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Rehabilitation to treat MS-related fatigue: the TREFAMS research programme
Author(s):
V. de Groot
,
V. de Groot
Affiliations:
H. Beckerman
,
H. Beckerman
Affiliations:
The TREFAMS Study Group
The TREFAMS Study Group
Affiliations:
ECTRIMS Online Library. de Groot V. Sep 15, 2016; 146997; 142
Vincent de Groot
Vincent de Groot
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Abstract: 142

Type: Oral

Fatigue is a common symptom in Multiple Sclerosis (MS) that restricts societal participation, and that is regularly treated during rehabilitation. Literature suggests that Aerobic training (AT), Cognitive Behavioural Therapy (CBT) and Energy conservation management (ECM) alleviate MS-related fatigue. Indeed, systematic reviews for these three interventions showed moderate effect sizes in favour of these treatment. However, the quality of the reviewed literature was limited, because studies often did not specifically include participants with MS-related fatigue, did not use fatigue as a primary outcome, were under-powered or used waiting list control groups.

The Treating fatigue in multiple sclerosis (TREFAMS) research programme consists of three randomized controlled trials (RCT), one for each of the abovementioned interventions, that were specifically designed to overcome these important limitations in the literature. In the sufficiently powered, single-blinded RCTs with fatigue and societal participation as primary outcomes, ambulatory patients with severe MS-related fatigue were randomly allocated to the trial-specific intervention or the control intervention. The therapy period lasted 16 weeks, and outcomes were assessed up to one year. The trial-specific interventions consisted of 12 individual therapist-supervised sessions with additional intervention-specific home exercises. The control intervention consisted of three individual consultations with a specialised MS-nurse.

The results of these well-performed RCTs show unequivocal results that should influence rehabilitation practice. Individually provided ECM is not effective. AT according to the studied training protocol shows a small positive, but not clinically relevant, effect. Furthermore, long term adherence to the AT protocol was difficult for patients. In contrast, CBT effectively reduced severe MS-related fatigue on the short term. Societal participation was not influenced by any of the interventions.

The combined results of the systematic reviews and RCTs of the TREFAMS research programme strongly suggest that CBT tailored to reduce MS-related fatigue is the most effective rehabilitation treatment for MS-related fatigue. However, more research is needed on how to maintain this effect on the long term.

Disclosure: Fonds NutsOhra funded this research programme (ZonMW 89000005). V. de Groot: nothing to disclose. H. Beckerman: nothing to disclose.

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