of heel pain, estimated to affect 10% of the general population during their lifetime. Ultrasound (US) imaging technique is increasingly being used to assess plantar fascia (PF) thickness, monitor the effect of different interventions and guide therapeutic interventions in patients with PFS. The purpose of the present study was to systematically review previously published studies concerning the application of US in the assessment of PF in patients with PFS. A literature search was performed for the period 2000-2012 using the Science Direct, Scopus, PubMed, CINAHL, Medline, Embase and Springer databases. The key words used were: ultrasound, sonography, imaging techniques, ultrasonography, interventional ultrasonography, plantar fascia and plantar fasciitis. The literature search yielded 34 relevant studies. Sixteen studies evaluated the effect of different interventions on PF thickness in patients with PFS using US; 12 studies compared PF thickness between patients with and without PFS using US; 6 studies investigated the application of US as a guide for therapeutic intervention in patients with PFS. There were variations among studies in terms of methodology used. The results indicated that US can be considered a reliable imaging technique for assessing PF thickness, monitoring the effect of different interventions and guiding therapeutic interventions in patients with PFS.
    • Development and preliminary evaluation of a new anatomically based prosthetic alignment method for below-knee prosthesis.

      Tafti, Nahid; Karimlou, Masoud; Mardani, Mohammad Ali; Jafarpisheh, Amir Salar; Aminian, Gholam Reza; Safari, Reza; University of Social Welfare and Rehabilitation Sciences; Islamic Azad University; University of Derby (Taylor and Francis, 2018-04-20)
      The objectives of current study were to a) assess similarities and relationships between anatomical landmark-based angles and distances of lower limbs in unilateral transtibial amputees and b) develop and evaluate a new anatomically based static prosthetic alignment method. First sub-study assessed the anthropometrical differences and relationships between the lower limbs in the photographs taken from amputees. Data were analysed via paired t-test and regression analysis. Results show no significant differences in frontal and transverse planes. In the sagittal plane, the anthropometric parameters of the amputated limb were significantly correlated to the corresponding variables of the sound limb. The results served as bases for the development of a new prosthetic alignment method. The method was evaluated on a single subject study. Prosthetic alignment carried out by an experienced prosthetist was compared with such alignment adjusted by an inexperienced prosthetist but with the use of the developed method. In sagittal and frontal planes, the socket angle was tuned with respect to the shin angle, and the position of the prosthetic foot was tuned in relation to the pelvic landmarks. Further study is needed to assess the proposed method on a larger sample of amputees and prosthetists.
    • Digital interventions to promote self-management in people with osteoarthritis: systematic review and meta-analysis - Study protocol

      Safari, Reza; Jackson, Jessica; Dhadda, Buk; Watkins, Merryl; Sheffield, David; Anthony, Denis; Ward, Derek; University of Derby; NHS Southern Derbyshire; Lincolnshire County Council (National Health Service (NHS), 2018-05-11)
      The proposed research is a systematic review and meta-analysis of available randomised controlled trials of digital interventions to promote self-management in people with osteoarthritis. The effects of self-management programs, on patient outcomes such as pain, disability, function and quality of life will be analysed in direct pairwise meta-analysis. The health service outcomes and cost effectiveness data will also be extracted if reported in the papers and will be synthesised narratively.
    • Digital-based self-management interventions for people with osteoarthritis: Systematic review with meta-analysis

