Review article (meta-analysis)
Effectiveness of Energy Conservation Treatment in Reducing Fatigue in Multiple Sclerosis: A Systematic Review and Meta-Analysis

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Abstract

Objectives

To systematically review the effects of energy conservation management (ECM) treatment for fatigue in multiple sclerosis (MS), and to study the effect of ECM treatment on restrictions in participation and quality of life (QoL).

Data Sources

PubMed, CINAHL, Embase, and Web of Knowledge were searched to identify relevant randomized controlled trials (RCTs) and controlled clinical trials.

Study Selection

To select potential studies, 2 reviewers independently applied the inclusion criteria.

Data Extraction

Two reviewers independently extracted data and assessed the methodologic quality of the studies included. If meta-analysis was not possible, qualitative best-evidence synthesis was used to summarize the results.

Data Synthesis

The searches identified 532 studies, 6 of which were included. The studies compared the short-term effects of ECM treatment and control treatment on fatigue and QoL; 1 study reported short-term and midterm effects on participation, but found no evidence for effectiveness. Meta-analyses (2 RCTs, N=350) showed that ECM treatment was more effective than no treatment in improving subscale scores of the (1) Fatigue Impact Scale: cognitive (mean difference [MD]=−2.91; 95% confidence interval [CI], −4.32 to −1.50), physical (MD=−2.99; 95% CI, −4.47 to −1.52), and psychosocial (MD=−6.05; 95% CI, −8.72 to −3.37); and (2) QoL: role physical (MD=17.26; 95% CI, 9.69–24.84), social function (MD=6.91; 95% CI, 1.32–12.49), and mental health (MD=5.55; 95% CI, 2.27–8.83). Limited or no evidence was found for the effectiveness of ECM treatment on the other outcomes in the short-term or midterm. None of the studies reported long-term results.

Conclusions

The systematic review results provide evidence that in the short-term, ECM treatment can be more effective than no treatment (waiting controls) in reducing the impact of fatigue and in improving 3 QoL scales—role physical, social function, and mental health—in fatigued patients with MS. More RCTs that also study long-term results are needed.

Section snippets

Search strategy

The PubMed, CINAHL, Embase, and Web of Knowledge databases were searched systematically to identify relevant randomized controlled trials (RCTs) and controlled clinical trials (CCTs) up to May 8, 2012. Keywords for identifying MS patients, ECM treatment, and fatigue were included in the search string. The complete search strategy is shown in appendix 1. Reference lists from the studies included were screened.

Inclusion criteria

References were included if they met the following selection criteria:

  • •

    Type of studies:

Characteristics of the studies included

The initial literature search identified 754 studies, 170 from PubMed, 370 from Embase, 62 from CINAHL, and 152 from the Web of Knowledge. After duplicates had been removed, 532 studies remained. If the full text of an abstract was not available, we requested the authors to send it. We eventually assessed 29 full-text articles for eligibility. Six of these, with a total of 494 patients with MS, met the inclusion criteria and were included in this review. The process of inclusion and exclusion

Discussion

The aim of the present study was to systematically review the effects of ECM treatment of fatigue in patients with MS. We also studied the effects of ECM treatment on restrictions in participation and on QoL. Six studies were included in this review. They compared the effects in MS patients of ECM or ECM-related treatment with those of no treatment (waiting controls), a placebo, or support. All studies included outcomes on fatigue, 1 also studied participation, and 2 also studied QoL. All 6

Conclusions

To the best of our knowledge, this study was the first systematic review and meta-analysis to study the effects of ECM treatment of fatigue and whether it affects restrictions in participation and QoL in patients with MS. The results provide evidence that ECM treatment can be more effective than no treatment (waiting controls) in reducing the impact of fatigue and improving 3 QoL scales—role physical, social function, and mental health—in fatigued MS patients in the short-term. Only 1 study

Supplier

Acknowledgments

We thank David R.M. Alexander, lecturer in Biomedical Writing and Communication, for his contribution to editing the text. This study was carried out as part of the TREFAMS-ACE research programme “Treatment of Fatigue in MS: Aerobic Training, Cognitive Behavioural Therapy and Energy Conservation Management.” We thank the TREFAMS-ACE Study Group for making this research possible: V. de Groot, H. Beckerman (programme coordination), A. Malekzadeh, M. Looijmans, S.A. Sanches (until February 2012),

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    Supported by the ZonMw Rehabilitation Program and Fonds NutsOhra (grant no. 60-61300-98-024).

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

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