Rooney Scott, Moffat Fiona, Wood Les, Paul Lorna
Int J MS Care. 2019 Jan-Feb;21(1):35-46. doi: 10.7224/1537-2073.2018-019.
Rehabilitation interventions are recommended to manage multiple sclerosis (MS)-related fatigue. However, existing research has largely been generalized to those with relapsing-remitting MS, making it difficult to determine the effectiveness of these interventions in people with progressive MS. Therefore, this study aimed to systematically review the evidence related to the effectiveness of fatigue management interventions in reducing the severity and impact of fatigue in people with progressive MS.
Six electronic databases (CINAHL, Cochrane Library, MEDLINE, PEDro, ProQuest, and Web of Science Core Collections) were searched for relevant articles up until November 2017. Randomized controlled trials and quasi-experimental studies that examined the effects of exercise, behavioral interventions, and rehabilitation on fatigue in people with progressive MS using self-reported fatigue outcome measures were included in this review.
Eight exercise, two rehabilitation, and two behavioral interventions were investigated in the 13 articles included in this review. Heterogeneous effects were reported between studies, with only two exercise, one behavioral, and two rehabilitation interventions recording significant improvements in postintervention fatigue severity or impact. However, most studies were underpowered, only two used fatigue as the primary outcome, and only one specifically recruited participants with predefined levels of fatigue.
Evidence from this review is inconclusive regarding the effectiveness of nonpharmacologic interventions in reducing the severity and impact of fatigue in progressive MS populations. Adequately powered randomized controlled trials are required to evaluate fatigue management interventions in people with progressive MS experiencing high levels of fatigue and using fatigue as the primary outcome.
推荐采用康复干预措施来应对与多发性硬化症（MS）相关的疲劳。然而，现有研究大多针对复发缓解型多发性硬化症患者，难以确定这些干预措施对进展型多发性硬化症患者的有效性。因此，本研究旨在系统回顾疲劳管理干预措施在减轻进展型多发性硬化症患者疲劳严重程度及影响方面有效性的相关证据。
检索了六个电子数据库（CINAHL、Cochrane图书馆、MEDLINE、PEDro、ProQuest和科学引文索引核心合集），截至2017年11月的相关文章。本综述纳入了采用自我报告疲劳结局指标，研究运动、行为干预和康复对进展型多发性硬化症患者疲劳影响的随机对照试验和准实验研究。
本综述纳入的13篇文章中，研究了8项运动干预、2项康复干预和2项行为干预。各研究报告的效果存在异质性，只有2项运动干预、1项行为干预和2项康复干预在干预后疲劳严重程度或影响方面有显著改善。然而，大多数研究样本量不足，只有2项将疲劳作为主要结局，只有1项专门招募了具有预定义疲劳水平的参与者。
本综述的证据对于非药物干预在减轻进展型多发性硬化症患者疲劳严重程度及影响方面的有效性尚无定论。需要开展足够样本量的随机对照试验，以评估针对疲劳程度较高且以疲劳为主要结局的进展型多发性硬化症患者的疲劳管理干预措施。