      Safari, Reza; Jackson, Jessica; Sheffield, David; University of Derby (JMIR Publications Inc., 2020-06)
      Osteoarthritis (OA) is not curable but the symptoms can be managed through Self-management programmes. Due to the growing burden of arthritis to the health system, and the need to ensure high quality integrated services, delivering Self-management programmes through digital technologies could be an economic and effective community-based model of care. To analyze the effectiveness of digital-based self-management programs on patient outcomes in people with OA. Seven online databases and three grey literature databases were searched for randomized controlled trials (RCT) assessing digital-based structured self-management programs (D-SMP) on self-reported outcomes including pain, function, disability, and health-related quality of life in people with OA. Two reviewers independently screened the search results and reference list of identified papers and related reviews. Data about the intervention components and delivery, and behavioral change techniques were extracted. Meta-analysis, risk of bias sensitivity analysis and subgroup analysis were performed where appropriate. The GRADE approach was used to assess the quality of evidence. Eight studies were eligible including 2687 people with OA. Self-management programs were delivered via telephone plus audio/video, internet or mobile app. D-SMP compared to Treatment As Usual control group resulted in a significant, homogeneous, moderate reduction in pain (SMD -0.28, 95% CI -0.38 to -0.18) and improvement in physical function (-0.26 95% CI -0.35 to -0.16) at post-treatment. The D-SMP effect reduced slightly at 12 months follow-up but remained significant and moderate. Using the GRADE approach, the quality of evidence was rated as ‘moderate’. D-SMPs may result in a moderate improvement in pain symptoms and function in people with OA delivered. Further research is required to confirm the findings of the review and assess the effects of D-SMPs on other health-related outcomes. Clinical Trial: PROSPERO: CRD42018089322
    • Effect of exercise interventions on perceived fatigue in people with multiple sclerosis: synthesis of meta-analytic reviews

      Safari, Reza; Van der Linden, Marietta L.; Mercer, Tom H.; University of Derby; Queen Margaret University; Centre for Health & Social Care Research, College of Health & Social Care, University of Derby, Derby, DE22 1GB, UK; Centre for Health & Social Care Research, College of Health & Social Care, University of Derby, Derby, DE22 1GB, UK; Centre for Health & Social Care Research, College of Health & Social Care, University of Derby, Derby, DE22 1GB, UK (Future Medicine, 2017-06-20)
      Although exercise training has been advocated as a nonpharmacological treatment for multiple sclerosis (MS) related fatigue, no consensus exists regarding its effectiveness. To address this, we collated meta-analytic reviews that explored the effectiveness of exercise training for the treatment of MS-related fatigue. We searched five online databases for relevant reviews, published since 2005, and identified 172 records. Five reviews were retained for systematic extraction of information and evidence quality analysis. Although our review synthesis indicated that exercise training interventions have a moderate effect on fatigue reduction in people with MS, no clear insight was obtained regarding the relative effectiveness of specific types or modes of exercise intervention. Moreover, Grading of Recommendation Assessment, Development and Evaluation revealed that the overall quality of evidence emanating from these five reviews was ‘very low’.
    • Fatigue interventions in long term, physical health conditions: a scoping review of systematic reviews.

      Hulme, Katrin; Safari, Reza; Thomas, Sarah; Mercer, Tom; White, Claire; Van der Linden, Marietta; Moss-Morris, Rona; University of Derby; King’s College London; Staffordshire University; et al. (PLOS, 2018-10-12)
      Fatigue is prominent across many long term physical health conditions. This scoping review aimed to map the fatigue intervention literature, to ascertain if certain interventions may be effective across conditions, and if novel interventions tested in specific long term conditions may be promising for other conditions.
    • Lower limb prosthetic interfaces: Clinical and technological advancement and potential future direction

      Safari, Reza; University of Derby (SAGE Publications, 2020-11-08)
      The human–prosthesis interface is one of the most complicated challenges facing the field of prosthetics, despite substantive investments in research and development by researchers and clinicians around the world. The journal of the International Society for Prosthetics and Orthotics, Prosthetics and Orthotics International, has contributed substantively to the growing body of knowledge on this topic. In celebrating the 50th anniversary of the International Society for Prosthetics and Orthotics, this narrative review aims to explore how human–prosthesis interfaces have changed over the last five decades; how research has contributed to an understanding of interface mechanics; how clinical practice has been informed as a result; and what might be potential future directions. Studies reporting on comparison, design, manufacturing and evaluation of lower limb prosthetic sockets, and osseointegration were considered. This review demonstrates that, over the last 50 years, clinical research has improved our understanding of socket designs and their effects; however, high-quality research is still needed. In particular, there have been advances in the development of volume and thermal control mechanisms with a few designs having the potential for clinical application. Similarly, advances in sensing technology, soft tissue quantification techniques, computing technology, and additive manufacturing are moving towards enabling automated, data-driven manufacturing of sockets. In people who are unable to use a prosthetic socket, osseointegration provides a functional solution not available 50 years ago. Furthermore, osseointegration has the potential to facilitate neuromuscular integration. Despite these advances, further improvement in mechanical features of implants, and infection control and prevention are needed.
    • Prevalence of heat and perspiration discomfort inside prostheses: literature review.

