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. (C) 2013 by the American Congress of Rehabilitation Medicine