Department of Rehabilitation Medicine and Physical Therapy, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Arch Phys Med Rehabil. 2013 Jul;94(7):1360-76. doi: 10.1016/j.apmr.2013.01.025. Epub 2013 Feb 8.
To systematically review the effects of energy conservation management (ECM) treatment for fatigue in multiple sclerosis (MS), and to study the effect of ECM treatment on restrictions in participation and quality of life (QoL).
PubMed, CINAHL, Embase, and Web of Knowledge were searched to identify relevant randomized controlled trials (RCTs) and controlled clinical trials.
To select potential studies, 2 reviewers independently applied the inclusion criteria.
Two reviewers independently extracted data and assessed the methodologic quality of the studies included. If meta-analysis was not possible, qualitative best-evidence synthesis was used to summarize the results.
The searches identified 532 studies, 6 of which were included. The studies compared the short-term effects of ECM treatment and control treatment on fatigue and QoL; 1 study reported short-term and midterm effects on participation, but found no evidence for effectiveness. Meta-analyses (2 RCTs, N=350) showed that ECM treatment was more effective than no treatment in improving subscale scores of the (1) Fatigue Impact Scale: cognitive (mean difference [MD]=-2.91; 95% confidence interval [CI], -4.32 to -1.50), physical (MD=-2.99; 95% CI, -4.47 to -1.52), and psychosocial (MD=-6.05; 95% CI, -8.72 to -3.37); and (2) QoL: role physical (MD=17.26; 95% CI, 9.69-24.84), social function (MD=6.91; 95% CI, 1.32-12.49), and mental health (MD=5.55; 95% CI, 2.27-8.83). Limited or no evidence was found for the effectiveness of ECM treatment on the other outcomes in the short-term or midterm. None of the studies reported long-term results.
The systematic review results provide evidence that in the short-term, ECM treatment can be more effective than no treatment (waiting controls) in reducing the impact of fatigue and in improving 3 QoL scales-role physical, social function, and mental health-in fatigued patients with MS. More RCTs that also study long-term results are needed.
系统回顾能量守恒管理（ECM）治疗对多发性硬化症（MS）疲劳的影响，并研究 ECM 治疗对参与受限和生活质量（QoL）的影响。
通过 PubMed、CINAHL、Embase 和 Web of Knowledge 检索相关随机对照试验（RCT）和对照临床试验。
为了选择潜在的研究，2 名审查员独立应用纳入标准。
2 名审查员独立提取数据并评估纳入研究的方法学质量。如果无法进行荟萃分析，则使用最佳证据综合定性方法来总结结果。
检索共确定了 532 项研究，其中 6 项符合纳入标准。这些研究比较了 ECM 治疗与对照治疗对疲劳和 QoL 的短期影响；1 项研究报告了短期和中期对参与的影响，但没有发现有效性的证据。荟萃分析（2 项 RCT，N=350）表明，与无治疗相比，ECM 治疗在改善（1）疲劳影响量表的子量表评分方面更有效：认知（平均差异[MD]=-2.91；95%置信区间[CI]，-4.32 至-1.50）、身体（MD=-2.99；95% CI，-4.47 至-1.52）和心理社会（MD=-6.05；95% CI，-8.72 至-3.37）；和（2）QoL：身体角色（MD=17.26；95% CI，9.69-24.84）、社会功能（MD=6.91；95% CI，1.32-12.49）和心理健康（MD=5.55；95% CI，2.27-8.83）。在短期或中期，ECM 治疗对其他结局的有效性的证据有限或不存在。没有研究报告长期结果。
系统评价结果提供了证据，表明在短期内，与无治疗（等待对照）相比，ECM 治疗可以更有效地减轻疲劳的影响，并改善多发性硬化症疲劳患者的 3 个 QoL 量表-身体角色、社会功能和心理健康。需要更多的 RCT 来研究长期结果。
