Elsevier

Journal of Psychosomatic Research

Volume 90, November 2016, Pages 33-42
Journal of Psychosomatic Research

Review article
Effectiveness of cognitive behavioral therapy for the treatment of fatigue in patients with multiple sclerosis: A systematic review and meta-analysis

https://doi.org/10.1016/j.jpsychores.2016.09.002Get rights and content

Highlights

  • A meta-analysis and review about the effectiveness of CBT for MS-related fatigue

  • The results suggest a moderately positive effect of CBT for MS-related fatigue.

  • CBT should be considered an evidence-based therapy for MS-related fatigue.

Abstract

Background

Fatigue is a frequently occurring symptom of multiple sclerosis (MS) that limits social participation.

Objective

To systematically determine the short and long-term effects of cognitive behavioral therapy (CBT) for the treatment of MS-related fatigue.

Data sources

Pubmed, Cochrane, EMBASE, Psychology and Behavioral Sciences Collection, ERIC, PsychINFO, Cinahl, PsycARTICLES, and relevant trial registers were searched up to February 2016. In addition, references from retrieved articles were examined.

Study selection

Studies were included if participants had MS, fatigue was a primary outcome measure, the intervention was CBT, and the design was a randomized controlled trial. The search was performed by two independent reviewers, three CBT experts determined whether interventions were CBT.

Data extraction

Data on patient and study characteristics and fatigue were systematically extracted using a standardized data extraction form. Two independent reviewers assessed risk of bias using the Cochrane Collaboration risk of bias tool. In the event of disagreement, a third reviewer was consulted.

Data synthesis

Of the 994 identified studies, 4 studies were included in the meta-analysis, comprising 193 CBT-treated patients and 210 patients who underwent a control treatment. Meta-analyses of these studies showed that CBT treatment had a positive short-term effect on fatigue (standardized mean difference [SMD] =  0.47; 95% confidence interval [CI] =  0.88; − 0.06; I2 = 73%). In addition, three studies showed a long-term positive effect of CBT (SMD =  0.30; CI − 0.51; − 0.08; I2 = 0%).

Conclusions

This review found that the use of CBT for the treatment of fatigue in patients with MS has a moderately positive short-term effect. However, this effect decreases with cessation of treatment.

Section snippets

Search methods

This meta-analysis used the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines for systematic reviews and meta-analyses [21]. The literature search concluded on February 8, 2016. The following databases were searched: Pubmed; Cochrane, EMBASE, Psychology and Behavioral Sciences Collection, ERIC, PsychINFO, Cinahl and PsycARTICLES. In addition, trial registers were searched to identify published and unpublished trials on the topic and, when necessary

Results

The initial search yielded 994 articles, of which 833 remained after removal of duplicates. Five authors of unpublished articles were contacted about the progress of their research and preliminary results, however, this did not result in extra information. In total, 734 articles were excluded based on the title and abstract. Of the remaining 99 articles, 30 were excluded because CBT was not used, 16 articles did not use fatigue as a primary outcome measure, 24 studies did not use an RCT design

Discussion

The results of this review and meta-analysis show that CBT has a positive moderate short-term effect (SMD =  0.47; CI 95% − 0.88, − 0.06), which turns into a small long-term effect when treatment ends (SMD =  0.30; CI 95% − 0.51, − 0.08). A note of caution is due since the way CBT was provided was quite heterogeneous in terms of the mode of delivery of CBT (e.g. internet guidance vs. phone contact; group vs. individual guidance), the intensity (i.e. number and duration of sessions) and the type of

Conclusion

The results of the current systematic review and meta-analysis suggest a moderately positive effect of CBT for the treatment of fatigue in patients with MS. However, this effect declines after cessation of treatment. Since the short-term effect of CBT on MS-related fatigue is positive, more research is needed to develop interventions that maintain these short-term effects in the long term.

Funding

The TREFAMS-ACE study is funded by the Fonds NutsOhra (ZonMw 89000005).

Acknowledgements

This study is supported by the Fonds NutsOhra (grant no. ZonMW 89000005). This article is produced in the context of the Trefams-ACE study: treatment of fatigue in multiple sclerosis: aerobic training, cognitive behavioral therapy and Energy Conservation Management.

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