Contributions
Abstract: P1325
Type: Poster
Abstract Category: RIMS - Neuropsychology and fatigue management
Background: Fatigue is a common and disabling symptom related to multiple sclerosis (MS), 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 more promising results.
Methods: We performed a systematic review and meta-analysis including randomized controlled trials (RCTs) that evaluated patient education programs for MS-related fatigue. Two authors independently assessed studies for inclusion and performed data extraction. We assessed risk of bias using the Cochrane tool and evidence quality using GRADE. Meta-analyses were performed using generic inverse variance methods in RevMan.
Results: Of 856 citations, 10 RCTs with n=1021 participants met the inclusion criteria. Educational interventions differed in terms of extend, content and method of information provision. Overall positive intervention effects on fatigue severity (weighted mean difference (WMD) -0.43; 95% confidence interval (CI) -0.74 to -0.11; high quality evidence) and fatigue impact (-0.48; -0.82 to -0.15; high quality evidence), but not for depression (-0.35; -0.75 to 0.05) were shown. Four interventions were based on cognitive-behavioral therapy (CBT) approaches. Analysing CBT studies only (n=4) the pooled WMD for fatigue severity was -0.60 (95% CI; -1.08 to -0.11) compared to non-CBT approaches (n=6) (-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 WMD for fatigue severity in face-to-face approaches: -0.80 (95% CI; -1.13 to -0.47) compared to group-based studies with -0.17 (95% CI; -0.39 to 0.05). Follow-up was generally short, with longest follow-up data available for 12 months.
Conclusion: Overall, included studies demonstrated that educational programs and especially CBT-based approaches seem to have a positive effect on reducing fatigue. Since fatigue is thought to be a multidimensional symptom, it should be treated with multidimensional approaches targeting patients" behavior as well as their emotional and mental attitude towards fatigue. However, clinical relevance of treatment effects and long-term effects remain unclear and warrant further work.
Disclosure: Maria Janina Wendebourg: nothing to disclose
Christoph Heesen: nothing to disclose
Marcia Finlayson: nothing to disclose
Björn Meyer: nothing to disclose
Jana Pöttgen: nothing to disclose
Sascha Köpke: nothing to disclose
Abstract: P1325
Type: Poster
Abstract Category: RIMS - Neuropsychology and fatigue management
Background: Fatigue is a common and disabling symptom related to multiple sclerosis (MS), 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 more promising results.
Methods: We performed a systematic review and meta-analysis including randomized controlled trials (RCTs) that evaluated patient education programs for MS-related fatigue. Two authors independently assessed studies for inclusion and performed data extraction. We assessed risk of bias using the Cochrane tool and evidence quality using GRADE. Meta-analyses were performed using generic inverse variance methods in RevMan.
Results: Of 856 citations, 10 RCTs with n=1021 participants met the inclusion criteria. Educational interventions differed in terms of extend, content and method of information provision. Overall positive intervention effects on fatigue severity (weighted mean difference (WMD) -0.43; 95% confidence interval (CI) -0.74 to -0.11; high quality evidence) and fatigue impact (-0.48; -0.82 to -0.15; high quality evidence), but not for depression (-0.35; -0.75 to 0.05) were shown. Four interventions were based on cognitive-behavioral therapy (CBT) approaches. Analysing CBT studies only (n=4) the pooled WMD for fatigue severity was -0.60 (95% CI; -1.08 to -0.11) compared to non-CBT approaches (n=6) (-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 WMD for fatigue severity in face-to-face approaches: -0.80 (95% CI; -1.13 to -0.47) compared to group-based studies with -0.17 (95% CI; -0.39 to 0.05). Follow-up was generally short, with longest follow-up data available for 12 months.
Conclusion: Overall, included studies demonstrated that educational programs and especially CBT-based approaches seem to have a positive effect on reducing fatigue. Since fatigue is thought to be a multidimensional symptom, it should be treated with multidimensional approaches targeting patients" behavior as well as their emotional and mental attitude towards fatigue. However, clinical relevance of treatment effects and long-term effects remain unclear and warrant further work.
Disclosure: Maria Janina Wendebourg: nothing to disclose
Christoph Heesen: nothing to disclose
Marcia Finlayson: nothing to disclose
Björn Meyer: nothing to disclose
Jana Pöttgen: nothing to disclose
Sascha Köpke: nothing to disclose