Behavioral and exercise interventions may be cost-effective therapies to target fatigue in patients with multiple sclerosis (MS), according to a systematic review and meta-analysis.
Fatigue is common in patients with MS and can often be debilitating, significantly affecting a patient’s quality of life.
“This meta-analytic systematic review with detailed narrative synthesis examined randomized-controlled (RCTs) and controlled trials of behavioral and exercise interventions targeting fatigue in adults with MS to assess which treatments offer the most promise in reducing fatigue severity/impact,” the researchers stated.
Electronic databases, including Medline, EMBASE, and PsycInfo, were searched for studies published through August 2018, resulting in 34 trials encompassing 2,434 total patients; there were 16 behavioral, 12 exercise, and six combined trials. Data from 31 studies encompassing 1,991 total patients were used in the meta-analysis. Bias risk was determined using the Cochrane tool, and study quality was assessed using GRADE.
The pooled end-of-treatment effect of exercise interventions (n=13) on self-reported fatigue was –0.84 (95% confidence interval [CI], –1.20 to –0.47); of behavioral interventions (n=16), –0.37 (95% CI, –0.53 to –0.22); and of combined interventions (n=5), –0.16 (95% CI, –0.36 to 0.04). The overall heterogeneity was high. Exercise interventions had low study quality, while behavioral and combined interventions had moderate study quality.
“Considering healthcare professional time, subgroup results suggest web-based cognitive behavioral 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,” the study authors concluded.