Abstract
ObjectiveFatigue is prominent across many long term physical health conditions. This scoping review aimed to map the fatigue intervention literature, to ascertain if certain interventions may be effective across conditions, and if novel interventions tested in specific long term conditions may be promising for other conditions.MethodsScoping review methodological frameworks were used. Electronic bibliographic databases were searched (inception to November 2016) for systematic reviews of fatigue interventions in long term conditions. Inclusion criteria were: long term physical health condition; review focus on fatigue management; objective and systematic review process; primary review outcome is fatigue. Articles focussing on surgical interventions or treatments thought to trigger fatigue were excluded. A narrative synthesis was performed.ResultsOf 115 full texts screened, 52 reviews were included. Interventions were categorised as pharmacological and non-pharmacological (exercise, psychological/behavioural and complementary medicine). Pharmacological interventions did not consistently demonstrate benefit, except for anti-TNFs and methylphenidate which may be effective at reducing fatigue. Non-pharmacological interventions such as graded exercise and fatigue-specific psychological interventions may be effective, but heterogeneous intervention components limit conclusions. ‘Complementary medicine’ interventions (e.g. Chinese herbal medicines) showed promise, but the possibility of publication bias must be considered.ConclusionsFurther research is necessary to inform clinical practice. The reported effectiveness of some interventions across inflammatory health conditions, such as anti-TNFs, aerobic exercise, and psychologically based approaches such as CBT, highlights a potential transdiagnostic avenue for fatigue management. More novel strategies that may be worth exploring include expressive writing and mindfulness, although the mechanisms for these in relation to fatigue are unclear. More work is needed to identify transdiagnostic mechanisms of fatigue and to design interventions based on these.
Highlights
Fatigue can be described as a lack of energy, feeling of exhaustion or overwhelming sense of tiredness, that is not relieved by rest and is a common and debilitating symptom in many long-term, physical health conditions (LTCs) [1,2,3,4]
Pharmacological interventions did not consistently demonstrate benefit, except for anti-tumour necrosis factor (TNF) and methylphenidate which may be effective at reducing fatigue
A protocol was developed prior to conducting this review, based upon detailed methodology outlined in the Joanna Briggs Institute (JBI) Reviewers’ Manual [15] and the framework proposed by Arksey & Malley [14] and updated by Levac et al [16]
Summary
Fatigue can be described as a lack of energy, feeling of exhaustion or overwhelming sense of tiredness (either physical or mental), that is not relieved by rest and is a common and debilitating symptom in many long-term, physical health conditions (LTCs) [1,2,3,4]. LTCs are, defined as a physical health conditions that require on-going management over a period of years [5], for example liver disease, HIV, rheumatoid arthritis (RA) and multiple sclerosis (MS)[6,7]. A recent scoping review of systematic reviews investigated interventions for fatigue in adults with advanced progressive illness. The search for relevant articles is likely to have been limited and insights missed from other conditions where fatigue is prominent, e.g. chronic fatigue syndrome and rheumatoid arthritis [11,12]. Additional systematic reviews have been conducted since, so an updated and more inclusive scoping review may provide more in-depth insights of clinical relevance
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