Objective To establish the efficacy of a multidisciplinary fatigue management programme (MFMP) in MS.
Method Fifty-one subjects with MS were randomly allocated to group A, who only received the four weeks MFMP, or group B receiving a placebo intervention programme first and the MFMP after 6 months. In both groups, assessment was performed at baseline, 3 weeks and 6 months after the programmes and included Modified Fatigue Impact Scale (MFIS), Fatigue Severity Scale (FSS), MS Self-Efficacy scale (MSSE), Mental Health Inventory (MHI) and Impact on Participation and Autonomy (IPA).
Results The MFIS showed a significant change over time (F(4,152) = 3.346, P = 0.012), which was similar in both groups (time*group interaction: F(4,152) = 1.094, P = 0.361). A clinically relevant reduction of MFIS score of 10 points or more was found in 17% of individuals following the MFMP, compared to 44% after the placebo intervention programme (P = 0.06). Compared to no intervention, a significant effect of the MFMP after 6 months (P = 0.003) was found in five participants (31%). No significant changes in FSS, MSSE, MHI and IPA, in both groups, were found.
Conclusion Although an additional effect was found, the multidisciplinary fatigue management programme showed no efficacy in reducing the impact of fatigue compared to a placebo intervention programme. Multiple Sclerosis 2007; 13: 996—1003. http://msj.sagepub.com
Fisk JD, Pontefract A., Ritvo PG, Archibald CJ, Murray TJThe impact of fatigue on patients with multiple sclerosis. Can J Neurol Sci1994; 21: 9—14.
2.
Packer TL, Sauriol A., Brouwer B.Fatigue secondary to chronic illness: postpolio syndrome, chronic fatigue syndrome, and multiple sclerosis. Arch Phys Med Rehabil1994; 75: 1122—26.
3.
Chan A.A review of common management strategies for fatigue in multiple sclerosis . Int J MS Care1999; 2: 13—19.
4.
Krupp LBFatigue. Elsevier Science, 2003.
5.
Baker NA, Tickle-Degnen L.The effectiveness of physical, psychological, and functional interventions in treating clients with multiple sclerosis: a meta-analysis. Am J Occup Ther2001; 55: 324—31.
6.
Branas P., Jordan R., Fry-Smith A., Burls A., Hyde C.Treatments for fatigue in multiple sclerosis: a rapid and systematic review . Health Technol Assess2000; 4: 1—61.
7.
Mathiowetz V. , Matuska KM, Murphy MEEfficacy of an energy conservation course for persons with multiple sclerosis. Arch Phys Med Rehabil2001; 82: 449—56.
8.
Mathiowetz VG , Finlayson ML, Matuska KM, Chen HY, Luo P.Randomized controlled trial of an energy conservation course for persons with multiple sclerosis. Mult Scler2005; 11: 592—601.
9.
Mostert S., Kesselring J.Effects of a short-term exercise training program on aerobic fitness, fatigue, health perception and activity level of subjects with multiple sclerosis. Mult Scler2002; 8: 161—68.
10.
NASA/MS Cooling Study Group.A randomized controlled study of the acute and chronic effects of cooling therapy for MS. Neurology2003; 60: 1955—60.
11.
Oken BS, Kishiyama S., Zajdel D., Bourdette D., Carlsen J., Haas M. et al. Randomized controlled trial of yoga and exercise in multiple sclerosis . Neurology2004; 62: 2058—64.
12.
Payne A.Nutrition and diet in the clinical management of multiple sclerosis. J Hum Nutr Diet2001; 14: 349—57.
13.
Petajan JH, Gappmauer E., White AT, Spencer MK, Mino L. and Hicks RWImpact of aerobic training on fitness and quality of life in multiple sclerosis . Ann Neurol1996; 39: 432—41.
14.
Rietberg M. , Brooks D., Uitdehaag B., Kwakkel G.Exercise therapy for multiple sclerosis. Cochrane Database Syst Rev2005; Issue 3: Art. No: CD003980. DOI: 10.1002/14651858.CD003980.pub2.
15.
Stankoff B. , Waubant E., Confavreux C., Edan G., Debouverie M., Rumbach L. et al. Modafinil for fatigue in MS: a randomized placebo-controlled double-blind study. Neurology2005; 64: 1139—43.
16.
Weinstock-Guttman B. et al. Low fat dietary intervention with [omega]-3 fatty acid supplementation in multiple sclerosis patients. Prostaglandins Leukot Essent Fatty Acids2005; 73: 397—404.
17.
O'Hara L., De Souza LH, Ide L.A Delphi study of self-care in a community population of people with multiple sclerosis. Clin Rehabil2000; 14: 62—71.
18.
McLaughlin J., Zeeberg I.Self-care and multiple sclerosis: a view from two cultures. Soc Sci Med1993; 37: 315—29.
19.
Wollin J., Dale H., Spenser N., Walsh A.What people with newly diagnosed MS (and their families and friends) need to know. Int J MS Care [serial online]2000; 2.
20.