      Ghoseiri, K; Safari, Reza; University of Social Welfare and Rehabilitation Sciences (U.S. Department of Veterans, 2014-01-01)
      People with limb amputation deal with thermal stresses in their daily activities. Unfortunately, in the majority of this population, all thermal transfer mechanisms, including convection, radiation, evaporation, and conduction, can be disturbed due to the prosthetic socket barrier, decreased body surface area, and/or vascular disease. The thermal environment inside prosthetic sockets, in addition to decreased quality of life and prosthesis use, comfort, and satisfaction, could endanger people with amputation with a high risk of skin irritations. The current review explores the importance of thermal and perspiration discomfort inside prosthetic sockets by providing an insight into the prevalence of the problem. The literature search was performed in two databases, PubMed and Web of Knowledge, to find relevant articles. After considering the review criteria and hand-searching the reference sections of the selected studies, 38 studies were listed for review and data extraction. This review revealed that more than 53% of people with amputation in the selected studies experienced heat and/or perspiration discomfort inside their prostheses. In spite of great technological advances, current prostheses are unable to resolve this problem. Therefore, more attention must be paid by researchers, clinicians, and manufacturers of prosthetic components to thermal-related biomechanics of soft tissues, proper fabrication technique, material selection, and introduction of efficient thermoregulatory systems.
    • Prevalence of pressure ulcers in Africa: A systematic review and meta-analysis

      Anthony, Denis; Alosaimi, Dalyal; Korsah, Kwadwo; Safari, Reza; Shiferaw, Wondimeneh Shibabaw; University of Derby; College of Nursing, King Saud University, Saudi Arabia; Institute of Medicine and College of Health Sciences, Debre Berhan University, Ethiopia; School of Nursing and Midwifery, University of Ghana, Ghana (Elsevier, 2021-10-27)
      A recent global review of pressure ulcers contained no studies from Africa. To identify the prevalence and incidence of pressure ulcers in Africa. Bibliographic databases, African specific databases, grey literature. Studies with prevalence or incidence data of pressure ulcers from Africa since the year 2000. Any age, including children, in any setting, specifically including hospital patients from any clinical area but not restricted to hospital settings. Holy score for bias, Joanna Briggs Institute Critical Appraisal Instrument. We followed the PRISMA guideline for systematic reviews. We searched Embase, Medline, Scopus, CINHAL, Google Scholar, specialist African databases and grey literature for studies reporting incidence or prevalence data. Nineteen studies met the inclusion criteria and were included in the study. Point prevalence rates varied from 3.4% to 18.6% for medical/surgical and other general hospital units with a pooled prevalence of 11%, for grades II-IV 5%. For spinal injury units the pooled prevalence was 44%. Restricted to English, French and Arabic. Prevalence of pressure ulcers in Africa reported here is similar to figures from a recent review of prevalence in Europe and two recent global reviews of hospitalised patients. Prevalence of pressure ulcers in spinal cord injury patients is similar to figures from a review of developing countries. The reporting of prevalence is lacking in detail in some studies. Studies using an observational design employing physical examination of patients showed higher prevalence than those relying on other methods such as medical notes or databases. Further prevalence and incidence studies are needed in Africa. Reporting of such studies should ensure items in the “Checklist for Prevalence Studies” from Joanna Briggs Institute (or similar well regarded resources) are addressed and the PICOS model and PRISMA guidelines are employed. Systematic review registration number. Prospero registration number CRD42020180093
    • Prevalence of pressure ulcers in long term care: A global review.

