Multidisciplinary rehabilitation and chronic fatigue in MS
This RCT aims to investigate the effects of an individually tailored, multidisciplinary outpatient rehab programme (consisting of aerobic training, cognitive behaviour therapy and energy management strategies), as compared to consultation by an MS nurse, focusing on energy conservation and stimulating physical activity.
Surprisingly, and contrary to hypothesis, fatigue showed to be quite invariant from baseline onwards, as measured by several checklists for fatigue, QoL and functional activities. No treatment effects could be demonstrated.
Fatigue is a common and disabling symptom in people with multiple sclerosis (MS), and is considered to be one of the main causes of impaired daily activities and reduced quality of life. Several pathophysiological mechanisms for fatigue, such as dysregulation of the immune system, impaired nerve conduction, and neuro-endocrine and neurotransmitter changes have been suggested to explain primary fatigue in MS; however, the exact mechanism is still not well known. Secondary fatigue may stem from pain and muscle spasms, frequent concomitant infections and depression. The effect of pharmacological treatment is not established, with exception of amantadine.
In this RCT, 48 ambulant MS patients with chronic fatigue were selected and assigned to either a multidisciplinary rehabilitation programme (MDR) or 3-weekly nurse consultation (NC).
MDR received an individually tailored programme that focused on optimising self management behaviour in daily life activities with involvement of PT, OT, and social work. A 12-week exercise training consisted of two 45-minute sessions a week of supervised aerobic training in circuit style, at 50-70% of VO2 peak.
Measurements were done at baseline, 12 weeks (after exercise programme) and follow-up at 24 weeks.
No treatment effects could be established for reduction of fatigue in this group of MS patients with chronic fatigue. Furthermore, there was no improvement in symptom management nor functional status, apart from a minor improvement in mobility. The authors suggest that chronic fatigue is immune to current strategies, and stress the need for alternative interventions.
What is your experience with MS and fatigue? What works, and what not? When and why?
> From: Rietberg et al., PLoS One 9 (2015) e107710 . All rights reserved to The Author(s). Click here for the Pubmed summary.