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

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    Moss-Morris 2019.pdf
    Embargo:
    2021-08-28
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    Authors
    Moss-Moris, R
    Harrison, A.M
    Safari, Reza cc
    Norton, S
    van der Linden, M.L
    Picariello, F
    Thomas, S
    White, C
    Mercer, T
    Affiliation
    University of Derby
    Issue Date
    2019-08-28
    
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    Abstract
    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.
    Citation
    Moss-Morris, R., Harrison, A.M., Safari, R., Norton, S., van der Linden, M.L., Picariello, F., Thomas, S., White, C. and Mercer, T., (2019). 'Which behavioural and exercise interventions targeting fatigue show the most promise in multiple sclerosis? A systematic review with narrative synthesis and meta-analysis'. Behaviour research and therapy, pp, 1-19. DOI: 10.1016/j.brat.2019.103464.
    Publisher
    Elsevier
    Journal
    Behaviour Research and Therapy
    URI
    http://hdl.handle.net/10545/624313
    DOI
    10.1016/j.brat.2019.103464
    Additional Links
    https://www.sciencedirect.com/science/article/pii/S0005796719301500
    Type
    Article
    Language
    en
    ISSN
    00057967
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.brat.2019.103464
    Scopus Count
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    Health and Social Care Research Centre

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