Browsing by Person "Safari, Reza"

Now showing 1 - 7 of 7

Effect of exercise interventions on perceived fatigue in people with multiple sclerosis: synthesis of meta-analytic reviews
(Future Science, 2017-06-20) Safari, Reza; van der Linden, Marietta; Mercer, Tom
Although exercise training has been advocated as a nonpharmacological treatment for multiple sclerosis (MS) related fatigue, no consensus exists regarding its effectiveness. To address this, we collated meta-analytic reviews that explored the effectiveness of exercise training for the treatment of MS-related fatigue. We searched five online databases for relevant reviews, published since 2005, and identified 172 records. Five reviews were retained for systematic extraction of information and evidence quality analysis. Although our review synthesis indicated that exercise training interventions have a moderate effect on fatigue reduction in people with MS, no clear insight was obtained regarding the relative effectiveness of specific types or modes of exercise intervention. Moreover, Grading of Recommendation Assessment, Development and Evaluation revealed that the overall quality of evidence emanating from these five reviews was 'very low'.
Efficacy of targeted versus non-targeted exercise and behavioural interventions on fatigue in multiple sclerosis: systematic review and meta-analysis
(PROSPERO, 2016-08-22) Moss-Morris, Rona; Mercer, Tom; White, Claire; van der Linden, Marietta; Thomas, Sarah; Harrison, Anthony; Safari, Reza; Norton, Sam
Review question(s) The specific objectives are to: (1) Provide a narrative synthesis of all the interventions, including a summary of the nature of the intervention using the Template for intervention Description and Replication (TiDieR), and assessment of study quality (risk of bias), alongside the standardised intervention effect sizes. As a detailed synthesis already includes studies evaluating interventions specifically targeting MS fatigue (ref: CRD42016033763), the narrative synthesis will focus on studies evaluating interventions that (a) do not specifically target fatigue, or (b) measured fatigue as a secondary outcome. (2) Conduct (pair-wise) meta-analyses to pool effect sizes across intervention types (exercise, behavioural, mixed) and estimate statistical heterogeneity. (3) Directly compare specific types of targeted versus non-targeted exercise, behavioural and combined interventions on fatigue in multiple sclerosis, using network meta-analyses. (4) Conduct exploratory moderator and sensitivity analyses to explore how treatment effects vary according to health care professional (HCP) contact, type of MS, and study quality (i.e. risk of bias).
Fatigue interventions in long term, physical health conditions: A scoping review of systematic reviews
(PLoS, 2018-10-12) Hulme, Katrin; Safari, Reza; Thomas, Sarah; Mercer, Tom; White, Claire; van der Linden, Marietta; Moss-Morris, Rona; Nater, Urs M.
Objective: Fatigue is prominent across many long term physical health conditions. This scoping review aimed to map the fatigue intervention literature, to ascertain if certain interventions may be effective across conditions, and if novel interventions tested in specific long term conditions may be promising for other conditions.
Is functional electrical stimulation effective in improving walking in adults with lower limb impairment due to an upper motor neuron lesion? An umbrella review
(2023-06-01) Andreopoulou, Georgia; Busselli, Giulia; Street, Tamsyn; Bulley, Catherine; Safari, Reza; van der Linden, Marietta; Burridge, Jane
Purpose: To conduct an umbrella review of systematic reviews on functional electrical stimulation (FES) to improve walking in adults with an upper motor neuron lesion. Methods: Five electronic databases were searched, focusing on the effect of FES on walking. The methodological quality of reviews was evaluated using AMSTAR2 and certainty of evidence was established through the GRADE approach. Results: The methodological quality of the 24 eligible reviews (stroke, n = 16; spinal cord injury (SCI), n = 5; multiple sclerosis (MS); n = 2; mixed population, n = 1) ranged from critically low to high. Stroke reviews concluded that FES improved walking speed through an orthotic (immediate) effect and had a therapeutic benefit (i.e., over time) compared to usual care (low certainty evidence). There was low‐to‐moderate certainty evidence that FES was no better or worse than an Ankle Foot Orthosis regarding walking speed post 6 months. MS reviews concluded that FES had an orthotic but no therapeutic effect on walking. SCI reviews concluded that FES with or without treadmill training improved speed but combined with an orthosis was no better than orthosis alone. FES may improve quality of life and reduce falls in MS and stroke populations. Conclusion: FES has orthotic and therapeutic benefits. Certainty of evidence was low‐to‐moderate, mostly due to high risk of bias, low sample sizes, and wide variation in outcome measures. Future trials must be of higher quality, use agreed outcome measures, including measures other than walking speed, and examine the effects of FES for adults with cerebral palsy, traumatic and acquired brain injury, and Parkinson's disease.
