Date Presented 4/16/2015
This review found strong evidence that group fatigue management education is effective for persons with multiple sclerosis while finding no evidence supporting the individual format. These results have the potential to change practice and demonstrate the need for research on the individual format.
SIGNIFICANCE: Occupational therapists use various fatigue management/energy conservation education formats to address fatigue problem for persons with multiple sclerosis. It is unclear which format is most effective for managing their fatigue. The results of this evidence-based review have the potential to change how occupational therapists deliver fatigue management education.
INNOVATION: The most common way for delivering fatigue management education in clinical practice is in a one-to-one format. However, there is no evidence to support its efficacy. In contrast, the evidence reviewed for this study describes innovative group approaches for providing fatigue management education, which have varying degrees of effectiveness.
METHOD: In this study, our approach was to conduct an evidence-based literature review of various fatigue management/energy conservations education formats for persons with multiple sclerosis. Six databases were used to search literature from January 2003 to May 2011. Level I to Level III studies examining the effectiveness of fatigue management/energy conservations courses for persons with multiple sclerosis were eligible for inclusion. In addition to appraising the content, a rating score was assigned to reflect the quality of each article. Information of all included articles was listed on the evidence table and was synthesized in the Critically Appraised Topic form.
RESULTS: Of 9 included articles, 6 were group face-to-face formats, 2 were group long-distance formats, and 1 was a systematic review. Strong evidence with high-quality studies supports group face-to-face fatigue management programs. Limited evidence with high-quality studies supports group long-distance programs. Participants benefited from the face-to-face courses in improving fatigue impact, self-efficacy, and quality of life. One study reported that the effect persisted at 1 yr postintervention. Participants benefited from the teleconference formats in improving fatigue impact and quality of life. However, the effect of the online fatigue self-management program was no better than the information-only group. No study reported the efficacy of fatigue management courses in the individual format.
CONCLUSION: Stronger evidence supports the group fatigue management course for persons with multiple sclerosis. Fatigue management courses were conducted independent of other rehabilitation services and indicate clearer evidence of the benefits of occupational therapy. It is important for practitioners to know the most effective format, for educators to construct curriculum, and for researchers to formulate future studies.
