Patient education for people with multiple sclerosis-associated fatigue: A systematic review

Abstract

BackgroundMultiple Sclerosis (MS) is an inflammatory and neurodegenerative disease often causing decreased quality of life, social withdrawal and unemployment. Studies examining the effect of pharmacological interventions demonstrated only minor effects, whereas non-pharmacological interventions as e.g. patient education programs have shown promising results.ObjectiveWe aim to systematically review the literature to determine the effect of patient education programs on fatigue in MS.MethodsWe conducted a comprehensive search in PubMed for randomized controlled trials (RCTs) that evaluated patient education programs for MS-related fatigue. Interventions evaluating physical exercise and/or pharmacological treatments were not included. Meta-analyses were performed using the generic inverse variance method.ResultsThe search identified 856 citations. After full-text screening we identified ten trials that met the inclusion criteria. Data of 1021 participants were analyzed. Meta-analyses showed significant positive effects on fatigue severity (weighted mean difference -0.43; 95% CI -0.74 to -0.11) and fatigue impact (-0.48; -0.82 to -0.15), but not for depression (-0.35 (95% CI -0.75 to 0.05; p = 0.08). Essentially, we categorized patient education programs into two types: firstly, interventions with a focus on cognitive-behavioral therapy (CBT) and secondly, interventions that teach patients ways of managing daily fatigue. CBT-based approaches seem to generate better results in reducing patient-reported fatigue severity. Analysing CBT studies only, the pooled weighted mean difference for fatigue severity was -0.60 (95% CI; -1.08 to -0.11) compared to non-CBT approaches (-0.20; 95% CI; -0.60 to -0.19). Furthermore, interventions employing an individual approach seem to reduce fatigue more effectively than group-based approaches (pooled weighted mean difference for fatigue severity in face-to-face studies was -0.80 (95% CI; -1.13 to -0.47) compared to group-based studies with -0,17 (95% CI; -0,39 to 0,05). Longest follow-up data were available for 12 months post-intervention.ConclusionOverall, included studies demonstrated that educational programs and especially CBT-based approaches have a positive effect on reducing fatigue. Since fatigue is thought to be a multidimensional symptom, it should be treated with a multidimensional approach targeting patients’ behavior as well as their emotional and mental attitude towards fatigue. However, the clinical relevance of the treatment effects i.e. the relevance for patients’ daily functioning remains unclear and long-term effects, i.e. sustainability of effects beyond 6 months, warrants further work. This review has been registered in the PROSPERO international prospective register of systematic reviews data base (Registration number: CRD42014014224).

Fatigue and Self-management among Multiple Sclerosis Patients

“…As it comes to the correlation between overall self-management factor scales and overall fatigue among MS patients, there was a statistically significant negative correlation with p-value (.019). This finding in line with [68] who mentioned that fatigue in MS is treated with a several self management approaches such as; patients' behavior emotional and mental attitude, in which have a positive effect on reducing fatigue output. In addition [69] added that self-management is one of the most powerful methods that MS patients can use to cope with the signs and symptoms of disease such as fatigue through promoting patients' learning skills, increases their decision-making and performing abilities as well as their use of adaptability mechanisms.…”

Pilot study on the effects of cognitive behavioral therapy on depression among Japanese patients with multiple sclerosis

“…Seven patients received an eight-session course of CBT, and the effects of CBT were evaluated by CES-D and FAMS. 19 The results of the present and other studies suggest the possible usefulness of CBT for treating fatigue in patients with MS. 6,11 A review article suggested that the use of CBT for the CBT, cognitive behavioral therapy; DMD, disease-modifying drug; EDSS, Expanded Disability Status Scale; SD, standard deviation. This result suggests that improvement in depressive status might be possible in the early stages of CBT intervention.…”

“…CBT-based approaches have been shown to be particularly effective in reducing MS-related fatigue, which has also been confirmed by meta-analyses. 19 The results of the present and other studies suggest the possible usefulness of CBT for treating fatigue in patients with MS. 6,11 A review article suggested that the use of CBT for the CBT, cognitive behavioral therapy; SD, standard deviation. treatment of fatigue in patients with MS has a moderately positive short-term effect.…”

“…7 CBT might also play a role in the management of MS fatigue and depression. 7,19,24 The present study provides some preliminary evidence suggesting that CBT might be helpful for the treatment of depression and fatigue in Japanese patients with MS. Studies with more patients and longer duration are expected to reinforce this concept and establish CBT as a useful method for improving depression in Japanese patients with MS.…”

Rehabilitation Intervention for Individuals With Heart Failure and Fatigue to Reduce Fatigue Impact: A Feasibility Study

“…These were consistent with previous findings. Both the EC+PST and Health Education interventions were shown to be effective in reducing fatigue in cardiac arrest survivors with fatigue, people with multiple sclerosis, or people with cancer-related fatigue [17,37,38], although the formats of educational intervention vary. The EC+PST intervention was more effective in reducing participation level in low-physical demand leisure activities than the Health Education intervention.…”