Which exercise and behavioural interventions show most promise for treating fatigue in multiple sclerosis? A network meta-analysis

Journal article


Harrison, Anthony M, Safari, Reza, Mercer, Tom, Picariello, Federica, van der Linden, Marietta L, White, Claire, Moss-Morris, Rona and Norton, Sam 2021. Which exercise and behavioural interventions show most promise for treating fatigue in multiple sclerosis? A network meta-analysis. Multiple Sclerosis Journal. https://doi.org/10.1177/1352458521996002
AuthorsHarrison, Anthony M, Safari, Reza, Mercer, Tom, Picariello, Federica, van der Linden, Marietta L, White, Claire, Moss-Morris, Rona and Norton, Sam
Abstract

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.

KeywordsNeurology; Clinical Neurology; Fatigue; Multiple Sclerosis; Network Meta-anlalysis; Randomised Controlled Trials; Behavioural Interventions; Exercise Interventions; TIDieR
Year2021
JournalMultiple Sclerosis Journal
PublisherSAGE Publications
ISSN1352-4585
1477-0970
Digital Object Identifier (DOI)https://doi.org/10.1177/1352458521996002
Web address (URL)http://hdl.handle.net/10545/625735
http://creativecommons.org/publicdomain/zero/1.0/
hdl:10545/625735
Publication dates20 Apr 2021
Publication process dates
Deposited29 Apr 2021, 14:32
Accepted29 Jan 2021
Rights

CC0 1.0 Universal

ContributorsUniversity of Derby
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