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Meta-Analysis
. 2024 Dec;31(12):e16452.
doi: 10.1111/ene.16452. Epub 2024 Sep 3.

Education for fatigue management in people with multiple sclerosis: Systematic review and meta-analysis

Maria Janina Wendebourg  1 , Jana Poettgen  2 , Marcia Finlayson  3 , Marien Gonzalez-Lorenzo  4 , Christoph Heesen  2 , Sascha Köpke  5 , Andrea Giordano  6
Affiliations
Meta-Analysis

Education for fatigue management in people with multiple sclerosis: Systematic review and meta-analysis

Maria Janina Wendebourg et al. Eur J Neurol. 2024 Dec.

Abstract

Background and purpose: Fatigue is a common and disabling symptom in multiple sclerosis (MS). Educational interventions have shown potential to reduce fatigue. The aim was to systematically review the current best evidence on patient education programmes for MS-related fatigue.

Methods: This was a systematic review and meta-analysis following Cochrane methodology. A systematic search was conducted in eight databases (September 2023). Moreover, reference lists and trial registers were searched and experts in the field were contacted. Randomized controlled trials were included evaluating patient education programmes for people with MS with the primary aim of reducing fatigue.

Results: In total, 1176 studies were identified and assessed by two independent reviewers; 15 studies (1473 participants) were included. All interventions provided information and education about different aspects of MS-related fatigue with different forms of application, some with components of psychological interventions. Amongst those, the most frequently applied were cognitive behavioural therapy (n = 5) and energy-conservation-based approaches (n = 4). Studies differed considerably concerning mode of intervention delivery, number of participants and length of follow-up. Interventions reduced fatigue severity (eight studies, n = 878, standardized mean difference -0.28; 95% confidence interval -0.53 to -0.03; low certainty) and fatigue impact (nine studies, n = 824, standardized mean difference -0.21; 95% confidence interval -0.42 to 0.00; moderate certainty) directly after the intervention. Mixed results were found for long-term effects on fatigue, for secondary endpoints (depressive symptoms, quality of life, coping) and for subgroup analyses.

Conclusion: Educational interventions for people with MS-related fatigue may be effective in reducing fatigue in the short term. More research is needed on long-term effects and the importance of specific intervention components, delivery and context.

Keywords: fatigue; meta‐analysis; multiple sclerosis; patient education; systematic review.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Study flow diagram.
FIGURE 2
FIGURE 2
Risk of bias summary: overview of the individual risk of bias across included studies.
FIGURE 3
FIGURE 3
Fatigue severity (a) directly after the intervention, (b) 2–4 months after the intervention and (c) at long‐term (8–14 months) follow‐up.
FIGURE 4
FIGURE 4
Fatigue impact (a) directly after the intervention, (b) 2–4 months after the intervention, (c) 6–8 months after the intervention and (d) at long‐term (8–14 months) follow‐up.
FIGURE 5
FIGURE 5
Depressive symptoms (a) directly after the intervention, (b) 2–4 months after the intervention, (c) 6–8 months after the intervention and (d) at long‐term (8–14 months) follow‐up.
FIGURE 6
FIGURE 6
Quality of life (a) directly after the intervention and (b) 2–4 months after the intervention.
See this image and copyright information in PMC

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