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Review
, 90, 33-42

Effectiveness of Cognitive Behavioral Therapy for the Treatment of Fatigue in Patients With Multiple Sclerosis: A Systematic Review and Meta-Analysis

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Review

Effectiveness of Cognitive Behavioral Therapy for the Treatment of Fatigue in Patients With Multiple Sclerosis: A Systematic Review and Meta-Analysis

Lizanne Eva van den Akker et al. J Psychosom Res.

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.

Keywords: Cognitive behavioral therapy; Fatigue; Multiple sclerosis; Systematic review and meta-analysis.

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