RESUMO
Objectives: To identify non-pharmacological fatigue interventions and determine the effectiveness of these non-pharmacological interventions in reducing fatigue immediately and over time in OA. Methods: A review protocol (CRD42020163730) was developed and registered with the PROSPERO database. Included studies comprised peer-reviewed randomized controlled trials (RCTs) that examined the effects of conservative interventions on fatigue in people with upper and lower limb OA. Cochrane Collaboration's tool for assessing the risk of bias (ROB-2) was used to assess the quality of evidence of studies. Narrative synthesis was used to summarize the effectiveness of identified fatigue interventions. Results: Out of 2644 citations identified from databases, 32 reports were included after screening for titles, abstracts and full texts. Of these reports, 30 parallel RCTs, one cluster and one cross-over RCT were included. 13 RCTs were of low ROB, 6 had some concerns and 13 had high ROB. The narrative synthesis identified interventions for fatigue including exercise, activity pacing, cognitive behavioural therapy, telerehabilitation and complementary alternative therapies. Exercise interventions showed the most significant beneficial effects on fatigue. Conclusions: Diverse interventions for fatigue management among individuals with upper and lower limb OA were identified. Of these, exercise interventions appear to be the most promising with the majority of these interventions favouring fatigue improvement. While cognitive behavioural therapy has limited evidence of beneficial effects, there is insufficient evidence regarding the effectiveness of other identified interventions, including complementary and alternative therapies, and telerehabilitation.
RESUMO
OBJECTIVES: Clinical research is the bedrock of clinical innovation, education and practice. We characterized and critically appraised physiotherapy clinical research to avoid implementing misleading research findings into practice and to task the Nigerian physiotherapy societies on responsible conduct of clinical research. METHODS: This is a systematic review of articles published in English between 2009 and 2023. We started with 2009 because at least few Nigerian Physiotherapy school had commenced postgraduate (research) training by then. We searched Pubmed, Medline, Cumulative Index to Nursing and Allied Health Literature, Academic Search Complete, PsycINFO and African Journal Online, and reference lists of relevant articles. We Data were selected and extracted according to predesigned eligibility criteria and using a standardized data extraction table. Where appropriate, the Pedro and Cochrane ROBINS1 were used to examine the risk of bias. RESULTS: A total of 76 Nigerian studies were included in this study. The mean age of the study participants was 46.7 ± 8.6 years. Approximately, 45% of the participants were males. Of the clinical experiments, the randomized controlled trial (RCT) was the most common design (87.5%). Musculoskeletal conditions (39.3%) were the most studied disorder. Approximately 86% of the RCT had studies possessed fair to good quality. Interventions constituted exercise therapy (76.3%), manual therapy (8.5%) and electrotherapy (8.5%). More than half (67.8%) of the studies recorded medium to large effect sizes. A fair proportion (48.2%) of the studies had a confounding-by-indication bias. Approximately 43% of the clinical experiments were underpowered, and a few studies conducted normality tests (10.9%) and intention-to-treat analysis (37.5%). CONCLUSIONS: RCT is the most frequent clinical experiment, with majority of them possessing fair to good quality. The most important flaws include improper computation of sample size, statistical analysis, absent intention-to-treat approach, among others. The magnitude of effects of Physiotherapy interventions varies from nil effect to large effect. Musculoskeletal condition is the most prevalent disorder and exercise is the most important intervention in Nigerian physiotherapy practice. TRIAL REGISTRATION: We registered the protocol with PROSPERO. The registration number: CRD42021228514.