      Anthony, Denis; Alosoumi, Dalyal; Safari, Reza; University of Derby (Mark Allen Healthcare, 2019)
      To identify the prevalence and incidence of pressure ulcers in people with long term conditions resident in care homes or nursing homes . We followed the PRISMA guideline for systematic reviews however due to funding constraints we do not claim this review to be systematic but it is a narrative review informed by PRISMA. We searched Embase, Medline and CINHAL for observational studies reporting incidence or prevalence data. Data reported relevant head to toe examination of the pressure ulcer in residence of care or nursing homes. Internat and external validity of the included studies were assessed using the checklist devised by Hoy et al (2012). Seventeen studies met the inclusion criteria an included in the study. Some studies gave a full breakdown by grade, some only gave overall figures and some excluded grade I pressure ulcers. However within those constraints certain patterns are clear. Prevalence rates varied from 3.4% to 32.4% and large differences in prevalence in different countries was not explained by methodological differences. While some countries such as Germany, the Netherlands and the USA had robust data some countries such as the UK had none. Pressure ulcers are a common problem in long term care. However there are substantial differences between countries and many countries have no published data.
    • The prototype of a thermoregulatory system for measurement and control of temperature inside prosthetic socket

      Ghoseiri, Kamiar; Ghoseiri, K; Zheng, Y.P; Hing, L.T; Safari, Reza; Leung, A.K.L; University of Social Welfare and Rehabilitation Sciences; Hong Kong Polytechnic University (SAGE, 2015-06-11)
      Thermal related problems with prostheses are common complaints of amputee people. This article aims to introduce a thermoregulatory technique as a potential solution for those problems in prostheses wearers. A smart thermoregulatory system was designed, manufactured, and installed on a phantom model of a prosthetic socket. It captured temperature data from 16 sensors positioned at the interface between the phantom model and a silicone liner and used their average for comparison with a defined set temperature to select required heating or cooling functions for thermal equilibrium. A thin layer of Aluminum was used to transfer temperature between thermal pump and different sites around the phantom model. The feasibility of this thermoregulatory technique was confirmed by its ability to provide thermal equilibrium. Further investigations to improve the design of thermoregulatory system are necessary including temperature transfer element and power consumption based on thermal capacity and thermal inertia of the residual limb. The smart thermoregulatory system by providing thermal equilibrium between two sides of a prosthetic silicone liner can control residual limb skin temperature and sweating. Consequently, it can improve quality of life in amputee people.
    • Socket interface pressure and amputee reported outcomes for comfortable and uncomfortable conditions of patellar tendon bearing socket: a pilot study

      Safari, Reza; Tafti, Nahid; Aminian, Gholamreza; University of Social Welfare and Rehabilitation Sciences (Taylor & Francis, 2015-03-11)
      The objectives of the current study were to compare intra-socket pressure differences between comfortable and uncomfortable socket conditions, and the usefulness of subject perception of satisfaction, activity limitations, and socket comfort in distinguishing between these two socket conditions. Five unilateral trans-tibial amputees took part in the study. They answered the Socket Comfort Score (SCS) and Trinity Amputation and Prosthetic Experience Scale (TAPES) questionnaires before the interface pressure (in standing and walking) was measured for the uncomfortable socket condition at five regions of the residual limb. Participants were then provided with a comfortable socket and wore it for two weeks. Participants who were satisfied with the socket fit after two weeks repeated the SCS and TAPES questionnaires and interface pressure measurements. The differences between the test results of the two conditions were not statistically significant, except for the interface pressure at the popliteal region during the early stance phase, TAPES socket fit subscale, and the SCS. Due to large variability of the data and the lack of statistical significance, no firm conclusion can be made on the possible relationship between the interface pressure values and the patient-reported outcomes of the two socket conditions. A larger sample size and longer acclimation period are required to locate significant differences.
    • Systematic review of effects of current transtibial prosthetic socket designs—Part 1: Qualitative outcomes

