Energy Conservation Management for People With Multiple Sclerosis-Related Fatigue: Who Benefits?

OBJECTIVE: We investigated whether demographic, disease-related, or personal baseline determinants can predict a positive response to energy conservation management (ECM). METHOD: We conducted a secondary analysis of a single-blind, two-parallel-arms randomized controlled trial that included ambulatory adults with severe MS-related fatigue. Therapy responders and nonresponders were categorized by Checklist Individual Strength fatigue change scores between baseline and end of treatment. Logistic regression analyses were used to assess the determinants of response. RESULTS: Sixty-nine participants were included (ECM group, n = 34; control group, n = 35). In the ECM group, fatigue severity, perception of fatigue, illness cognitions about MS, and social support discrepancies were related to the probability of being a responder. CONCLUSION: The results suggest that people with MS-related fatigue who had a less negative perception of fatigue and who perceived fewer disease benefits and a higher discrepancy in social support had the best response to ECM treatment.

Is physical behavior affected in fatigued persons with multiple sclerosis?

OBJECTIVE: To study physical behavior in detail in fatigued persons with multiple sclerosis (MS). DESIGN: Case-control explorative study. SETTING: Outpatient rehabilitation department and participants' daily environment. PARTICIPANTS: Fatigued persons with MS (n=23) were selected from a randomized controlled trial. Cases were matched by age and sex to healthy, nonfatigued controls (n=23). Eligible persons with MS were severely fatigued (Checklist Individual Strength fatigue domain mean score, 43.2±6.6) and ambulatory (Expanded Disability Status Scale mean score, 2.5±1.5). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Measurements were performed using an accelerometer over 7 days. Outcomes included the following: amount of physical activity expressed in counts per day, counts per minute (CPM), and counts per day period (morning, afternoon, evening); duration of activity intensity categories (sedentary, light physical activity, moderate-to-vigorous physical activity [MVPA]); and distribution of MVPA and sedentary periods over the day. RESULTS: Persons with MS had fewer counts per day (mean difference, -156×10(3); 95% confidence interval [CI], -273×10(3) to -39×10(3); P=.010), had fewer CPM (mean difference, -135; 95% CI, -256 to -14; P=.030), and were less physically active in the morning (mean difference, -200; 95% CI, -389 to -11; P=.039) and evening (mean difference, -175; 95% CI, -336 to -14; P=.034) than controls. Persons with MS spent a higher percentage of their time sedentary (mean difference, 5.6; 95% CI, .1-11.1; P=.045) and spent less time at the higher MVPA intensity (mean difference, -2.4; 95% CI, -4.7 to -0.09; P=.042). They had fewer MVPA periods (mean difference, 29; 95% CI, -56.2 to -2.6; P=.032) and a different distribution of sedentary (mean difference, .033; 95% CI, .002 to .064; P=.039) and MVPA periods (mean difference, -.08; 95% CI, -.15 to -.01; P=.023). CONCLUSIONS: Detailed analyses of physical behavior showed that ambulatory fatigued persons with MS do differ from healthy controls not only in physical activity level, but also in other physical behavior dimensions (eg, day patterns, intensity, distribution).

Effectiveness of energy conservation treatment in reducing fatigue in multiple sclerosis: a systematic review and meta-analysis.

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.

Physical behaviour is weakly associated with physical fatigue in persons with multiple sclerosis-related fatigue.

BACKGROUND: Fatigue affects 80% of persons with multiple sclerosis and is associated with daily physical functioning. Both fatigue and physical behaviour are multidimensional concepts. OBJECTIVE: To study the association between the dimensions of physical behaviour and multiple sclerosis-related fatigue. METHODS: Cross-sectional analysis of 212 persons with multiple sclerosis. Participants were severely fatigued, with a Fatigue Severity Scale median (interquartile range): 5.4 (4.8-5.9) and were minimally to moderately neurologically impaired, based on the Expanded Disability Status Scale: 2.5 (2.0-3.5), 73% had relapsing-remitting multiple sclerosis. Fatigue was measured by questionnaires (i.e. Checklist Individual Strength, Modified Fatigue Impact Scale), and the dimensions subjective, physical, cognitive and psychological fatigue were distinguished. Physical behaviour was measured using an Actigraph GT3X+, and outcomes were categorized into the dimensions of activity amount, activity intensity, day pattern, and distribution of activities. RESULTS: The physical behaviour dimensions were significantly associated with only the physical fatigue dimension (omnibus F-test: 3.96; df1 = 4, df2 = 207; p = 0.004). Additional analysis showed that the amount of activity (unstandardized beta coefficient (ß) = -0.16; 95% confidence interval (CI) -0.27 to -0.04; p = 0.007), activity intensity (ß = -0.18; 95% CI -0.31 to -0.06; p = 0.004) and day pattern of activity (ß = -0.17; 95% CI, -0.28 to -0.06; p = 0.002) were the physical behaviour dimensions that were significantly associated with physical fatigue. CONCLUSION: Physical behaviour is weakly associated with physical fatigue and is not associated with other dimensions of fatigue.