Steen Carlotta, Zalpur Anna, Bentele Marissa, Zipfel Stephan, Stengel Andreas
Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Germany; German Center for Mental Health (DZPG), site Tübingen, Germany.
Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Germany; German Center for Mental Health (DZPG), site Tübingen, Germany; Clinic for Psychosomatic Medicine and Psychotherapy, Klinikum Stuttgart, Germany.
J Psychosom Res. 2025 Apr;191:112084. doi: 10.1016/j.jpsychores.2025.112084. Epub 2025 Feb 28.
Fatigue is a significant contributor to the burden experienced by patients with chronic disorders. The development of standardized treatments is challenging due to the lack of consensus concerning the etiology of fatigue. The aim of this systematic review is to provide an overview of non-pharmacological interventions for fatigue. The efficacy and differences in fatigue treatment across conditions will be explored.
A systematic literature search was conducted using the databases PubMed, Web of Science, PsycInfo and CINAHL. Trials were eligible when (1) adult patients (≥ 18 years old) with disorders causing fatigue were included, (2) non-pharmacological interventions performed, (3) treatment was compared to standard care, placebo or active control group, (4) fatigue was the only primary outcome assessed with a multidimensional tool, and (5) a randomized controlled trial (RCT) design was applied.
7592 papers were screened. 91 RCTs were eligible, with data reported in 95 papers. Specific fatigue interventions were present for a broad range of conditions. Findings demonstrated promising evidence for physical activity, CBT, online programs and multidimensional modules. Additional types of interventions were effective, but evidence was limited due to risk of bias and small sample sizes. Due to high heterogeneity concerning methodology, a meta-analysis was not possible.
Several non-pharmacological treatment options for fatigue are promising. No clear evidence was found that fatigue should be treated differently depending on the underlying condition. However, further research is necessary with a focus on a transdiagnostic approach to fatigue, high study quality and long-term follow-ups.
疲劳是慢性疾病患者负担的一个重要因素。由于对疲劳病因缺乏共识，标准化治疗的开发具有挑战性。本系统评价的目的是概述针对疲劳的非药物干预措施。将探讨不同疾病状态下疲劳治疗的疗效和差异。
使用PubMed、Web of Science、PsycInfo和CINAHL数据库进行系统的文献检索。纳入的试验需满足以下条件：（1）纳入患有导致疲劳疾病的成年患者（≥18岁）；（2）实施了非药物干预措施；（3）将治疗与标准护理、安慰剂或活性对照组进行比较；（4）疲劳是使用多维工具评估的唯一主要结局；（5）采用随机对照试验（RCT）设计。
共筛选了7592篇论文。91项RCT符合要求，95篇论文报告了相关数据。针对多种疾病状态都有特定的疲劳干预措施。研究结果表明，体育活动、认知行为疗法（CBT）、在线项目和多维模块有令人鼓舞的证据支持。其他类型的干预措施也有效，但由于存在偏倚风险和样本量小，证据有限。由于方法学上的高度异质性，无法进行荟萃分析。
几种针对疲劳的非药物治疗方案很有前景。没有明确证据表明应根据潜在疾病状态对疲劳进行不同的治疗。然而，有必要进一步开展研究，重点关注疲劳的跨诊断方法、高研究质量和长期随访。
