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dc.contributor.authorHarrison, Anthony M
dc.contributor.authorSafari, Reza
dc.contributor.authorMercer, Tom
dc.contributor.authorPicariello, Federica
dc.contributor.authorvan der Linden, Marietta L
dc.contributor.authorWhite, Claire
dc.contributor.authorMoss-Morris, Rona
dc.contributor.authorNorton, Sam
dc.date.accessioned2021-04-29T14:32:40Z
dc.date.available2021-04-29T14:32:40Z
dc.date.issued2021-04-20
dc.identifier.citationHarrison, A.M., Safari, R., Mercer, T., Picariello, F., van der Linden, M.L., White, C., Moss-Morris, R. and Norton, S., (2021). 'Which exercise and behavioural interventions show most promise for treating fatigue in multiple sclerosis? A network meta-analysis'. Multiple Sclerosis Journal, pp. 1-22.en_US
dc.identifier.issn1352-4585
dc.identifier.doi10.1177/1352458521996002
dc.identifier.urihttp://hdl.handle.net/10545/625735
dc.description.abstractFatigue is a common, debilitating symptom of multiple sclerosis (MS) without a current standardised treatment. The aim of this systematic review with network meta-analyses was to estimate the relative effectiveness of both fatigue-targeted and non-targeted exercise, behavioural and combined (behavioural and exercise) interventions. Nine electronic databases up to August 2018 were searched, and 113 trials (n = 6909) were included: 34 were fatigue-targeted and 79 non-fatigue-targeted trials. Intervention characteristics were extracted using the Template for Intervention Description and Replication guidelines. Certainty of evidence was assessed using GRADE. Pairwise meta-analyses showed that exercise interventions demonstrated moderate to large effects across subtypes regardless of treatment target, with the largest effect for balance exercise (SMD = 0.84). Cognitive behavioural therapies (CBTs) showed moderate to large effects (SMD = 0.60), with fatigue-targeted treatments showing larger effects than those targeting distress. Network meta-analysis showed that balance exercise performed significantly better compared to other exercise and behavioural intervention subtypes, except CBT. CBT was estimated to be superior to energy conservation and other behavioural interventions. Combined exercise also had a moderate to large effect. Treatment recommendations for balance and combined exercise are tentative as the certainty of the evidence was moderate. The certainty of the evidence for CBT was high.en_US
dc.description.sponsorshipMultiple Sclerosis Societyen_US
dc.language.isoenen_US
dc.publisherSAGE Publicationsen_US
dc.relation.urlhttps://journals.sagepub.com/doi/10.1177/1352458521996002en_US
dc.rightsCC0 1.0 Universal*
dc.rights.urihttp://creativecommons.org/publicdomain/zero/1.0/*
dc.subjectNeurologyen_US
dc.subjectClinical Neurologyen_US
dc.subjectFatigueen_US
dc.subjectMultiple Sclerosisen_US
dc.subjectNetwork Meta-anlalysisen_US
dc.subjectRandomised Controlled Trialsen_US
dc.subjectBehavioural Interventionsen_US
dc.subjectExercise Interventionsen_US
dc.subjectTIDieRen_US
dc.titleWhich exercise and behavioural interventions show most promise for treating fatigue in multiple sclerosis? A network meta-analysisen_US
dc.typeArticleen_US
dc.identifier.eissn1477-0970
dc.contributor.departmentUniversity of Derbyen_US
dc.identifier.journalMultiple Sclerosis Journalen_US
dc.identifier.pii10.1177/1352458521996002
dc.source.journaltitleMultiple Sclerosis Journal
dc.source.beginpage135245852199600
dcterms.dateAccepted2021-01-29
refterms.dateFOA2021-04-20T00:00:00Z
dc.author.detail785511en_US


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