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dc.contributor.authorMoss-Moris, R
dc.contributor.authorHarrison, A.M
dc.contributor.authorSafari, Reza
dc.contributor.authorNorton, S
dc.contributor.authorvan der Linden, M.L
dc.contributor.authorPicariello, F
dc.contributor.authorThomas, S
dc.contributor.authorWhite, C
dc.contributor.authorMercer, T
dc.creatorRona, Moss-Morris
dc.date.accessioned2019-12-05T09:22:22Z
dc.date.available2019-12-05T09:22:22Z
dc.date.issued2019-08-28
dc.identifier.citationMoss-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.en_US
dc.identifier.issn00057967
dc.identifier.doi10.1016/j.brat.2019.103464
dc.identifier.urihttp://hdl.handle.net/10545/624313
dc.description.abstractFatigue 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.en_US
dc.description.sponsorshipMS Society, UKen_US
dc.language.isoenen_US
dc.publisherElsevieren_US
dc.relation.ispartofBehaviour Research and Therapy
dc.relation.urlhttps://www.sciencedirect.com/science/article/pii/S0005796719301500en_US
dc.rights© 2019 Elsevier Ltd. All rights reserved.
dc.subjectFatigueen_US
dc.subjectMultiple sclerosis (MS)en_US
dc.subjectMeta-analysisen_US
dc.subjectRandomised controlled trialsen_US
dc.subjectBehavioural interventionsen_US
dc.subjectExercise interventionsen_US
dc.titleWhich behavioural and exercise interventions targeting fatigue show the most promise in multiple sclerosis? A systematic review with narrative synthesis and meta-analysisen_US
dc.typeArticleen_US
dc.contributor.departmentUniversity of Derbyen_US
dc.identifier.journalBehaviour Research and Therapyen_US
dc.identifier.eid1-s2.0-S0005796719301500
dc.identifier.piiS0005-7967(19)30150-0
dc.source.beginpage103464
dcterms.dateAccepted2019-08-25
refterms.dateFOA2020-11-18T16:24:57Z
dc.author.detail785511en_US


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