Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands.
Care and Public Health Research Institute (CAPHRI), Maastricht University Faculty of Health Medicine and Life Sciences, Maastricht, The Netherlands.
RMD Open. 2023 Aug;9(3). doi: 10.1136/rmdopen-2023-003056.
To scope published reviews addressing fatigue in rheumatoid arthritis (RA), spondyloarthritis, osteoarthritis and fibromyalgia in areas relevant for clinical practice: (1) definition, (2) measurement instruments and diagnosis, (3) determinants, (4) consequences and (5) effectiveness of interventions.
A systematic literature search of reviews was performed in five bibliographical databases. A hierarchical data extraction was applied based on review type (Cochrane reviews (CRs), followed by non-Cochrane systematic reviews (SRs) and narrative reviews (NRs)) and year of publication. Extracted data were summarised in elaborated narrative syntheses. Results were discussed with a patient panel.
One hundred and thirty-four reviews were included (19 CRs, 44 SRs, 71 NRs). No agreed on definition was reported for general fatigue, nor for types of fatigue. Twenty-five measurement instruments were found, all self-reported. Five instruments proposed a threshold for excessive fatigue. Pain, physical function and depressive symptoms were the most frequently studied disease-related determinants of fatigue; female sex and stress the most frequent contextual determinants. Work performance, followed by impact on pain, physical activity and social roles were the most frequently studied consequences. Whenever quantified, associations between fatigue with determinants and consequences were on average small. For non-pharmacological interventions, if effect sizes were reported, these were negligible to small and for pharmacological interventions negligible to moderate. Patients recommended actions for research and practice.
Syntheses of reviews point to the complexity of fatigue. The extensive amount of evidence could be used to offer tailored management plans to patients in clinical practice and inform future research agendas.
综述发表的文献，以了解与临床实践相关的类风湿关节炎 (RA)、脊柱关节炎、骨关节炎和纤维肌痛的疲劳问题：(1) 定义，(2) 测量工具和诊断，(3) 决定因素，(4) 后果和 (5) 干预措施的效果。
在五个文献数据库中进行了系统的文献检索。根据综述类型（Cochrane 综述 (CRs)、非 Cochrane 系统综述 (SRs) 和叙述性综述 (NRs)) 和发表年份，采用分层数据提取方法。提取的数据以详细的叙述性综合形式进行总结。结果与患者小组进行了讨论。
共纳入 134 篇综述（19 篇 CRs、44 篇 SRs、71 篇 NRs）。对于一般疲劳和各种类型的疲劳，均未报告达成共识的定义。发现 25 种测量工具，均为自我报告。有 5 种仪器提出了过度疲劳的阈值。疼痛、身体功能和抑郁症状是疲劳最常见的疾病相关决定因素；女性和压力是最常见的环境决定因素。工作表现，其次是对疼痛、身体活动和社会角色的影响，是疲劳最常见的后果。只要进行量化，疲劳与决定因素和后果之间的关联平均较小。对于非药物干预，如果报告了效应大小，这些大小从微不足道到小，对于药物干预则从微不足道到中等。患者为研究和实践推荐了行动方案。
综述的综合结果表明疲劳问题的复杂性。大量证据可以用于为临床实践中的患者提供量身定制的管理计划，并为未来的研究议程提供信息。