      Safari, Reza; Meier, Margrit Regula; University Of Social Welfare and Rehabilitation Sciences; Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran;; Department for Occupational Therapy, Prosthetics, and Orthotics, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway (PLOS, 2015)
      This review is an attempt to untangle the complexity of transtibial prosthetic socket fit, determine the most important characteristic for a successful fitting, and perhaps find some indication of whether a particular prosthetic socket type might be best for a given situation. Further, it is intended to provide directions for future research. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and used medical subject headings and standard key words to search for articles in relevant databases. No restrictions were made on study design or type of outcome measure. From the obtained search results (n = 1,863), 35 articles were included. The relevant data were entered into a predefined data form that incorporated the Downs and Black risk of bias assessment checklist. Results for the qualitative outcomes (n = 19 articles) are synthesized. Total surface bearing sockets lead to greater activity levels and satisfaction in active persons with amputation, those with a traumatic cause of amputation, and younger persons with amputation than patellar tendon bearing sockets. Evidence on vacuum-assisted suction and hydrostatic sockets is inadequate, and further studies are much needed. To improve the scientific basis for prescription, comparison of and correlation between mechanical properties of interface material, socket designs, user characteristics, and outcome measures should be conducted and reported in future studies.
    • Systematic review of effects of current transtibial prosthetic socket designs—Part 2: Quantitative outcomes

      Safari, Reza; Meier, Margrit Regula; University of Social Welfare and Rehabilitation Sciences; Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran;; Department for Occupational Therapy, Prosthetics, and Orthotics, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway (PLOS, 2015)
      This review is an attempt to untangle the complexity of transtibial prosthetic socket fit and perhaps find some indication of whether a particular prosthetic socket type might be best for a given situation. In addition, we identified knowledge gaps, thus providing direction for possible future research. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, using medical subject headings and standard key words to search for articles in relevant databases. No restrictions were made on study design and type of outcome measure used. From the obtained search results (n = 1,863), 35 articles were included. The relevant data were entered into a predefined data form that included the Downs and Black risk of bias assessment checklist. This article presents the results from the systematic review of the quantitative outcomes (n = 27 articles). Trends indicate that vacuum-assisted suction sockets improve gait symmetry, volume control, and residual limb health more than other socket designs. Hydrostatic sockets seem to create less inconsistent socket fittings, reducing a problem that greatly influences outcome measures. Knowledge gaps exist in the understanding of clinically meaningful changes in socket fit and its effect on biomechanical outcomes. Further, safe and comfortable pressure thresholds under various conditions should be determined through a systematic approach.
    • A systematic review of variables used to assess clinically acceptable alignment of unilateral transtibial amputees in the literature.

      Tafti, Nahid; Hemmati, Fatemeh; Safari, Reza; Karimi, Mohammad Taghi; Farmani, Farzad; Khalaf, Ali; Mardani, Mohammad Ali; University of Derby; University of Social Welfare and Rehabilitation Sciences; Shiraz University of Medical Sciences; et al. (Sage, 2018-08-08)
      Prosthetic alignment is a subjective concept which lacks reliability. The outcome responsiveness to prosthetic alignment quality could help to improve subjective and instrument assisted prosthetic alignment. This study was aimed to review variables used to assess clinically acceptable alignment in the literature. The search was done in some databases including: Google Scholar, PubMed, EBSCO, EMBASE, ISI Web of Knowledge and Scopus. The first selection criterion was based on abstracts and titles to address the research questions of interest. The American Academy of Orthotics and Prosthetics checklists were used for paper risk of bias assessment. A total of 25 studies were included in this study. Twenty-four studies revealed the critics of standing position or walking to locate clinically acceptable alignment, only one study measured outcomes in both situations. A total of 253 adults with transtibial amputations and mean age of 48.71 years participated in included studies. The confidence level of included studies was low to moderate, and before-after trial was the most common study design (n = 19). The joint angle, load line location with respect to joints and center of pressure-related parameters were reported as sensitive outcomes to prosthetic alignment quality in standing posture. The amount of forces at various parts of gait cycle and time of events were sensitive to prosthetic alignment quality during walking. Standing balance and posture and temporal parameters of walking could help to locate clinically acceptable alignment.
    • Temperature measurement and control system for transtibial prostheses: functional evaluation.

