Which exercise or behavioural fatigue interventions are effective for people with multiple sclerosis (MS)? A systematic review with detailed intervention breakdown and meta-analysis

Abstract

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.