Which behavioural and exercise interventions targeting fatigue show the most promise in multiple sclerosis? A systematic review with narrative synthesis and meta-analysis
(Elsevier, 2019-08-28) Moss-Morris, Rona; Harrison, Anthony M.; Safari, Reza; Norton, Sam; van der Linden, Marietta; Picariello, Federica; Thomas, Sarah; White, Claire; Mercer, Tom
Fatigue is a common and highly debilitating symptom of multiple sclerosis (MS). This meta-analytic systematic review with detailed narrative synthesis examined randomised-controlled (RCTs) and controlled trials of behavioural and exercise interventions targeting fatigue in adults with MS to assess which treatments offer the most promise in reducing fatigue severity/impact. Medline, EMBASE and PsycInfo electronic databases, amongst others, were searched through to August 2018. Thirty-four trials (12 exercise, 16 behavioural and 6 combined; n = 2,434 participants) met inclusion criteria. Data from 31 studies (n = 1,991 participants) contributed to the meta-analysis. Risk of bias (using the Cochrane tool) and study quality (GRADE) were assessed. The pooled (SMD) end-of-treatment effects on self-reported fatigue were: exercise interventions (n = 13) -.84 (95% CI -1.20 to -.47); behavioural interventions (n = 16) -.37 (95% CI -.53 to -.22); combined interventions (n = 5) -.16 (95% CI: -.36 to .04). Heterogeneity was high overall. Study quality was very low for exercise interventions and moderate for behavioural and combined interventions. Considering health care professional time, subgroup results suggest web-based cognitive behavioural therapy for fatigue, balance and/or multicomponent exercise interventions may be the cost-efficient therapies. These need testing in large RCTs with long-term follow-up to help define an implementable fatigue management pathway in MS.
Which exercise and behavioural interventions show most promise for treating fatigue in multiple sclerosis? A network meta-analysis
(SAGE, 2021-04-20) Harrison, Anthony M.; Safari, Reza; Mercer, Tom; Picariello, Federica; van der Linden, Marietta; White, Claire; Moss-Morris, Rona; Norton, Sam
Background: Fatigue is a common, debilitating symptom of multiple sclerosis (MS) without a current standardised treatment.
Which exercise or behavioural fatigue interventions are effective for people with multiple sclerosis (MS)? A systematic review with detailed intervention breakdown and meta-analysis
(PROSPERO, 2016-06-01) Moss-Morris, Rona; Mercer, Tom; White, Claire; Thomas, Sarah; van der Linden, Marietta; Harrison, Anthony; Safari, Reza; Norton, Sam
Review question(s) The overall aim of this review is to provide guidance as to which of the existing exercise and behavioural interventions appear most promising for the treatment of MS fatigue. The specific objectives are to: (1) Provide a narrative synthesis of all the interventions including a breakdown of the key contextual and treatment components of each of the interventions, the acceptability of the interventions (uptake and adherence), and the study quality (risk of bias) alongside the standardized intervention effect sizes. (2) Conduct meta-analyses of effect sizes across interventions with similar key intervention components. (3) Compare the overall effect sizes of the exercise and behavioral interventions followed by subgroup analysis within each of these groups (e.g. behavioral interventions: energy conservation, CBT, combined; exercise interventions: aerobic endurance, strength, balance and combined). (4) Conduct exploratory moderator and sensitivity analyses to explore how treatment effects vary according to whether interventions were guided by theory or not, different levels of health care professional contact (e.g. email support, telephone, face-to-face), types of MS, comparators used, and study quality.