      Ghoseiri, Kamiar; Zheng, Yong Ping; Leung, Aaron K L; Rahgozar, Mehdi; Aminian, Gholamreza; Lee, Tat Hing; Safari, Reza; University of Social Welfare and Rehabilitation Sciences (Taylor & Francis, 2016-11-14)
      The accumulation of heat inside the prosthetic socket increases skin temperature and fosters perspiration, which consequently leads to high tissue stress, friction blister, discomfort, unpleasant odor, and decreased prosthesis suspension and use. In the present study, the prototype of a temperature measurement and control (TM&C) system was designed, fabricated, and functionally evaluated in a phantom model of the transtibial prosthetic socket. The TM&C system was comprised of 12 thermistors divided equally into two groups that arranged internal and external to a prosthetic silicone liner. Its control system was programmed to select the required heating or cooling function of a thermal pump to provide thermal equilibrium based on the amount of temperature difference from a defined set temperature, or the amount of difference between the mean temperature recorded by inside and outside thermistors. A thin layer of aluminum was used for thermal conduction between the thermal pump and different sites around the silicone liner. The results showed functionality of the TM&C system for thermoregulation inside the prosthetic socket. However, enhancing the structure of this TM&C system, increasing its thermal power, and decreasing its weight and cost are main priorities before further development.
    • Temperature measurement and control system for transtibial prostheses: single subject clinical evaluation.

      Ghoseiri, Kamiar; Zheng, Yong Ping; Leung, Aaron K L; Rahgozar, Mehdi; Aminian, Gholamreza; Masoumi, Mehdi; Safari, Reza; University of Social Welfare and Rehabilitation Sciences (Taylor & Francis, 2016-11-14)
      The snug fit of a prosthetic socket over the residual limb can disturb thermal balance and put skin integrity in jeopardy by providing an unpleasant and infectious environment. The prototype of a temperature measurement and control (TM&C) system was previously introduced to resolve thermal problems related to prostheses. This study evaluates its clinical application in a setting with reversal, single subject design. The TM&C system was installed on a fabricated prosthetic socket of a man with unilateral transtibial amputation. Skin temperature of the residual limb without prosthesis at baseline and with prosthesis during rest and walking was evaluated. The thermal sense and thermal comfort of the participant were also evaluated. The results showed different skin temperature around the residual limb with a temperature decrease tendency from proximal to distal. The TM&C system decreased skin temperature rise after prosthesis wearing. The same situation occurred during walking, but the thermal power of the TM&C system was insufficient to overcome heat build-up in some regions of the residual limb. The participant reported no significant change of thermal sense and thermal comfort. Further investigations are warranted to examine thermography pattern of the residual limb, thermal sense, and thermal comfort in people with amputation.
    • Which behavioural and exercise interventions targeting fatigue show the most promise in multiple sclerosis? A systematic review with narrative synthesis and meta-analysis

      Moss-Moris, R; Harrison, A.M; Safari, Reza; Norton, S; van der Linden, M.L; Picariello, F; Thomas, S; White, C; Mercer, T; University of Derby (Elsevier, 2019-08-28)
      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.
    • Which exercise and behavioural interventions show most promise for treating fatigue in multiple sclerosis? A network meta-analysis

      Harrison, Anthony M; Safari, Reza; Mercer, Tom; Picariello, Federica; van der Linden, Marietta L; White, Claire; Moss-Morris, Rona; Norton, Sam; University of Derby (SAGE Publications, 2021-04-20)
      Fatigue is a common, debilitating symptom of multiple sclerosis (MS) without a current standardised treatment. The aim of this systematic review with network meta-analyses was to estimate the relative effectiveness of both fatigue-targeted and non-targeted exercise, behavioural and combined (behavioural and exercise) interventions. Nine electronic databases up to August 2018 were searched, and 113 trials (n = 6909) were included: 34 were fatigue-targeted and 79 non-fatigue-targeted trials. Intervention characteristics were extracted using the Template for Intervention Description and Replication guidelines. Certainty of evidence was assessed using GRADE. Pairwise meta-analyses showed that exercise interventions demonstrated moderate to large effects across subtypes regardless of treatment target, with the largest effect for balance exercise (SMD = 0.84). Cognitive behavioural therapies (CBTs) showed moderate to large effects (SMD = 0.60), with fatigue-targeted treatments showing larger effects than those targeting distress. Network meta-analysis showed that balance exercise performed significantly better compared to other exercise and behavioural intervention subtypes, except CBT. CBT was estimated to be superior to energy conservation and other behavioural interventions. Combined exercise also had a moderate to large effect. Treatment recommendations for balance and combined exercise are tentative as the certainty of the evidence was moderate. The certainty of the evidence for CBT was high.