O'Hara L., Cadbury H., De SL, Ide L.Evaluation of the effectiveness of professionally guided self-care for people with multiple sclerosis living in the community: a randomized controlled trial . Clin Rehabil2002; 16: 119—28.
MultipleSclerosis Council for Clinical Practice Guidelines. Fatigue and multiple sclerosis: evidence-based management strategies for fatigue in multiple sclerosis. Paralyzed Veterans of America, 1998.
23.
Kos D. et al. [Omgaan met vermoeidheid in het dagelijks leven bij personen met multiple sclerose: een pilootstudie]. Acta Ergotherapeutica Belgica2005; 3: 51—58.
24.
Sharrack B. , Hughes RAThe Guy's Neurological Disability Scale (GNDS): a new disability measure for multiple sclerosis. Mult Scler1999; 5: 223—33.
25.
Rao S.A manual for the brief, repeatable battery of neuropsychological tests in multiple sclerosis. National Multiple Sclerosis Society , 1990.
26.
Kos D., Kerckhofs E., Nagels G., D'Hooghe BD, Duquet W., Duportail M. et al. Assessing fatigue in multiple sclerosis: Dutch modified fatigue impact scale. Acta Neurol Belg2003; 103: 185—91.
27.
Kos D., Kerckhofs E., Carrea I., Verza R., Ramos M., Jansa J.Evaluation of the Modified Fatigue Impact Scale in four different European countries. Mult Scler2005; 11: 76—80.
28.
Rammohan KW , Rosenberg JH, Lynn DJ, Blumenfeld AM, Pollak CP, Nagaraja HNEfficacy and safety of modafinil (Provigil) for the treatment of fatigue in multiple sclerosis: a two centre phase 2 study . J Neurol Neurosurg Psychiatry2002; 72: 179—83.
29.
Gillson G., Richard TL, Smith RB, Wright JVA double-blind pilot study of the effect of Prokarin on fatigue in multiple sclerosis. Mult Scler2002; 8: 30—35.
30.
Krupp LB, LaRocca NG, Muir-Nash J., Steinberg ADThe fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol1989; 46: 1121—23.
31.
Schwartz CE , Coulthard-Morris L., Zeng Q., Retzlaff P.Measuring self-efficacy in people with multiple sclerosis: a validation study. Arch Phys Med Rehabil1996; 77: 394—98.
32.
Cardol M., de Haan RJ, van den Bos GA, De Jong BA, de Groot IJThe development of a handicap assessment questionnaire: the Impact on Participation and Autonomy (IPA). Clin Rehabil1999; 13: 411—19.
33.
Cardol M., de Haan RJ, de Jong BA, van den Bos Gam, de Groot Ijm.Psychometric properties of the impact on Participation and Autonomy Questionnaire . Arch Phys Med Rehabil2001; 82: 210—16.
34.
Cardol M., Beelen A., van den Bos GA, de Jong BA, de Groot IJ, de Haan RJResponsiveness of the impact on participation and autonomy questionnaire. Arch Phys Med Rehabil2002; 83: 1524—29.
35.
Ritvo PG et al. Multiple sclerosis quality of life inventory: a user's manual . 1997.
36.
Bethoux F., Miller DM, Kinkel RPRecovery following acute exacerbations of multiple sclerosis: from impairment to quality of life. Mult Scler2001; 7: 137—42.
37.
Portney LG, Watkins MPFoundations of clinical research: applications to practice. Prentice-Hall, 2000.
38.
Kok GJTheories concerning behavioral control [Theorieën over gedragsbeïnvloeding] . In Damoiseaux V, Gerards FM, Kok GJ, Nijhuis F eds. Gezondheidsvoorlichting en - opvoeding: van analyse tot effecten. Van Gorcum, 1987: 53—76.
39.
Mallik PS, Finlayson M., Mathiowetz V., Fogg L.Psychometric evaluation of the Energy Conservation Strategies Survey. Clin Rehabil2005; 19: 538—43.
40.
Bakshi R., Shaik ZA, Miletich RS, Czarnecki D., Dmochowski J., Henschel K. et al. Fatigue in multiple sclerosis and its relationship to depression and neurologic disability. Mult Scler2000 ; 6: 181—85.
41.
van der Werf SP, Jongen PJ, Lychlana á Nijeholt GJ, Barkhof F., Hommes OR, Bleijenberg G. et al. Fatigue in multiple sclerosis: interrelations between fatigue complaints, cerebral MRI abnormalities and neurological disability. J Neurol Sci1998; 160: 164—70.
42.
Hoogervorst EL, Kalkers NF, van Winsen LML, Uitdehaag BM, Polman CHDifferential treatment effect on measures of neurologic exam, functional impairment and patient self-report in multiple sclerosis. Mult Scler2001; 7: 335—39.
43.
Vanage SM, Gilbertson KK, Mathiowetz V.Effects of an energy conservation course on fatigue impact for persons with progressive multiple sclerosis. Am J Occup Ther2003; 57: 315—23.
