Contributions
Abstract: 225
Type: Educational Session
Abstract Category: N/A
Fatigue is a common symptom in Multiple Sclerosis (MS) that restricts societal participation, and that is regularly treated. Literature suggests that several pharmacological and non-pharmacological treatments can be used to reduce fatigue. Several systematic reviews showed moderate effect sizes in favor of non-pharmacological treatments, but not for pharmacological treatments. However, the quality of the reviewed literature was limited, because studies often did not specifically include participants with MS-related fatigue, did not use fatigue as a primary outcome, were under-powered or used waiting list control groups.
In the last years, new randomized controlled trials (RCT) that were specifically designed to overcome these important limitations in the literature, have been published. In the sufficiently powered, single-blinded RCTs with fatigue as primary outcomes, ambulatory patients with severe MS-related fatigue were randomly allocated to the trial-specific intervention or the control intervention.
The results of these well-performed RCTs show unequivocal results that should influence rehabilitation practice. Individually provided Energy Conservation Management is not effective. Aerobic Training (AT) according to the studied training protocol shows a small positive, but not clinically relevant, effect. Furthermore, long term adherence to the AT protocol was difficult for patients. In contrast, Cognitive Behavioral Therapy (CBT) effectively reduced severe MS-related fatigue on the short term. An online self-guided fatigue management program based on CBT principles showed effective reduction of fatigue.
The combined results of the systematic reviews and these RCTs strongly suggest that CBT tailored to reduce MS-related fatigue is the most effective rehabilitation treatment for MS-related fatigue, at least on the short-term. More research that aims to improve the long-term effect is underway.
Disclosure: Disclosure: Fonds NutsOhra funded this research programme (ZonMW 89000005). V. de Groot: nothing to disclose.
Abstract: 225
Type: Educational Session
Abstract Category: N/A
Fatigue is a common symptom in Multiple Sclerosis (MS) that restricts societal participation, and that is regularly treated. Literature suggests that several pharmacological and non-pharmacological treatments can be used to reduce fatigue. Several systematic reviews showed moderate effect sizes in favor of non-pharmacological treatments, but not for pharmacological treatments. However, the quality of the reviewed literature was limited, because studies often did not specifically include participants with MS-related fatigue, did not use fatigue as a primary outcome, were under-powered or used waiting list control groups.
In the last years, new randomized controlled trials (RCT) that were specifically designed to overcome these important limitations in the literature, have been published. In the sufficiently powered, single-blinded RCTs with fatigue as primary outcomes, ambulatory patients with severe MS-related fatigue were randomly allocated to the trial-specific intervention or the control intervention.
The results of these well-performed RCTs show unequivocal results that should influence rehabilitation practice. Individually provided Energy Conservation Management is not effective. Aerobic Training (AT) according to the studied training protocol shows a small positive, but not clinically relevant, effect. Furthermore, long term adherence to the AT protocol was difficult for patients. In contrast, Cognitive Behavioral Therapy (CBT) effectively reduced severe MS-related fatigue on the short term. An online self-guided fatigue management program based on CBT principles showed effective reduction of fatigue.
The combined results of the systematic reviews and these RCTs strongly suggest that CBT tailored to reduce MS-related fatigue is the most effective rehabilitation treatment for MS-related fatigue, at least on the short-term. More research that aims to improve the long-term effect is underway.
Disclosure: Disclosure: Fonds NutsOhra funded this research programme (ZonMW 89000005). V. de Groot: nothing to disclose.