Department of Clinical Research, Neurology Clinic and Policlinic, University Hospital Basel, University of Basel, Basel, Switzerland.
Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
Eur J Neurol. 2024 Dec;31(12):e16452. doi: 10.1111/ene.16452. Epub 2024 Sep 3.
Fatigue is a common and disabling symptom in multiple sclerosis (MS). Educational interventions have shown potential to reduce fatigue. The aim was to systematically review the current best evidence on patient education programmes for MS-related fatigue.
This was a systematic review and meta-analysis following Cochrane methodology. A systematic search was conducted in eight databases (September 2023). Moreover, reference lists and trial registers were searched and experts in the field were contacted. Randomized controlled trials were included evaluating patient education programmes for people with MS with the primary aim of reducing fatigue.
In total, 1176 studies were identified and assessed by two independent reviewers; 15 studies (1473 participants) were included. All interventions provided information and education about different aspects of MS-related fatigue with different forms of application, some with components of psychological interventions. Amongst those, the most frequently applied were cognitive behavioural therapy (n = 5) and energy-conservation-based approaches (n = 4). Studies differed considerably concerning mode of intervention delivery, number of participants and length of follow-up. Interventions reduced fatigue severity (eight studies, n = 878, standardized mean difference -0.28; 95% confidence interval -0.53 to -0.03; low certainty) and fatigue impact (nine studies, n = 824, standardized mean difference -0.21; 95% confidence interval -0.42 to 0.00; moderate certainty) directly after the intervention. Mixed results were found for long-term effects on fatigue, for secondary endpoints (depressive symptoms, quality of life, coping) and for subgroup analyses.
Educational interventions for people with MS-related fatigue may be effective in reducing fatigue in the short term. More research is needed on long-term effects and the importance of specific intervention components, delivery and context.
疲劳是多发性硬化症（MS）的一种常见且使人致残的症状。教育干预已显示出减轻疲劳的潜力。本研究旨在系统回顾目前关于针对 MS 相关性疲劳的患者教育计划的最佳证据。
这是一项遵循 Cochrane 方法的系统评价和荟萃分析。我们在八个数据库中进行了系统检索（2023 年 9 月）。此外，还检索了参考文献列表和试验登记册，并联系了该领域的专家。我们纳入了评估针对 MS 患者的患者教育计划的随机对照试验，这些计划的主要目的是减轻疲劳。
共确定了 1176 项研究，并由两名独立的审查员进行评估；纳入了 15 项研究（1473 名参与者）。所有干预措施均提供了有关 MS 相关性疲劳的不同方面的信息和教育，其应用形式各不相同，有些干预措施包含心理干预的成分。其中，最常应用的是认知行为疗法（n=5）和基于能量节约的方法（n=4）。研究在干预措施实施方式、参与者数量和随访时间长度方面差异较大。干预措施直接干预后可降低疲劳严重程度（8 项研究，n=878，标准化均数差-0.28；95%置信区间-0.53 至-0.03；低确定性）和疲劳影响（9 项研究，n=824，标准化均数差-0.21；95%置信区间-0.42 至 0.00；中等确定性）。对疲劳的长期影响、次要终点（抑郁症状、生活质量、应对方式）和亚组分析，研究结果则喜忧参半。
针对 MS 相关性疲劳的患者教育干预可能在短期内有效减轻疲劳。需要更多研究来评估长期效果以及特定干预措施成分、实施方式和环境的重要性。
