Phyo Aung Zaw Zaw, Demaneuf Thibaut, De Livera Alysha M, Jelinek George A, Brown Chelsea R, Marck Claudia H, Neate Sandra L, Taylor Keryn L, Mills Taylor, O'Kearney Emily, Karahalios Amalia, Weiland Tracey J
Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
Biostatistics Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
Front Neurol. 2018 Apr 4;9:149. doi: 10.3389/fneur.2018.00149. eCollection 2018.
Multiple sclerosis (MS) is a complex, demyelinating disease of the central nervous system. Fatigue is commonly reported by people with MS (PwMS). MS-related fatigue severely affects daily activities, employment, socioeconomic status, and quality of life.
We conducted this systematic review and meta-analysis to determine whether psychological interventions are effective in managing fatigue in PwMS.
We performed systematic searches of Medline, EMBASE, PsycINFO, and CINAHL to identify relevant articles published from database inception to April 5, 2017. Reference lists from relevant reviews were also searched.
Two independent reviewers screened the papers, extracted data, and appraised the included studies. A clinical psychologist verified whether interventions were psychological approaches. A narrative synthesis was conducted for all included studies. For relevant randomized controlled trials that reported sufficient information to determine standardized mean differences (SMDs) and 95% confidence intervals (CIs), meta-analyses were conducted using a random-effects model.
Of the 353 identified articles, 20 studies with 1,249 PwMS were included in this systematic review. Narrative synthesis revealed that psychological interventions reduced fatigue in PwMS. Meta-analyses revealed that cognitive behavioral therapy decreased levels of fatigue compared with non-active controls (SMD = -0.32; 95% CI: -0.63 to -0.01) and compared with active controls (relaxation or psychotherapy) (SMD = -0.71; 95% CI: -1.05 to -0.37). Meta-analyses further showed that both relaxation (SMD = -0.90; 95% CI: -1.30 to -0.51), and mindfulness interventions (SMD = -0.62; 95% CI: -1.12 to -0.12), compared with non-active control, decreased fatigue levels. The estimates of heterogeneity for the four meta-analyses varied between none and moderate.
This study found that the use of psychological interventions for MS-related fatigue management reduced fatigue in PwMS. While psychological interventions are generally considered first-line therapy for MS-related fatigue, further studies are needed to explore the long-term effect of this therapy.
多发性硬化症（MS）是一种中枢神经系统的复杂脱髓鞘疾病。多发性硬化症患者（PwMS）普遍报告有疲劳症状。与MS相关的疲劳严重影响日常活动、就业、社会经济地位和生活质量。
我们进行了这项系统评价和荟萃分析，以确定心理干预对管理PwMS疲劳是否有效。
我们对Medline、EMBASE、PsycINFO和CINAHL进行了系统检索，以识别从数据库建立到2017年4月5日发表的相关文章。还检索了相关综述的参考文献列表。
两名独立评审员筛选论文、提取数据并评估纳入的研究。一名临床心理学家核实干预措施是否为心理方法。对所有纳入研究进行叙述性综合分析。对于报告了足够信息以确定标准化均值差（SMD）和95%置信区间（CI）的相关随机对照试验，使用随机效应模型进行荟萃分析。
在353篇已识别的文章中，本系统评价纳入了20项研究，共1249名PwMS。叙述性综合分析表明，心理干预可减轻PwMS的疲劳。荟萃分析表明，与非活性对照相比，认知行为疗法降低了疲劳水平（SMD = -0.32；95% CI：-0.63至-0.01），与活性对照（放松或心理治疗）相比（SMD = -0.71；95% CI：-1.05至-0.37）。荟萃分析进一步表明，与非活性对照相比，放松（SMD = -0.90；95% CI：-1.30至-0.51）和正念干预（SMD = -0.62；95% CI：-1.12至-0.12）均降低了疲劳水平。四项荟萃分析的异质性估计在无到中度之间变化。
本研究发现，使用心理干预管理与MS相关的疲劳可减轻PwMS的疲劳。虽然心理干预通常被认为是治疗与MS相关疲劳的一线疗法，但需要进一步研究来探索这种疗法的长期效果。
